The Ugly Duckling Sign as a Warning Feature of Melanoma - Memphis Dermatologist

George Woodbury Jr. M.D. (04/18/2023)

Skin Cancer including Melanoma takes the lives of upwards of 20,000 Americans every year. That’s about one person every 26 minutes. The good news is that early detection leads to early treatment. Let’s take a look at an important warning feature – the “Ugly Duckling Mole” - that Dermatologists like myself have used to catch many Melanomas that might otherwise go unchecked.

First, you’ve got to look for Skin Cancer to detect Skin Cancer. Getting a Skin Cancer Screening regularly – by both yourself and by a Dermatologist – really helps. And to spot what might be a suspicious growth early, you do need to get your family members pretty much completely undressed, at least once a month, for a home inspection, because Skin Cancer can occur on all parts of the body. Remember that he most common location for Melanoma in women is the upper leg, and for men it’s the back, areas of the body that many of us do not routinely check.

We Dermatologists routinely look for the A, B, C, D, E warning signs for Skin Cancer: rules of thumb for recognizing significant lesions or growths. And I’d like to add a sixth warning sign that’s allowed me to spot many Skin Cancers early: the “Ugly Duckling Mole” sign.

A stands for Asymmetry: one half of the lesion does not match the other half.

B stands for Border: a jagged border, perhaps like the coast of Maine, rather than of Florida.

The lesion below - from a person's forehead - is a classic Melanoma: irregular Border and Asymmetric.

C stands for Color change: different hues of brown or black within the lesion, or one mole that’s a darker color than the person’s other moles.

D stands for an increasing Diameter of the lesion.

E stands for Evolving: if the lesion is changing, it’s best to bring it to the attention of a Dermatologist.

The melanoma below shows a dark color, and the patient would probably report that its diameter is getting larger.

But there is an important sixth warning sign: the “Ugly Duckling Mole,” by which I mean a mole that by itself might look low risk, but when compared to a person’s other moles, it stands out. It might be darker than a person’s other moles, or it might have a different shade of grey, or it might be more raised. I’ve caught many Melanomas over the years by simply looking for “Ugly Duckling Moles.”

And the youngest patient in my own Memphis Dermatology practice was only ten years old! Remember that the median age for Melanoma is 52. So we have to inspect young people as well as seniors. And everyone is at risk of Melanoma, not just redheads and people who burn in the sun. Just yesterday, I diagnosed Basal Cell Skin Cancer in a woman in my office in her late 20s.

And what better time of year to inspect your own family members - because warming weather means people are outside, at the beach, undressed, and you can look at their moles.

We know what action to take for suspicious moles or growths: if caught early, generally a simple removal, or “excision” of the lesion under local anesthetic is curative. If the lesion turns out to be a precancerous lesion – such as a high-risk atypical mole – or a full-fledged skin cancer – Dermatologic Surgeons like myself often try to ensure that the lesion is completely out – by doing what’s called a “reexcision.”

I have practiced as a Memphis Dermatologist these last 31 years is with Rheumatology and Dermatology Associates, Cordova, TN (1-901-753-0168; wwwRheumderm.com). You can find a Dermatologist closer to you by going to the American Academy of Dermatology web site, AAD.org, then simply plugging your zip code into the “Find a Dermatologist” tab.

For more helpful tips and photos of melanoma, go to the Skin Cancer Foundation website: skincancer.org. I've been a proud member of the Skin Cancer Foundation for over 15 years, the largest American organization specifically focused on early detection of and awareness of Skin Cancer.

My own Memphis Dermatology practice sponsored a short movie on Melanoma about a beautiful young lady named Scarlet Akins, a 28-year-old woman studying to be a teacher at Ole Miss who discovered a changing spot on her knee when she was about two months from delivering her daughter. Check out her moving story on Youtube: “Understanding the Melanoma Crisis: Scarlet’s Story.”

So see spot. See spot change. See a Dermatologist!