A good portion of my time as clinical editor is spent reading journals, blogs, articles, news, and anything else having to do with nurses, impacting nurses, or written by nurses. Last evening, while perusing a stack of journals, I learned something new - something important that I thought would be good to share. It’s a technique to use when assessing someone’s skin.

I’ve learned, relearned, and reviewed the ABCDEs of melanoma many times, as I’m sure many of you have as well. Remember Asymmetry, Border irregularity or bleeding, Color, Diameter, and Evolving or changing? In the January/February issue of Nursing Made Incredibly Easy!, I learned an additional technique to use in conjunction with the ABCDEs, called the “ugly duckling” approach. This approach encourages you to look at a person’s general mole appearance and pattern while being alert for any “outlier” lesions which look or feel different than the other moles or that change over time.

Here are some examples shared by the authors:

  • In a patient with a dominant mole pattern with slight variation in size, the ugly duckling might be clearly darker and larger than all the other moles.
  • When there are two predominant patterns, one of larger moles and the other of smaller, darker moles, the ugly duckling could be small and lack pigmentation.
  • When there’s only one lesion on the back that is changing, symptomatic, or deemed atypical.

Here’s the link to the pdf of the article: Caring for a patient with malignant melanoma - great information, great photos, and great illustrations to help you understand the “ugly duckling” approach. So, next time you are assessing a patient's skin, or even your own, remember to look for any "ugly ducklings" around.