The ABCD rule of dermatoscopy: High prospective value in the diagnosis of doubtful melanocytic skin lesions

doi:10.1016/S0190-9622(94)70061-3

Journal of the American Academy of Dermatology

Volume 30, Issue 4, April 1994, Pages 551-559

https://doi.org/10.1016/S0190-9622(94)70061-3 Get rights and content

Background: The difficulties in accurately assessing pigmented skin lesions are ever present in practice. The recently described ABCD rule of dermatoscopy (skin surface microscopy at ×10 magnification), based on the criteria asymmetry (A), border (B), color (C), and differential structure (D), improved diagnostic accuracy when applied retrospectively to clinical slides.

Objective: A study was designed to evaluate the prospective value of the ABCD rule of dermatoscopy in melanocytic lesions.

Methods: In 172 melanocytic pigmented skin lesions, the criteria of the ABCD rule of dermatoscopy were analyzed with a semiquantitative scoring system before excision.

Results: According to the retrospectively determined threshold, tumors with a score higher than 5.45 (64/69 melanomas [92.8%]) were classified as malignant, whereas lesions with a lower score were considered as benign (93/103 melanocytic nevi [90.3%]). Negative predictive value for melanoma (True-Negative ÷ [True-Negative + False-Negative]) was 9 5.8%, whereas positive predictive value (True-Positive ÷ [True-Positive + False-Positive]) was 85.3%. Diagnostic accuracy for melanoma (True-Positive ÷ [True-Positive + False- Positive + False-Negative]) was 80.0%, compared with 64.4% by the naked eye. Melanoma showed a mean final dermatoscopy score of 6.79 (SD, ± 0.92), significantly differing from melanocytic nevi (mean score, 4.27 ± 0.99; p <0.01, U test).

Conclusion: The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented skin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.

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^*: Supported by a grant of the German Minister of Research and Technology and the Deutsche Forschungsgemeinschaft (Sto 189/1-2).

^**: Presented in part at the Twentieth Annual Meeting of the German Society of Dermatological Research, Nov. 13 to 15, 1992, Mainz, Germany.

^a: From the Department of Dermatology, University of Munich

^b: From The Department of Dermatology, University of Regensburg

^c: From the Dermatology Associates, Tallahassee.

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The ABCD rule of dermatoscopy: High prospective value in the diagnosis of doubtful melanocytic skin lesions*,**

J Am Acad Dermatol

Jam Acad Dermatol

J Am Acad Dermatol

Lancet

Hum Pathol

Lancet

J Am Acad Dermatol

Accuracy in the clinical diagnosis of malignant melanoma

Arch Dermatol

Zur Auffichtmikroskopie von Pigmenttumoren der Haul

Hautarzt