Two studies have assessed its accuracy. The first found a 92% sensitivity for lesions with >1/5 diagnostic
features. The second evaluated instead the accuracy of only the BCD items, and found 100% sensitivity and
98% specificity for lesions with all three features. Still, the major problem is D, since some melanomas are <6 mm.
Because D considerably lowers the checklist’s sensitivity, some authors have suggested dropping it
altogether. Yet, available data argue against this approach and propose instead changing the “E” from
“Elevation” and “Enlargement” to “Evolving” because significant elevation is not apparent in most early
melanomas, and thus not a good warning sign of early disease; enlargement can be inaccurate, too, since it
focuses primarily on change in size and not, for example, in color, which can be very important in the
progress of the disease.
Evolving, on the other hand, would include not only evolution (i.e., change of any kind, color included), but also elevation and enlargement. It also supports the observation that 89– 95% of 100 consecutively accrued melanomas demonstrate changes in these features, and 100% show changes in at least one feature. Hence, beware of evolving nevi that change size, shape, surface (especially bleeding), symptoms (itching, tenderness), or shades of color. Also, beware of new pigmented lesions.
features. The second evaluated instead the accuracy of only the BCD items, and found 100% sensitivity and
98% specificity for lesions with all three features. Still, the major problem is D, since some melanomas are <6 mm.
Because D considerably lowers the checklist’s sensitivity, some authors have suggested dropping it
altogether. Yet, available data argue against this approach and propose instead changing the “E” from
“Elevation” and “Enlargement” to “Evolving” because significant elevation is not apparent in most early
melanomas, and thus not a good warning sign of early disease; enlargement can be inaccurate, too, since it
focuses primarily on change in size and not, for example, in color, which can be very important in the
progress of the disease.
Evolving, on the other hand, would include not only evolution (i.e., change of any kind, color included), but also elevation and enlargement. It also supports the observation that 89– 95% of 100 consecutively accrued melanomas demonstrate changes in these features, and 100% show changes in at least one feature. Hence, beware of evolving nevi that change size, shape, surface (especially bleeding), symptoms (itching, tenderness), or shades of color. Also, beware of new pigmented lesions.