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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.
Financial Disclosure: To reveal any potential bias in this publication, and in accordance with Accreditation Council for Continuing Medical Education guidelines, Dr. Brunton reports he is a retained consultant for Abbott Diabetes, Actavis, AstraZeneca, Becton Dickinson, Boehringer Ingelheim, Cempra, Janssen, Lilly, Merck, Novo Nordisk, and Sanofi; he serves on the speakers bureau of AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, and Novo Nordisk. Dr. Kuritzky (author) is a retained consultant for and on the speakers bureau of Allergan, Daiichi Sankyo, Lilly, and Lundbeck. Ms. Coplin, Mr. Springston, and Editorial Group Manager Terrey L. Hatcher report no financial relationships relevant to this field of study.