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April 1, 2008

Utility of Lesion Diameter in the Clinical Diagnosis of Cutaneous Melanoma

Author Affiliations

Author Affiliations: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York (Drs Abbasi, Yancovitz, Osman, Friedman, Rigel, Kopf, and Polsky), Electro-Optical Sciences Inc, Irvington (Dr Gutkowicz-Krusin), and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Panageas); Department of Dermatology, Harvard Medical School, Boston, Massachusetts (Dr Mihm); Knoxville Dermatopathology Laboratory, Knoxville, Tennessee (Drs Googe and King); and The University of Texas M. D. Anderson Cancer Center, Houston (Dr Prieto).

Arch Dermatol. 2008;144(4):469-474. doi:10.1001/archderm.144.4.469

Objective  To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma.

Design  Cohort study.

Setting  Dermatology hospital-based clinics and community practice offices.

Patients  A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma.

Main Outcome Measure  The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system.

Results  Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter.

Conclusion  The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy.