How to Identify the Suspicious Self? The ABCDE and Ugly Duckling Approach

Most moles are benign. The ABCDE and Ugly Duckling approaches in patient self-assessment help identify lesions that warrant dermatological evaluation; however, they do not provide a diagnosis.

ABCDE: A-asymmetry, B-irregular border, C-color variation, D-diameter, E-change. The classic 6 mm diameter threshold is only a warning sign; melanoma can be smaller than 6 mm. Especially E, meaning change over time, is important.

The Ugly Duckling approach is based on the individual's own nevus pattern. While most moles are similar, a distinctly different "outlier" lesion can raise suspicion. This is practically valuable in individuals with numerous moles.

Not every new mole is dangerous; however, in adulthood, new and changing lesions that differ from others, bleed spontaneously, ulcerate, or grow rapidly should be evaluated.

Itching, the presence of hair on the affected area, or bleeding due to trauma are not, by themselves, indicative of cancer. Light-colored/melanotic melanoma and nodular melanoma may not fully fit the classic ABCDE; therefore, focusing solely on large, dark lesions is insufficient.

Suspicious pigmented lesions should not be cosmetically destroyed in a way that would preclude histopathological evaluation. Dermoscopy enhances diagnostic assessment; histopathology is essential in cases requiring a definitive diagnosis.