ABCDE Criteria for Melanoma Recognition
Five-feature clinical screening checklist for early melanoma recognition. Developed by Friedman et al. 1985. Expanded to include E (evolution). Primary care and emergency tool for urgent 2-week-wait referral decisions. Three or more features = suspicious; urgent dermatology referral indicated. Does not replace dermoscopy or biopsy.
Score interpretation
0-1 ABCDE features -- low clinical suspicion for melanoma
→ Advise on sun protection (SPF 50+, avoid tanning beds); skin self-examination education; photograph lesion for baseline documentation; review in 6-8 weeks if evolution or patient concern; warn patient explicitly to return if any change; document decision in notes.
2 ABCDE features -- intermediate suspicion; dermoscopy preferred
→ Dermoscopy assessment if trained clinician available; photograph with scale; refer urgently if NICE NG12 2-week-wait criteria met; if not referring: follow up in 4 weeks and refer if any concern; biopsy can be arranged via dermatology; document all features examined.
3 or more ABCDE features -- high clinical suspicion for melanoma; urgent referral required
→ Urgent dermatology referral via 2-week-wait cancer pathway (NICE NG12); do NOT biopsy in primary care -- refer for specialist excision; advise patient of concern clearly; in hospital setting: dermatology review same day; excisional biopsy with 2 mm margins (do not use shave biopsy); Breslow thickness from histopathology guides further management including sentinel node biopsy.
Interpretation bands for the ABCDE Melanoma. Apply clinical judgement and local guidance.
References
- Friedman RJ et al. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin. 1985;35(3):130-151.
- NICE NG12. Suspected cancer: recognition and referral. NICE. 2015 (updated 2023). Melanoma section.
Related
Curated clinical cross-links plus same-class fallbacks.
- Chlorhexidine gluconate with isopropyl alcohol · Skin antiseptic
- Chlorhexidine with cetrimide · Skin antiseptic / wound cleanser
- Barrier creams and ointments · Topical skin protectant
- Risedronate Sodium · Bisphosphonate
- Zoledronic Acid · Bisphosphonate (IV)
- Denosumab · RANK Ligand Inhibitor (Anti-resorptive)
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.