VANCOUVER, B.C. — Color change, in addition to color variegation, often heralds melanoma, thus bolstering the need for adding an E to the ABCD mnemonic for melanoma detection, Dr. Robert J. Friedman said at the Sixth World Congress on Melanoma.
The color change appears to occur often before a melanoma exhibits a change in diameter, meaning it can signal a melanoma long before its diameter reaches 6 mm, said Dr. Friedman, an originator of the ABCD mnemonic for melanoma detection.
Dr. Friedman said he recently followed 24 very small lesions (2.3-5.7 mm in diameter) that, when removed after a period of observation, were found to be melanomas.
In 17 of the 24 lesions, color was the first change noted, followed by a change in diameter, and then the appearance of asymmetry.
Only two of the lesions were invasive; both had a diameter greater than 4 mm. This is consistent with previous observations that melanomas can begin to become invasive when they reach a size of 4 mm in diameter and start to form nests of melanocytes, said Dr. Friedman of New York University, New York.
The fact that melanomas can become invasive at 4 mm in diameter, and before they reach a diameter of 6 mm underscores the importance of early detection, he added.
“Melanoma may undergo transformation from an in situ lesion to an invasive lesion, even when it is relatively small,” Dr. Friedman said.
The ABCD criteria for melanoma detection are: A for asymmetry; B for irregular borders; C for multiple colors; and D for a diameter greater than 6 mm.
Dr. Friedman and his group proposed adding the E, for evolution or any change in a nevus, in 2004, in part to improve the criteria for detecting melanomas with a diameter less than 6 mm, for detecting nodular melanomas, and for detecting the 10% of melanomas that do not meet A, B, C, or D.