Semiological value of ABCDE criteria in the diagnosis of cutaneous pigmented tumors

Abstract

Objective: The aim of this study was to evaluate the semiological value of the so-called ABCDE criteria in the differential diagnosis of pigmented tumours. Aside from the classical ABCD criteria, an E criterion for 'enlargement' is studied.

Material and methods: Records from melanoma patients were obtained from a melanoma database prospectively including patients treated for melanoma in our department since 1992; 460 files were found informative for this study. A prospective control group was established including 680 cases of benign pigmented tumors. All cases included in the study were histopathologically controlled in our dermatopathology unit. Records of ABCDE, i.e. corresponding to asymmetry, irregular borders, irregular coloration, diameter > or = 6 mm and enlargement, were codified as present or absent in every case. Data were statistically compared for every individual criterion with the chi 2 test and for the number of criteria present in melanoma versus other pigmented tumors with Student's t test.

Results: Significant differences were observed for all individual criteria (p < 0.001) between melanomas and common nevi. Significant differences were also observed for B, C and E criteria between melanomas and atypical nevi. The sensitivity of the individual criteria for the diagnosis of melanoma was 57, 57, 65, 90 and 84% for ABCDE, respectively. The specificity of the individual criteria for the diagnosis of melanoma versus other pigmented tumors was 72, 71, 59, 63 and 90% for ABCDE, respectively. The number of criteria present was significatively different between common nevi (1.24 +/- 1.26) and melanomas (3.53 +/- 1.53; p < 0.001) and between common nevi and atypical nevi (3.62 +/- 0.83, p < 0.001), but no significant difference was found between melanomas and atypical nevi. Sensitivity and specificity of diagnosis of melanoma are 89.3 and 65.3% if 2 criteria are present. Sensitivity and specificity of diagnosis of melanoma are 65.5 and 81% if 3 criteria are present.

Conclusion: The so-called ABCD criteria have a good semiological value in the differential diagnosis of pigmented tumors. Addition of an E criterion for enlargement optimizes sensitivity and specificity of diagnosis.