Won't become a swan
This article will give you a simple and reliable tool for identifying moles with which it is better to appear to a dermatologist as soon as possible.
If your back or the back of your loved one looks like in the collage above, it's better to sign up for a dermatoscopy right now. Such a number and size of nevi immediately mean a high risk of melanoma.
Have you heard about the ABCD rule?
A - asymmetry
B - border (uneven edge)
C - color (uneven coloring)
D - diameter (size more than 5 mm)
The use of these "signs of melanoma" during self-examination destroyed hundreds of billions of nerve cells and led to neurosis of more than one thousand people. Fortunately, the disorder lasts only until a visit to a qualified dermatooncologist with a dermatoscope. At the reception, in the vast majority of cases, it turns out that the fears were not justified.
Almost any person will have several moles that can easily be "adjusted" to the ABCD rule. Where have you seen a mole, a perfect round shape? I am sure that almost anyone, if desired, will also find a mole with not the most heterogeneous coloring. Moreover, many congenital benign nevi have several "signs of melanoma" listed above. Here is an example of a benign congenital nevus that perfectly fits all the criteria of ABCD.
A - asymmetry
B - border (uneven edge)
C - color (uneven coloring)
D - diameter (size more than 5 mm)
The use of these "signs of melanoma" during self-examination destroyed hundreds of billions of nerve cells and led to neurosis of more than one thousand people. Fortunately, the disorder lasts only until a visit to a qualified dermatooncologist with a dermatoscope. At the reception, in the vast majority of cases, it turns out that the fears were not justified.
Almost any person will have several moles that can easily be "adjusted" to the ABCD rule. Where have you seen a mole, a perfect round shape? I am sure that almost anyone, if desired, will also find a mole with not the most heterogeneous coloring. Moreover, many congenital benign nevi have several "signs of melanoma" listed above. Here is an example of a benign congenital nevus that perfectly fits all the criteria of ABCD.
And what should people do who have dozens of moles on their skin fit these ABCD? Wrap yourself in a sheet right away?
In these cases, unfortunately, it is difficult to talk about early diagnosis and that everything will be fine from now on.
Thus, we have come to the most important question:
How to detect melanoma at an early stage?
As we found out, the ABCD rule now does not meet the goals of early diagnosis. If you are not a dermatooncologist, then you probably don't have a dermatoscope and knowledge for it either, only the naked eye.
What else is there from self-examination methods with proven effectiveness?
Thus, we have come to the most important question:
How to detect melanoma at an early stage?
As we found out, the ABCD rule now does not meet the goals of early diagnosis. If you are not a dermatooncologist, then you probably don't have a dermatoscope and knowledge for it either, only the naked eye.
What else is there from self-examination methods with proven effectiveness?
At the time of writing this article, it must be recognized that the ABCD rule is hopelessly outdated for early diagnosis of melanoma, not only for use by a doctor, but even for self-examination by a patient.
They were relevant at the end of the XX - very beginning of the XXI century, when melanomas were detected in 75% of cases at stage II, III, IV with an average thickness of more than 5 mm according to Breslow [1].
In the case when a dermatoscope is not needed to establish a diagnosis, when a melanoma looks like this:
They were relevant at the end of the XX - very beginning of the XXI century, when melanomas were detected in 75% of cases at stage II, III, IV with an average thickness of more than 5 mm according to Breslow [1].
In the case when a dermatoscope is not needed to establish a diagnosis, when a melanoma looks like this:
This is exactly how it works: the bulk of moles on a person's skin are similar to each other. However, melanoma, even at an early stage, in the vast majority of cases, stands out against the background of other formations on the skin. [2]
There are several studies that show that in the vast majority of cases, the ugly duckling rule works successfully in the diagnosis of melanoma [3, 4, 5].
Learning to apply the Ugly Duckling rule.
In this section there will be only overview photos of entire anatomical areas. They will have melanomas and other skin formations. There will be no special emphasis on dermatoscopic signs and characteristics of ABCD.
important!!! Here and further we will talk only about the diagnosis of flat skin formations. This is due to the fact that at least 70% of melanomas belong to a surface-spreading form and appear initially in the form of a flat spot [6]. From simple to complex!
A good schematic example for understanding from the site skincancer.org
There are several studies that show that in the vast majority of cases, the ugly duckling rule works successfully in the diagnosis of melanoma [3, 4, 5].
Learning to apply the Ugly Duckling rule.
In this section there will be only overview photos of entire anatomical areas. They will have melanomas and other skin formations. There will be no special emphasis on dermatoscopic signs and characteristics of ABCD.
important!!! Here and further we will talk only about the diagnosis of flat skin formations. This is due to the fact that at least 70% of melanomas belong to a surface-spreading form and appear initially in the form of a flat spot [6]. From simple to complex!
A good schematic example for understanding from the site skincancer.org
NOTA - check your moles!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
NOTA measures the impedance (resistance) of cells and gives the result. The bioimpedance method has been recognized by the FDA as a method of noninvasive (without biopsy) diagnosis of skin cancer.
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
The Ugly duckling rule.
Do you remember Andersen's fairy tale, in which one of the duck chicks was not like everyone else and eventually grew up as a swan?
Do you remember Andersen's fairy tale, in which one of the duck chicks was not like everyone else and eventually grew up as a swan?
Promptly! Regularly! At home!
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Now let's try to transfer from the scheme to a living person.
Find an "ugly duckling" (melanoma) on the skin of a woman's legs - a formation that stands out from the rest:
Find an "ugly duckling" (melanoma) on the skin of a woman's legs - a formation that stands out from the rest:
We are sure you have coped, everything is quite obvious here.
Very similar to the previous and as simple as possible case. In it, using the ugly duckling rule, it is easier to detect melanoma:
Very similar to the previous and as simple as possible case. In it, using the ugly duckling rule, it is easier to detect melanoma:
Now let's complicate the task a little - add other nevi to the picture. Which of the formations on the back is clearly not similar to the surrounding ones?
Did you manage? We're moving on. Another photo of melanoma, but with an increased number of "neighbors".
Can you find her here?
Can you find her here?
Now a difficult example, but we believe that you will cope:
NOTA - check your moles!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
NOTA measures the impedance (resistance) of cells and gives the result. The bioimpedance method has been recognized by the FDA as a method of noninvasive (without biopsy) diagnosis of skin cancer.
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
More than 1 out of 4 points = suspicion of melanoma
The Ugly duckling checklist
"Stands out from the rest" is a rather vague thesis, so below we will try to formalize the ugly duckling rule.
Thus, the rule was simplified to a simple checklist "more than 1 out of 4 points = suspicion of melanoma".
Recall that this checklist is designed for flat formations - in the form of a spot (we'll talk about convex ones at the end).
Here it is:
How it works:
Does some mole have more than 1 point out of 4?
Do not postpone a visit to a dermatologist with this education, this "mole" can be dangerous, i.e. melanoma.
Now let's apply it to the previous examples, and also apply them to new cases.
"Stands out from the rest" is a rather vague thesis, so below we will try to formalize the ugly duckling rule.
Thus, the rule was simplified to a simple checklist "more than 1 out of 4 points = suspicion of melanoma".
Recall that this checklist is designed for flat formations - in the form of a spot (we'll talk about convex ones at the end).
Here it is:
- The largest?
- The darkest?
- The most heterogeneous color?
- The most asymmetrical?
How it works:
Does some mole have more than 1 point out of 4?
Do not postpone a visit to a dermatologist with this education, this "mole" can be dangerous, i.e. melanoma.
Now let's apply it to the previous examples, and also apply them to new cases.
NOTA - check your moles!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
NOTA measures the impedance (resistance) of cells and gives the result. The bioimpedance method has been recognized by the FDA as a method of noninvasive (without biopsy) diagnosis of skin cancer.
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
We think you have caught the essence of the duck checklist. However, there are a few more points that you need to know in order to identify those "dangerous moles" that may turn out to be melanoma as effectively as possible.
"Melanoma-threatening and melanomone-dangerous" nevi
Perhaps you have already read somewhere about such a classification.
According to her, some moles are "reborn", others are not. Unfortunately, this classification does not correspond to the currently available sufficiently voluminous scientific data - thousands of patients have proven that melanoma develops against the background of ALL types of nevi, without exception. Yes, the figures for different types are slightly different. However, based on this meta-analysis, it can be considered proven that the classification I mentioned at the beginning of the paragraph has lost its relevance.
It is also important to note that in the same work it was proved that only 30% of all melanomas develop against the background of nevi (moles). The remaining 70% develop on unchanged skin, by themselves, without connection with nevus. This fact makes us seriously doubt the very possibility of the "rebirth" of benign nevi into melanoma. I also want to note that currently there are no studies proving exactly the "rebirth/malignancy/malignancy" of moles.
To summarize, melanoma develops wherever it wants and the type of mole / nevus does not matter here.
"Melanoma-threatening and melanomone-dangerous" nevi
Perhaps you have already read somewhere about such a classification.
According to her, some moles are "reborn", others are not. Unfortunately, this classification does not correspond to the currently available sufficiently voluminous scientific data - thousands of patients have proven that melanoma develops against the background of ALL types of nevi, without exception. Yes, the figures for different types are slightly different. However, based on this meta-analysis, it can be considered proven that the classification I mentioned at the beginning of the paragraph has lost its relevance.
It is also important to note that in the same work it was proved that only 30% of all melanomas develop against the background of nevi (moles). The remaining 70% develop on unchanged skin, by themselves, without connection with nevus. This fact makes us seriously doubt the very possibility of the "rebirth" of benign nevi into melanoma. I also want to note that currently there are no studies proving exactly the "rebirth/malignancy/malignancy" of moles.
To summarize, melanoma develops wherever it wants and the type of mole / nevus does not matter here.
Limitations of the Ugly duckling checklist
It seems that it turns out to be a fairly simple and accurate tool for self-diagnosis, but let's add a fly in the ointment. In some cases, a duck checklist will not help you determine melanoma on your own:
It seems that it turns out to be a fairly simple and accurate tool for self-diagnosis, but let's add a fly in the ointment. In some cases, a duck checklist will not help you determine melanoma on your own:
NOTA - check your moles!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
Safe, or a lurking danger? Check your mole and get the result in 20 seconds!
NOTA measures the impedance (resistance) of cells and gives the result. The bioimpedance method has been recognized by the FDA as a method of noninvasive (without biopsy) diagnosis of skin cancer.
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
NOTA does not replace a doctor, but helps to find dangerous changes as early as possible and win the most important thing - time for the treatment of the disease!
This tumor does not stand out from the rest. It is neither the largest, nor the darkest, nor the most asymmetrical, nor the most heterogeneously colored. It was revealed during a full examination by a dermatologist.
It seems terrible, but there are two good news:
It is also worth noting that the checklist does not work for all types of melanomas.
Surface-spreading melanoma accounts for about 70% of all melanomas. This checklist is perfect for self-diagnosis of this form, even at an early stage.
To determine nodular, non-pigmented, subarticular melanoma, as well as basal cell and squamous cell skin cancer, the "Ugly Duckling" checklist will most likely not help.
My mole scored more than 1 point. Am I going to die?
Please remember, the checklist allows you to diagnose melanoma with much less accuracy than dermatoscopy or histological examination. More than 1 point out of 4 is an excuse to sign up for an examination. No more and no less.
I don't have moles with more than 1 point. Hooray?
Again, a duck checklist is a way of self-examination, not a way of diagnosis. Diagnosis should be handled by a doctor with a dermatoscope, knowledge and experience. Recall that approximately 20% of melanomas cannot be detected using the ugly duckling rule.
Conclusion:
If you have never been examined by a dermatologist and found a formation on your skin that is gaining more than one point on the duck checklist - sign up for a dermatoscopy, however, you do not need to think that life is over. In most cases, we will be talking about a congenital nevus, however, the Ugly Duckling checklist can save someone's life.
List of literature
It seems terrible, but there are two good news:
- The first is that the percentage of such melanomas is too small for you to worry about it.
- The second is that until such tumors grow to a life-threatening thickness, it will most likely take a year or even several.
It is also worth noting that the checklist does not work for all types of melanomas.
Surface-spreading melanoma accounts for about 70% of all melanomas. This checklist is perfect for self-diagnosis of this form, even at an early stage.
To determine nodular, non-pigmented, subarticular melanoma, as well as basal cell and squamous cell skin cancer, the "Ugly Duckling" checklist will most likely not help.
My mole scored more than 1 point. Am I going to die?
Please remember, the checklist allows you to diagnose melanoma with much less accuracy than dermatoscopy or histological examination. More than 1 point out of 4 is an excuse to sign up for an examination. No more and no less.
I don't have moles with more than 1 point. Hooray?
Again, a duck checklist is a way of self-examination, not a way of diagnosis. Diagnosis should be handled by a doctor with a dermatoscope, knowledge and experience. Recall that approximately 20% of melanomas cannot be detected using the ugly duckling rule.
Conclusion:
If you have never been examined by a dermatologist and found a formation on your skin that is gaining more than one point on the duck checklist - sign up for a dermatoscopy, however, you do not need to think that life is over. In most cases, we will be talking about a congenital nevus, however, the Ugly Duckling checklist can save someone's life.
List of literature
Read about the topic:
List of literature
- Harkevich G.Y. Epidemiology of melanoma of the skin // Official newspaper of the professional society of oncologists-chemotherapists RUSSCO. – Issue 6, 2011.
- 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 Jan;134(1):103-4.
- Ilyas M, Costello CM, Zhang N, Sharma A. The role of the ugly duckling sign in patient education. J Am Acad Dermatol. 2017 Dec;77(6):1088-1095.
- Scope A, Dusza SW, Halpern AC, Rabinovitz H, Braun RP, Zalaudek I, Argenziano G, Marghoob AA. The "ugly duckling" sign: agreement between observers. Arch Dermatol. 2008 Jan;144(1):58-64
- Gaudy-Marqueste C, Wazaefi Y, Bruneu Y, Triller R, Thomas L, Pellacani G, Malvehy J, Avril MF, Monestier S, Richard MA, Fertil B, Grob JJ. Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection. JAMA Dermatol. 2017 Apr 1;153(4):279-284.
- Markovic SN et al.Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis.Mayo Clin Proc3:364-380,2007.