Introduction
They are a major reason for consultation because they may be an atypical naevus or an early melanoma. The guiding principle is simple: it is better to examine one lesion too many than to miss an early diagnosis.
Symptoms
- A new pigmented spot or lesion in an adult
- A recent change in an existing lesion
- Asymmetrical shape
- Irregular or poorly defined borders
- Uneven colour (brown, black, grey, red, blue)
- Rapid increase in size
- Itching, pain or bleeding
- A lesion that looks different from the others (the ‘ugly duckling sign’)
Causes
- Atypical or changing naevus
- Early melanoma
- Atypical lentigo
- Inflammatory or traumatic pigmented lesion
- Personal or family history of melanoma
- Intense or repeated sun exposure
- Fair skin type (fair skin, light eyes and hair)
- High number of naevi (moles)
- Weakened immune system
- Use of sunbeds
Diagnosis
- Full skin examination
- Dermoscopy (analysis of pigment structures)
- Comparison with the ABCDE criteria
- Standardised photographs and digital monitoring of doubtful lesions
- Diagnostic surgical excision whenever there is suspicion
Treatments
- Close dermoscopic monitoring (lesions of low suspicion)
- Total body mapping if there are multiple lesions
- Complete surgical excision of suspicious lesions
- Histological analysis of every specimen removed
- dermoscopic
- contraindicated
Management
Specialist dermatology consultation
Personalised risk assessment
Shared decision between monitoring and excision
Information for the patient on warning signs
Regular follow-up according to risk profile (sometimes lifelong)