We’ve all heard the story of the ugly duckling; How one baby duckling was ostracized and neglected for being different. Well, research now suggests that identifying that skin mole that looks different than all the others may save your life. The “ugly duckling” sign showed very good sensitivity when used as a tool to identify individuals at risk for melanoma.
Melanoma is the most dangerous form of skin cancer. If undetected, this cancer can spread to other parts of the body where it is difficult to treat and can be fatal. If caught early, it has a 100% cure rate.
Melanoma originates in the melanocytes which are the cells that produce the pigment of the skin, hair and eyes called melanin. Even though it’s not the most common cancer, it is the deadliest. In 2007, the American Cancer Society estimated 8,110 deaths, 5,220 in men and 2,800 in women in the United States.
The overall survival rate in the U.S. has increased from 60% in 1970 to greater than 90% in 2008. This is mainly due to early detection since there are still no effective therapies for advanced melanoma.
Health practitioners used to rely on the ABCD rule to identify risk for melanoma. This rule, developed in 1985 is a general clinical analysis of early recognition of melanoma. Each letter represented a characteristic to look for in a mole at high risk. A=assymetry, B=border (irregular), C=color change and D= diameter of more than 5mm. Many times patients would have unnecessary excisions and this criterion did not fit for many thin melanomas.
A recent study had 13 general dermatologists, 8 dermatologists (specialists in pigmented lesions), 5 nurses and 8 secretaries and other hospital staff members try to identify differing nevi (moles) seen on photographs of the backs of 12 patients. They were asked to find the nevi that differed from all the rest. For the overall group, the sensitivity of the ugly duckling sign was 90%. Even the non-medical staff scored 85%.
The take home message: If you see a mole that looks different from the surrounding moles on your skin, see a dermatologist.
Reference: Jancin, B. “‘Ugly Duckling’ Could Be Useful Melanoma Flag.” Family Practice News: Skin Disorders, April 15, 2008.