ABCDEs of melanoma
Dr. Siegfried: Your publications have been very diverse including a couple of really great articles. Can you talk about what inspired the ABCDEs for pediatric melanoma and the seminal article on eczema coxsackium?
Dr. Cordoro: Thank you for the compliment. My articles have been driven by my passion for dermatology and the confusion that arises when caring for complex patients. My patient care practice really dominates the questions that I have asked.
The ABCDE story for pediatric melanoma really began in my pediatric dermatology fellowship. As I mentioned earlier, I transitioned from being an adult dermatologist to pediatric dermatology, and it was profound for me when I realized how differently melanoma can present in children and that it could be missed a large part of the time because of the different clinical presentation.
I remember saying to my fellowship director and mentor, [Dr.] Ilona Frieden, while caring for a young girl with amelanotic melanoma, ‘The ABCDEs do not always apply to pediatric melanoma. These kids are at risk for very late detection. I want to write this up.” This was in 2007. She said, “Why don’t you collect data and see if it supports your notion?” So, the idea was born in 2007 and resulted in a paper that was published in 2013.4 In reviewing the literature on childhood melanoma, I realized the paucity of clinical information—in particular, the original appearance of the melanoma—provided in published series. We reviewed the details of every melanoma diagnosed before the age of 18 at UCSF, and our data together with other published series allowed us to make some clinically important observations.
One of the things we learned is that E is the most predictive criterion. Persistent lesions that are evolving or changing should be approached with a higher degree of suspicion. The study supported the need for raised awareness for melanoma in children with lesions that are amelanotic, or bleeding, and even those that are uniform in color and of small diameter [<6mm].