Question

What are the 5 things to assess in a suspicious lesion/mole to evaluate for melanoma?

Answer

The ABCDEs of melanoma will help you identify suspicious lesions that will need dermatologic follow-up

Asymmetry

• Draw a line through the lesion and the two halves do not look similar, it is concerning

Border Irregularity

• If the borders of the lesion are not uniform and smooth, it is concerning

Color

• Different colors within the same lesion are concerning

Diameter

• ≥ 6 mm is concerning

Evolution

• Any lesion that changes in size, shape, color is concerning

The is also another set of criteria that was developed in the UK by the United Kingdom National Institute for Clinical Excellence (NICE) and by the Scottish Intercollegiate Guidelines Network called the Glasgow Seven-point Checklist.  These guidelines incorporate 3 major and 4 minor criteria and any major or 3 minor criteria is an indication for referral.

Major

• Change in size or new lesion
• Change in shape
• Change in color

Minor

• Diameter ≥ 7mm
• Inflammation
• Crusting or bleeding
• Sensory change

Once a patient has been referred to a dermatologist, they use a similar seven point system on dermoscopy to diagnose melanoma.

Major (2 points each)

• Atypical pigment network
• Blue-whitish veil
• Atypical vascular pattern

Minor (1 point each)

• Irregular streaks
• Irregular pigmentation
• Irregular dots/globules
• Regression structures

A melonoma score of ≥ 3 is required for diagnosis

Melanoma – http://www.dermoscopy.org/consensus/2d.asp

Melanoma – http://www.dermoscopy.org/consensus/2d.asp

Clark nevus – http://www.dermoscopy.org/consensus/2d.asp

References

1. National Collaborating Centre for Cancer (UK). Melanoma: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2015
2. Scottish Intercollegiate Guidelines Network. Cutaneous Melanoma. A national clinical guideline. January 2017.
3. Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Archives of dermatology. 1998; 134(12):1563-70. [pubmed]
4. http://www.dermoscopy.org/consensus/2d.asp