Why Is Darkness an Essential Feature for Melanoma Recognition?

Most conditions and diseases have one or more features that are essential for recognizing the most common presentations of the disease. Melanoma is a cancer of pigment-producing cells, and the term "melanoma" is derived from the Greek term for "dark tumor." Many, if not most, descriptions of melanomas include their being in general dark brown or black; however, the most utilized set of criteria for melanoma education, the ABCDE (asymmetry, border irregularity, color variation, diameter > 6mm, evolving) criteria, omits darkness as even one of the five emphasized features. A growing number of current approaches to melanoma recognition have addressed this need. In 2019, the Skin Cancer Foundation, for example, added that the "D" in the ABCDE mnemonic represents not just "Diameter" but also "Dark" (https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/ Accessed April 5, 2020). The Georgia approach, for which this author advocates, includes an increase in emphasis on a screening look, with dark, different, and changing as screening features, as well as a "D" for "Dark" change in the ABCDE criteria.¹ Given the number of new strategies for melanoma education being developed, it is a particularly appropriate time to review the logic and rationale of why darkness is an essential feature for recognition of melanoma.