Skin cancer has many types but the most serious one is melanoma. Currently, the traditional ABCD criteria are likely to miss early nodular melanomas(pink melanoma), which is why the EFG rule was added to the TOTAL 7 RULES proposed to aid the clinical diagnosis of melanomas that can appear as innocent lesions.
7 warning signs for melanoma skin cancer:
ABCD+EFG rules!
- Asymmetry: if a lesion is bisected, one half is not identical to the other half.
- Border: irregularities
- Color variegation: presence of multiple shades of red, blue, black, gray, or white
- Diameter : ≥6 mm
- Evolution: a lesion that is changing in size, shape, or color, or a new lesion Plus Elevation
- Firm: on palpation
- Growth continuously for one month or longer
Combining additional criteria also helps increase accuracy and confidence in detecting melanoma skin cancer. United Kingdom National Institute for Clinical Excellence and the Scottish Intercollegiate Guidelines Network proposed the revised 7-point checklist includes three major features and four minor features described here:
Major:
- Change in size -new lesion
- Change in shape-irregular border
- Change in color- irregular pigmentation
Minor:
- Diameter ≥7 mm
- Inflammation
- Crusting or bleeding
- Sensory change or itch
The presence of any major feature plus a minor feature or at least three minor features is an indication to see a dermatologist.
Ref:
- Susan Swetter, MD, Alan C Geller, RN, MPH. UpToDate website last updated: Oct 04, 2023, assessed Oct 31, 2023. <https://www.uptodate.com/contents/melanoma-clinical-features-and-diagnosis?search=MELANOMA&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2682382315>
- Walter FM, Prevost AT, Vasconcelos J, et al. Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study. Br J Gen Pract. 2013;63(610):e345-e353. doi:10.3399/bjgp13X667213
