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Melanomas
may appear noticeably different than other
moles
A preliminary study suggests
that melanomas have a different appearance
than other irregular skin moles (i.e., are
“ugly ducklings”), according to a report in
the January issue of Archives of
Dermatology, one of the JAMA/Archives
journals.
Rates of malignant melanoma
continue to increase, and early
identification allows surgeons to treat the
disease by removing the tumor, according to
background information in the article.
The disease is more common in
individuals with many moles or other skin
marks, especially if the marks are atypical
in color, shape or size.
“The challenge for
clinicians who diagnose and treat pigmented
skin lesions is to distinguish between
malignant melanoma and benign simulants,”
the authors write.
Alon Scope, M.D., of the
Memorial Sloan-Kettering Cancer Center, New
York, and colleagues obtained images of the
backs of 12 patients from a database of
standardized patient images.
All of the patients had at
least eight atypical moles, and five
patients had one lesion that had been
confirmed as a melanoma.
Thirty-four study
participants—including eight pigmented
lesion experts, 13 general dermatologists,
five dermatology nurses and eight
non-clinical medical staff—were asked to
evaluate the images and identify lesions
that looked different from all other
atypical moles.
All five melanomas and only
three of 140 benign lesions (2.1 percent)
were generally apparent as different,
meaning that two-thirds of the participants
identified them as “ugly ducklings.”
“The malignant melanomas were
apparent as being different to at least 85
percent of participants, whereas the
agreement rate on the benign lesions
perceived as being different was 76 percent
at most,” the authors write.
“Four lesions were generally
apparent as completely different, all four
being malignant melanomas.”
For all participants, the
test had a sensitivity of 90 percent,
meaning 90 percent of the melanomas were
identified as different.
Sensitivity was 100 percent
for the pigmented lesion experts, 89 percent
for general dermatologists, 88 percent for
nurses and 85 percent for non-clinicians.
“Although the sensitivity and
specificity and diagnostic accuracy of the
ugly duckling sign depended on clinical
expertise, the values for these parameters
were good in all subgroups of participants,”
the authors write.
“These preliminary findings
suggest that the ugly duckling sign may
prove to be a useful screening strategy for
primary health care providers and even for
skin self-examination.”
