Written by Aaron Brasuell, PA-C
Most children are taught the ABC’s of the alphabet at a very young age. However, in the medical community, and more specifically the specialty of dermatology, we have a different set of ABC’s that can alert a person or a provider of an abnormal lesion and more importantly can save a patient’s life if detected early enough.
ABC’s of Skin Exams
A stands for Asymmetry. If you were to hypothetically cut a mole in half, a normal mole typically should look the same on both sides or in other words be symmetrical, therefore asymmetry of a lesion is a sign of abnormality.
B stands for Border irregularity. The border of a normal mole is usually smooth, circular and well defined. If the borders of the mole in question are notched, uneven, blurred, scalloped, or poorly defined in any way, this is a potential sign of abnormality.
C stands for Color variegation or variations in color. A normal mole is typically either skin colored, or a light/chocolate brown. In addition, a normal mole should be 1 color. An abnormal mole will usually have more than one color, and will have different shades of brown, tan, blue, white, black, red or a combination of these.
D stands for Diameter. Most normal moles are less than 6 millimeters or the size of a pencil eraser. Melanomas tend to be bigger than 6mm, however the diameter criteria is a weakness in this system because when melanomas begin, they can start off as small as a pinhead and grow from there. Also, many atypical moles are smaller that 6mm and need to be removed regardless of size.
E stands for Evolution or Evolving. Any mole that has changed or evolved in color, size, shape, and/or border irregularity should be looked at by a dermatologic provider. More recently F and G were added to the criteria.
F stands for Firm. New moles that are firm to the touch as opposed to soft and fleshy may need to be evaluated.
And finally, G stands for Growing. If a mole is rapidly growing, it may need to be evaluated. Other warning signs of abnormality include the appearance of a new bump or nodule, color spreading into surrounding skin, redness or swelling beyond the mole, pain, tenderness, itching, bleeding, oozing, or a scaly appearance.
3 Different Categories of Moles
- Moles that are completely normal when they are looked at in the clinic and under the microscope at the pathologist’s lab
- Moles that are atypical (dysplastic), and do not have the characteristics of normal moles.
- Moles that have become malignant and are called malignant melanoma. Melanoma can also arise by itself without the presence of a mole.