SOURCE: Ilyas M, et al. J Am Acad Dermatol 2017;77:1088-1095.

Patients or their partners detect most malignant melanomas first. Enhancing public awareness of malignant melanomas and enabling patients’ ability to promptly and accurately identify at-risk lesions is important.

The ABCDE rule (Asymmetry, Border irregularity, Color variegation, Diameter > 6 mm, and Evolution) has gained widespread utility among health professionals as well as the lay public since its introduction in 1985; however, there are limitations to the rule. Ilyas et al suggested that adding an additional tool to patient self-identification of lesions could be helpful: the Ugly Duckling Sign (UDS).

The UDS simply asks that the examiner identify whether a lesion in question is distinctly different from other skin lesions on his or her body. Ilyas et al performed a randomized, controlled trial to compare the accuracy of malignant melanoma identification in two groups of subjects: one educated in the ABCDE method and one in the UDS method. After brief instruction in only one method, participants (n = 101) were shown photographs of skin lesions. Although both methods of identification proved to be highly accurate, the UDS demonstrated a statistically significant advantage over ABCDE. The authors encouraged more widespread sharing of the UDS as a method to help patients self-identify risky lesions.