We understand the concerns of Bystryn relating to potential confusion that may result from promoting awareness of the clinical characteristics of nodular and rapidly growing melanomas.1,2 We do not, however, believe that it is appropriate to ignore the distinctive clinical characteristics of rapidly growing melanomas simply to avoid confusion. These are the most important melanomas to recognize at first sight and for which to undertake urgent excision. Though they make up a minority of melanomas (10%-20%), they are likely to make a disproportionately high contribution to mortality. Our research does not contest the traditional teaching of the ABCD rule, but rather it indicates the need to be aware of a different type of melanoma that is biologically aggressive.
Kelly JW, McArthur GA, Wolfe R, Thompson JF, Liu W. A Confusing Message Will Not Improve the Detection of Melanoma—Reply. Arch Dermatol. 2007;143(6):799–816. doi:10.1001/archderm.143.6.806-b
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