In a recent editorial, Swerlick and Chen1 suggested that a part of the melanoma epidemic could be the consequence of increased surveillance, leading to an excess of removal of benign melanocytic tumors that are classified as melanoma on the basis of inadequate histopathological criteria. A better selection of tumors submitted for histological examination would be the first step to improve the effectiveness of screening. The decision to remove a pigmented lesion is usually based on a detailed morphological analysis of the clinical characteristics of the lesion using checklists,2,3 such as "ABCD" (asymmetry, irregular b order, irregular c olor, and d iameter >6 mm), and the estimation of the recent e volution of this lesion (ABCD + E).4 As practitioners are prompted to lower their biopsy threshold, millions of nevi are uselessly removed, whereas many melanomas are still not recognized. There is a crucial need to improve the specificity of clinical diagnosis without losing sensitivity. In this regard, we would like to draw the attention of dermatologists to a useful clinical indicator: the "ugly duckling" sign.
Grob JJ, Bonerandi JJ. The ‘Ugly Duckling' Sign: Identification of the Common Characteristics of Nevi in an Individual as a Basis for Melanoma Screening. Arch Dermatol. 1998;134(1):103-104. doi: