Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Drs Whited and Grichnik1 reviewed the evidence pertaining to 2 checklists used to aid the nondermatologist in the diagnosis of melanoma: the ABCD rule and the revised 7-point checklist. These algorithms are useful to a degree and appear to have advanced the ability of nondermtologists to diagnose melanoma; however, they have substantial and potentially serious deficiencies, some of which were mentioned in the article. Deficiencies of one or both include (1) failure to detect individuals at very high risk and in need of surveillance because of presence of many dysplastic nevi, familial melanoma, or personal history of melanoma; (2) failure to screen out common, innocuous benign lesions, such as seborrheic keratoses; (3) failure to identify individuals with nonmelanoma skin cancers, particularly high-risk squamous cell carcinomas, which can also be fatal; (4) failure to include criteria for nodular melanomas, which can achieve considerable Breslow depth without asymmetry, irregular border, multiple colors, or diameter greater than 6 mm; (5) failure to detect melanomas 3 to 6 mm in diameter; and (6) failure to make full use of historical data.
Weinstock MA, Goldstein MG, Dube CE, Rhodes AR, Sober AJ. Clinical Diagnosis of Moles vs Melanoma. JAMA. 1998;280(10):881-882. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-10-jac80015