November 9, 2017 | Stephen Fine, Founder and President

Important New Information on Spotting Nodular Melanoma

A few decades ago, New York-based dermatologists created a simple, effective mnemonic device to help people remember what to look for when performing their monthly skin cancer self-examinations. How simple? It’s (now) just the first 5 letters of the alphabet: ABCDE. The letters stand for Asymmetry, Border, Color, Diameter and Evolving. Advances throughout medical science are perpetual however, and new findings will at times reveal that updates to previously-promoted public education need to be made. Skin Cancer is no exception, and this post will address one important educational update.

Nodular Melanoma

Nodular melanoma is the more dangerous of the two types of potentially lethal melanoma, radial and nodular. Even worse, it disproportionally affects children. 40%-60% of newly diagnosed melanomas in teens and preteens are nodular, compared to 20% in adults. (For more information, please read Radial and Nodular Melanoma).

Many people who look for nodular melanoma concentrate their focus on finding new or changing dark-hued, irregularly-shaped moles and skin growths, which is consistent with ABCDE. That is, it was– prior to a recent, vital change.

A Crucial Discovery from the Land Down Under

Australia and New Zealand have the world’s highest incidence of melanoma; their citizens are 5 times more likely to develop melanoma than U.S. citizens. This gives their medical scientists significant motivation to continually try and find new breakthroughs in the fight against skin cancer.

In 2003, the head of the Victorian Melanoma Service published a summary of the research done by noted dermatologist Dr. John W. Kelly. It focused on the inadequacy of the ABCD warning signs, and advocated for the addition of EFG (Elevated, Firm, Growing) signs of nodular melanoma.

This quote from the cited source article illustrates just how vital the results of Dr. Kelly’s research is in helping both doctors and patients identify nodular melanoma:

“Nodular melanomas were mostly symmet-rical (80%), with a regular border and of single colour (78%), the majority (55%) being amelanotic. They were also more likely to be elevated (90%), weeping, crusted or tender in comparison to SSM.* Nodular melanoma are mostly red or pink in colour and if present, pigmenta-tion is usually evenly distributed throughout the lesion. They are raised from the outset and grow progressively as a round nodule.”

Additionally, some nodular melanoma can actually be pale in color. Together, all of this means that people who apply only the ABCDE principles to skin lesions may very well mistake a deadly cancer for a common, benign skin blemish. That type of error can have fatal consequences.

Upon learning the details of Dr. Kelly’s research, the Melanoma Education Foundation (MEF) recognized their importance and immediately incorporated the EFG signs into its educational materials and website (skincheck.org).

The Cancer Council of Australia was slow to follow-up. But last month (October 2017) it finally changed its melanoma diagnosis guidelines for doctors. The new guidelines have been updated to include EFG warning signs in addition to the previous ABCD signs. It’s time for the U.S. to follow suit!

Please help us spread the word.

Additional source articles: Researchgate.net, Australian Broadcasting Corporation

*“SSM” refers to the more common superficial spreading melanoma.