Diagnosis of Melanoma using the ABCDE Schema

Introduction to the ABCDE Schema

The American Joint Committee on Cancer recommends using the ABCDE schema to evaluate suspicious skin lesions, where D stands for "Durchmesser" (diameter) and refers to lesions larger than 6 mm 1, 2
The ABCDE schema is a crucial diagnostic tool for the early detection of malignant melanomas, with A standing for asymmetry, B for border, C for color, D for diameter, and E for evolution 1, 3

The diagnosis should always be based on an excisional biopsy with complete thickness and a recommended margin of 2 mm of normal skin around the lesion 1, 2
Processing by an experienced pathological institute is mandatory, and the histological report should follow the WHO classification, including the maximum thickness in millimeters (Breslow), the level of invasion (Clark level I-V), the freedom of surgical margins, the presence of ulceration, and the presence and extent of regression 1, 2
The American Academy of Dermatology recommends using the ABCDE criteria in combination with dermoscopy to improve diagnostic accuracy 3

Dermoscopy by an experienced physician increases the diagnostic accuracy in the evaluation of suspicious lesions 3
The combination of clinical ABCDE evaluation with dermoscopic methods can significantly improve diagnostic accuracy, although the sensitivity and specificity of the ABCDE rule in diagnosing small melanomas (≤6 mm) are limited 3