The Ugly Duckling

The Ugly Duckling

After my diagnosis, surgery and recovery for malignant melanoma in 1988, I began to read everything I could on skin cancer detection, prevention, and treatment. Those early days for me were very simple. If something didn’t look right, get it checked out. That is what I did. I trusted my gut feelings about my own skin and what I would see on the skin of others. Not every scientific, but it seemed to work.

ABCD rule

Over the years we got pretty fancy to where most information regarding skin checks involved following the ABCD rule. This meant looking for moles that had Assymetry (one half was not like the other half, irregular Border (jagged edge and not uniform), Color variation (one side darker than the other or a different color), and a Diameter larger than six millimeters (measuring across). These made sense to me and still do and have served well, but new recommendations are being made in melanoma detection.

Adding to our alphabet

Let’s now add “E” and “F” to our acronym. According to Graeme Lipper, MD, (Assistant Clinical Professor, University of Vermont College of Medicine; Staff Physician, Department of Dermatology, Danbury Hospital, Danbury, Connecticut), new letters have been added to our expanding alphabet.1

Change is not always a good thing

“E” – Evolving lesions are also to be considered when looking for skin cancer. Moles that change can be signs of melanoma and should be monitored. This is why benchmarking and mapping lesions and moles are very important. In order to know if something has changed, you must know what was there at the beginning. I suggest taking photos of your skin and seeing a doctor when you notice any changes in any of the above considerations (asymmetry, border, color, diameter, and evolving).

A duck that is ugly

So, what about the “F”? Now, this goes back to my original statement. Dr. Lipper notes in the final paragraph of his referenced article that patients using the latest screening tools are instructed to look for UD’s or Ugly Duckling moles.1 What moles, lesion, growth looks out of place? Some of you may recall Sesame Street and the song entitled “One of these things is not like the other.” Ernie sang about finding the one item that was different among similar items. I was pretty good at determining that the one square was out of place with the three circles.

What about the ‘F”?

“F” – Funny looking moles, lesions, growths should be noted, monitored and examined. Funny looking does not mean fun and it is no laughing matter, but according to Dr. Lipper, knowing the differences in your skin may save your life.1 The UD rule comes from the notion that each person has a characteristic pattern in their “melanocytic nevi” (think moles) based on genetic determinants, such as a skin prototype.1 Patients are thus encouraged to look for moles that break the pattern, the funny looking, ugly ducklings.

A song to remember

The ABCD rule is a good one in my opinion, but gut instincts have been helpful for me as well. When something look different or out of place on your skin, take notice and share with your doctor. And as the song goes, if something is not like the other, hopefully the dermatologist will be able to tell you so. How many more letters will be added next year?

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