Stolz, Nachbar et al developed a score for pigmented skin lesions viewed by dermatoscopy based on the ABCD rule. This can help separate benign from potentially malignant lesions. The authors are from the Universities of Munich and Regensburg and Dermatology Associates in Tallahassee, Florida.
Recommended for inclusion by: Dr J de Waard, Kollum, The Netherlands
Parameters:
(1) A for asymmetry
(2) B for border (based on dividing the lesion into 8 wedge-shaped segments)
(3) C for colors
(4) D for different structural components (pigment network, branched streaks, structureless/homogeneous areas, dots and globules)
|
Parameter |
Finding |
Points |
|---|---|---|
|
asymmetry |
totally symmetric in contour, color and structure |
0 |
|
|
asymmetry in 1 axis for contour, color or structure |
1 |
|
|
asymmetry in 2 axes |
2 |
|
borders showing abrupt cut-off of pigment |
no segments show an abrupt cut-off |
0 |
|
|
1 segment shows an abrupt cut-off |
1 |
|
|
2 segments show an abrupt cut-off |
2 |
|
|
3 segments show an abrupt cut-off |
3 |
|
|
4 segments show an abrupt cut-off |
4 |
|
|
5 segments show an abrupt cut-off |
5 |
|
|
6 segments show an abrupt cut-off |
6 |
|
|
7 segments show an abrupt cut-off |
7 |
|
|
8 segments show an abrupt cut-off |
8 |
|
colors |
1 color |
1 |
|
|
2 colors |
2 |
|
|
3 colors |
3 |
|
|
4 colors |
4 |
|
|
5 colors |
5 |
|
|
6 or more colors |
6 |
|
different structural components |
1 structural component (see below) |
1 |
|
|
2 structural components |
2 |
|
|
3 structural components |
3 |
|
|
4 structural components |
4 |
|
|
5 structural components |
5 |
where (from Johr, 2002):
• Colors include red, white (must be lighter than the surrounding skin if Caucasian), light brown, dark brown, blue-gray and black.
• Structureless or homogeneous areas show a color but lack structures such as a pigment network, branched streaks, dots or globules. It should be > 10% of the lesion area to be counted.
• Branched streaks are thickened and branched pigment networks anywhere in the lesion. These are counted only if more than 2 are clearly seen.
• Dots are counted only if more than 2 are clearly seen.
• A single globule is sufficient to be counted.
total score =
= (1.3 * (points for asymmetry)) + (0.1 * (points for border)) + (0.5 * (points for colors)) + (0.5 * (points for different structural components))
Interpretation:
• minimum score: 1
• maximum score: 8.9
|
Score |
Interpretation |
|---|---|
|
< 4.75 |
benign |
|
4.75 to 5.45 |
suspicious for melanoma |
|
> 5.45 |
highly suspicious for melanoma |
Purpose: To examine a pigmented skin lesion using the ABCD rule for dermatoscopy.
Specialty: Dermatology, Hematology Oncology
Objective: clinical diagnosis, including family history for genetics, other testing, criteria for diagnosis
ICD-10: C43, D22,
