Suspicious Pigmented Lesions and Changing Melanocytic Naevi

Patients often present with new or changing occasionally symptomatic pigmented lesions.

Assess for suspicious ABCD signs:

A Asymmetry

Ankle melanoma

B Border irregularity

Abdomen Melanoma with dermatoscopic image

C Colour variation / asymmetry

Melanomas of left side of nose and back.

D Diameter >6mm 

Lentigo maligna Melanoma jaw

History

• Assess risk factors:
  • high sun exposure
  • family history of melanoma
  • presence of atypical naevi

• Provide education about moles e.g. Cancer Research UK leaflet
• Give advice on sun avoidance and protection
• If any surgery performed, ensure the specimen is sent to pathology

Key points in history and examination:

Changing naevus with suspicious ABCD signs:

• Asymmetry
• Irregular Border
• Colour variation
• Increasing Diameter
• Evolution- changing features

Dermatology Referral Criteria

Suspected malignant melanoma

• Refer via “Urgent suspicion of cancer” (USOC) dermatology referral pathway and mark letter accordingly
• Where available refer to local fast track lesion/ cancer clinic
• Use electronic referral if available. Attach photo if available
• Any patient who has a malignant melanoma removed in primary care must be discussed with a skin cancer MDT