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



  • 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
Patient Information
Diagnostic Tips
  • Malignant melanoma may be a new lesion or develop in a pre-existing mole
  • Amelanotic malignant melanoma may present as an enlarging, granulating or smooth pink nodule