A 66-year-old Australian man presents with a pigmented lesion on his upper back that has recently increased in size. The lesion has a symmetrical circular shape and the colour of the lesion is uniform. The largest diameter of the lesion is 8 mm. There is no inflammation, oozing, or change in sensation.

  1. Which diagnosis should you be most concerned about?
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With this presentation you should be most concerned about the possibility of malignant melanoma.

Malignant melanoma is a tumour of melanocytes that causes 75% of deaths related to skin cancer. The most common site in women is the legs and in men is on the back. The primary cause is UV exposure, even from sunbeds, especially in Caucasian populations. Early signs are changes in shape or colour of existing moles, and at later stages the mole may itch, ulcerate or bleed.

  1. Using the NICE 7-point checklist recommended for the assessment of skin lesions, what does he score?
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The NICE weighted 7-point checklist is as follows:

  • Major features of the lesions (scoring 2 points each):
    • Change in size
    • Irregular shape
    • Irregular colour.
  • Minor features of the lesions (scoring 1 point each):
    • Largest diameter 7 mm or more
    • Inflammation
    • Oozing
    • Change in sensation

 

This patient has an enlarging lesion that is greater than 7 mm in diameter, which would score him 3 points.

  1. How should this patient be managed?
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The current NICE guidelines recommend that patients are referred using a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma if they have a suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more.

Patients should also be referred for an urgent appointment within 2 weeks if dermoscopy is suggestive of melanoma.

 

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