Small diameter melanoma: a follow-up of the Norwegian Melanoma Project.
BACKGROUND
Melanoma prognosis is dependent upon early recognition and treatment. There is a need for good clinical guidelines that focus on the early signs of melanoma. The ABCD (asymmetry, border, colour and diameter) rule states that most melanomas are more than 6 mm in diameter. Critics crave a modification, arguing that small diameter melanomas are not infrequent.


OBJECTIVE
The aim of the present study was to describe the frequency and prognosis of melanomas less than 7 mm in a clinical setting.


METHODS
The Norwegian Melanoma Project was conducted as a multicentre, prospective study with inclusion criteria. Patients were recruited from five dermatological departments in Norway from 1990 to 1993.


RESULTS
The frequency of small melanomas was 11.4% (18/158). One-third was in situ melanoma, the rest invasive with a median thickness of 0.8 mm. Four small melanomas were T2 lesions, with a Breslow thickness of more than 1 mm. One nodular T2 melanoma recurred locally 2 years after diagnosis and the patient died of distant metastasis only months later.


CONCLUSIONS
The ABCD rule remains a practical guide for early recognition of melanoma. Clinicians must be aware of its limitations.
Helsing
P
P
Department of Dermatology, National Hospital, 0027 Oslo, Norway. per.helsing@rikshospitalet.no
Loeb
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology