DOES THIS PATIENT HAVE A MOLE OR A MELANOMA

Lifetime risk for malignant melanoma has increased from 1 in 1500 in t he United States in 1930 to 1 in 75 projected for the year 2000, Becau se the tumor's thickness at excision is the primary prognostic determi nant, early detection through the history and physical examination can play an important role in the patient's clinical course, Two checklis ts have been developed as diagnostic aids, the ABCD (A indicates asymm etry; B, border irregularity; C, irregular color; and D, diameter >6 m m) and the revised 7-point checklists, These checklists should be inte rpreted with some discretion, but 2 studies have found the sensitivity for the ABCD checklist to be 92% (95% confidence interval [CI], 82%-9 6%) and 100% (95% CI, 54%-100%); 1 study found the specificity to be 9 8% (95% CI, 95%-99%), The revised 7-point checklist has been reported to have a sensitivity of 79% (95% CI, 70%-85%) to 100% (95% CI, 94%-10 0%) and specificity of 30% (95% CI, 21%-39%) to 37% (95% CI, 28%-46%), Physicians' global assessments for detecting the presence or absence of melanoma are estimated to have a specificity of 96% to 99%, while s ensitivity ranges widely from 50% to 97%. Nondermatologists' examinati ons appear to be less sensitive than examinations performed by dermato logists.