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SUMMARY
Numerous diagnostic modalities and algorithms aid in the diagnosis of melanoma.
Dermoscopy is a noninvasive tool that allows for increased diagnostic accuracy, an improved benign-to-malignant ratio of biopsied lesions, and earlier detection of melanoma when combined with a naked eye examination.
Mole monitoring can aid in the detection of melanomas for which dermoscopy fails to show any characteristic features of melanoma.
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DON’T FORGET
While most melanomas can be diagnosed with dermoscopy due to the presence of a disorganized pattern, some melanomas can manifest an organized pattern for which context and the triage amalgamated dermoscopic algorithm (TADA) can be utilized for detection.
Featureless melanomas can be diagnosed via the detection of change over time with mole monitoring.
For lesions that cannot be diagnosed via clinical examination and dermoscopy, other technologies such as reflectance confocal microscopy can be leveraged in their diagnosis.
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CLINICAL PEARLS
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PATIENT EDUCATION POINTS
High-risk patients should examine their skin on a regular basis and bring to the attention of their physician any new, changing, or symptomatic lesions.
Patients may choose to utilize cell phone applications to facilitate the practice of mole monitoring.
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The incidence of melanoma is trending upwards in the United States1; however, melanoma-specific survival appears to be increasing in some populations, which may be attributed to increased detection of early disease and better treatment for late-stage disease.2 It is important to detect melanoma at an early stage because the 5-year relative survival rate in the United States for localized disease was 98% as compared to 23% for distant disease based on the years 2008 to 2014.1 Initial efforts to assist patients and clinicians in detecting early melanoma led to clinical mnemonics such as “ABCD,” which emphasized the morphologic features (asymmetry, border irregularity, color variegation, and diameter >6 mm or a dark lesion) that are more commonly associated with melanoma as compared to nevi.3 However, it soon became apparent that not all melanomas manifest the ABCD features. The importance of enlargement as a diagnostic criterion was studied to help detect these melanomas, and the ABCD mnemonic was later revised to “ABCDE” with E standing for evolution (ie, changing lesion).4,5 Others proposed the “EFG rule,” suggesting that elevated, firm, and growing lesions should also raise concern for melanoma.6 Unfortunately, while change is a sensitive feature associated with melanoma, it lacks specificity given that most changing lesions prove not to be melanomas. In addition, most firm and elevated lesions also prove not to be melanomas. Thus, there was a clear need to find ways to improve both the sensitivity and specificity for melanoma detection.
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