Abcd rule

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Clinical rule for assessing the dignity of pigmented skin lesions or melanocytic nevi according to the following criteria:

  • A = Asymmetry (unequal halves on both sides of an imaginary centre line)
  • B = Border irregularity (irregular limitation)
  • C = Colour variation, especially occurrence of black, grey, red tones, fading of individual components (most important criterion)
  • D = Diameter (diameter): more than 5 mm or size growth

If all four criteria are met, a pigmented skin change is highly suspect of a malignant melanoma. Exophytic growth (E = elevation) can be included as the 5th parameter in the assessment of the tumour.

  • E = Elevation

Remember! The ABCD rule is generally accepted as a guideline for dignity criteria of melanocytic nevi. However, it often fails in nodular malignant melanoma, but especially in amelanotic tumors.

Literature
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  1. Chamberlain AJ et al (2003) Nodular melanoma: Patient`s perceptions of presenting features and implications for earlier detection. J Am Dermatol 48: 694-701

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Last updated on: 29.10.2020

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