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ABCDEF Rule of Levit et al for Detection of Subungual Melanoma

Purpose: To identify a patient who should be evaluated for a subungual melanoma based on the ABCDEF rule of Levit et al.

Description

Levit et al developed an "ABC" rule to help identify patients with subungual malignant melanoma. This is intended to reduce the time to diagnosis and improve patient survival. The authors are from St. Lukes/Roosevelt Hospital and Columbia University in New York.


Letter

Clinical Feature Indicated

A

age 20 to 90 years (adult), usually in 40s to 60s

A

Asian, Native American, Afro-American

B

band under nail that is brown or black

B

breadth >= 3 mm

B

border that is irregular and/or blurred

C

change, with rapid increase in size

C

failure to change despite adequate treatment for onychomycosis, etc

D

digit involved: thumb or hallux > index finger

D

single digit more often than multiple digits involved

D

dominant hand

E

extension of pigment to involve the proximal or lateral nail fold (Hutchinson's sign)

E

extension of pigment to the free edge of the nail plate

F

family history of malignant melanoma or the dysplastic nevus syndrome

F

personal history of malignant melanoma or the dysplastic nevus syndrome

 


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Specialty

Objective

ICD-10