The ABCD memory-aid used to recognize early-stage melanoma should be expanded to include the letter E for “Evolving,” researchers recommend.

This would emphasize that changes often occur in melanomas during the course of the disease, according to a report in the Journal of the American Medical Association.

The ABCD acronym - standing for Asymmetry, Border irregularity, Color variegation, and Diameter greater than 6 mm - was first proposed in 1985 and is now used globally to identify pigmented cutaneous lesions that may need to be evaluated by a specialist, Dr. David Polsky and his group explain.

Polsky, a dermatologist at New York University School of Medicine, and colleagues define “evolving lesions” as those that change in size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or shades of color.

For their current report, the authors searched databases for reports that studied a minimum of 30 patients with melanoma.

Their search revealed that up to 88 percent of patients noted an evolution of their melanoma before it was removed. Enlargement was the change most often seen.

“We urge broad physician and public education in the use of the ABCDE criteria,” Polsky’s team says.

Studies show that with increased patient awareness, melanomas are identified at less advanced stages and more often by patients themselves or their family members.

“Even one-time instruction in the proper management of pigmented cutaneous lesions can result in immediate improvement in the capacity of clinicians and laypersons to identify cutaneous melanomas” while they are still curable, the researchers say.

SOURCE: Journal of the American Medical Association, December 8, 2004.