Skin self-examination and the ABCDE rule in the early diagnosis of melanoma: Is the game over?

Tumour prevention should aim at decreasing tumour mortality, not at increasing the diagnosis of indolent forms (which might never be fatal). Epidemiological data show that skin self examination and the ABCDE rule (asymmetry, border, colour, diameter, elevation) were not effective in reducing mortality. In fact, we know that the poorest prognosis is most often that of nodular melanoma, which escapes the ABCDE rule by being symmetrical, regular borders and homogeneous colour, and often being only around 6 mm in size, despite having a thickness that carries a poor prognosis per se. Furthermore, patients have difficulty in assessing changes in small and rapidly progressing on lesions, such as nodular melanoma.