Review of Answer Choices (Correct Answer in Green):
Explanation:
When determining whether a lesion is a benign melanocytic nevus or melanoma, remember the ABCDEs:
The ABCDEs are good for patient education and helpful for self-exam. In clinical practice, dermatologists rely more on a cognitive (i.e., overall pattern) and comparative (e.g., ugly duckling sign) process when deciding if a pigmented lesion is suspicious for melanoma. Dermoscopy is also an adjunctive tool to assess pigmented lesions for signs of malignancy.
It is crucial to know that not all cutaneous melanomas present with these typical clinical clues. Diagnostic accuracy for the clinical diagnosis of melanoma does not exceed 75%.
● Sometimes, patients are the first to recognize these featureless melanomas. Garbe’s rule dictates that if a patient is worried about a single skin lesion, do not ignore their suspicion and maintain a low threshold for performing a biopsy.
● The EFG rule is used for nodular melanoma and stands for ‘elevated, firm, and growing’. If a lesion meets these criteria, maintain a low threshold for biopsy.
● The ugly duckling sign refers to one nevus among many that sticks out and looks different (“the ugly duck”) and should raise suspicion for malignancy.