The ugly duckling

As a clinical editor, I spend a good portion of my time reading journals, blogs, articles, news, and anything related to nurses, that affects nurses, or is written by nurses. Last night, while going through a stack of journals, I learned something latest—something essential that I assumed could be good to share. This is a method to make use of when assessing someone’s skin.

I even have studied, reviewed, and reviewed the ABCDEs of melanoma over and over, as I’m sure a lot of you could have. Remember, within the January/February issue, I learned a further technique that could be used at the side of the ABCDEs called the “ugly duckling” approach. This approach encourages you to have a look at the general appearance and pattern of an individual’s moles while being attentive to any “outliers” that look or feel different than other moles or that change over time.

Here are some examples provided by the authors:

• In a patient with a dominant pattern of moles with slight variations in size, the ugly duckling could also be noticeably darker and bigger than all the opposite moles.
• If there are two dominant patterns – one consisting of larger moles and the opposite of smaller, darker moles – the ugly duckling could also be small and lacking pigmentation.
• When there is simply one lesion on the back that changes, causes symptoms, or is taken into account atypical.

Here is a link to the PDF of the article: – great information, great photos and great illustrations to enable you understand the “ugly duckling” approach. So the subsequent time you might be evaluating a patient’s skin, and even your personal skin, remember to go searching for the “ugly ducklings.”