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The Ugly Duckling Sign: An Early Melanoma Recognition Tool PDF Print E-mail
A recently developed early detection tool can improve early diagnosis critical to the successful treatment of melanoma.

For many years, the early warning signs of melanoma have been identified by the acronym "ABCDE" (A stands for Asymmetry, B stands for Border, C for Color, D for Diameter and E for Evolving or changing was recently added.). While the ABCDE rule helps detect many melanomas, there are a group of melanomas that do not manifest the ABCDE features. Recently, several melanoma specialists developed a new method of sight detection for skin lesions which could be melanoma.
This new method of sight detection for skin lesions is based on the concept that these melanomas look different -- ie, "the ugly duckling" -- compared to surrounding moles. Thus, during skin self examination, patients and physicians should be looking for lesions that manifest the ABCDE's AND for lesions that look different compared to surrounding moles.

As reported in December 2007 issue of The Melanoma Letter, a publication of The Skin Cancer Foundation, an approach combining the ABCDEs and the “Ugly Duckling” technique should improve the chances of early detection of all types of melanoma. In the article "The “Ugly Duckling” Sign: An Early Melanoma Recognition Tool For Clinicians and the Public" by Dr. Alon Scope and Dr. Ashfaq A. Marghoob of Memorial Sloan Kettering Cancer Center (New York, NY), the premise of the ugly duckling sign is that the patient’s “normal” moles resemble each other, like siblings.

The doctors suggest thinking of "the ugly duckling" mole, aka “the outlier”, as the lesion that, at a given moment in time, looks or feels different than the patient’s other moles, or that over time, changes differently than the patient’s other moles. The “ugly duckling” methodology may be especially useful in the detection of nodular melanoma, a dangerous type of melanoma, which notoriously lacks the classic ABCDE signs.



representation of 3 Ugly Duckling mole types

These three different scenarios depict “ugly ducklings” moles that should prompt
suspicion. Squares A, B, and C each represent a body area such as the back.
  • In A, there is a dominant mole pattern with slight variation in size. The "ugly duckling" is clearly darker and larger than all other moles.
  • In B, there are two predominant patterns, one of larger moles and the other of smaller, darker moles. The "ugly duckling" is small but lacks pigmentation.
  • In C, there is only one lesion on the back. If this lesion is changing, symptomatic, or deemed atypical, see a doctor and have this "ugly duckling" examined.
The best way to identify an "ugly duckling" is to perform a self-examination of your skin monthly. Instructions on how to perform a skin self-examination are available from The Skin Cancer Foundation. If you spot an "ugly duckling", see a dermatologist without delay.
 
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