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ABCD Criteria Still Effective, Study Shows

While the “ABCD” acronym (Asymmetry, Border, Color, Diameter) was developed more than 35 years ago, modern clinicians may wonder if its use is still warranted with the number of new tools available. A poster presented at the American Academy of Dermatology Virtual Meeting Experience 2020 highlighted the continuing clinical utility of the ABCD criteria in the evaluation of melanomas.1

Researchers out of Pittsburgh, PA, performed a retrospective cohort chart review of 290 consecutive cases. Three independent dermatologists assessed photographs of pre-biopsy lesions for ABCD criteria.

Of 290 photographs, the frequency of the ABCD criteria were as follows:

  • 239 (85.4%) had asymmetry in one or more axis;
  • 241 (85.5%) had irregular borders;
  • 205 (70.7%) had two or more colors, including 74 (25.5%) had black coloring and 78 (26,9%) had a pink or red color; and
  • 171 (59.8%) had a diameter greater than 6 mm.

The sample size included 54.8% in situ and 45.2% invasive melanomas. The median Breslow thickness was 0.55 mm (range, 0.4mm-1.0mm). Thirteen (4.5%) lesions were classified as amelanotic melanomas; however, these lesions did not differ significantly in ABCD features compared with pigmented melanomas. Of these 13 lesions, 10 (83.3%) had asymmetry, 10 (76.9%) had border irregularity, 7 (53.8%) had two or more colors present, and 7 (53.8%) had a diameter greater than 6 mm.

The authors then compared their own ABCD criteria data against the 1998 analysis by Thomas et al.2 Liu et al1 saw 85%, 85%, 71%, and 60% of their sample melanomas exhibiting A, B, C, and D criteria compared with 57%, 57%, 65%, and 90% for the same criteria in Thomas et al.2

“We acknowledge the utility of the ABCD criteria,” concluded the study authors.1


1. Liu R, Pugliano0-Mauro M, Patton T, Wang L, Siripong N, Ferris LK. Re-evaluating the ABCD criteria using a consecutive series of melanomas. Presented at:  American Academy of Dermatology Virtual Meeting Experience 2020; June 12-14, 2020.

2. Thomas L, Tranchand P, Berard F, Secchi T, Colin C, Moulin G. Semiological value of ABCDE criteria in the diagnosis of cutaneous pigmented tumors. Dermatology. 1998;197(1):11-17. doi:10.1159/000017969.

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