Synopsis
Assess a pigmented lesion systematically, compare it with the patient’s mole pattern, use the weighted seven-point checklist correctly, and arrange urgent specialist assessment without unsafe destructive sampling.
- ABCDE prompts asymmetry, border irregularity, colour variation, diameter and evolution; evolution is often the most useful single feature.
- The ugly-duckling sign identifies a lesion that differs from the person’s background naevus pattern, even if it does not satisfy every ABCDE letter.
- Nodular melanoma may be symmetrical, uniformly coloured and initially small; use elevated, firm and growing over weeks to months as an additional warning pattern.
Key red flags
Evolution, an ugly-duckling lesion, nodular growth, bleeding, ulceration, irregular colour or shape, nail-unit pigment extending onto skin, or a weighted seven-point score of 3 or more requires urgent suspected-cancer referral.
A new elevated, firm and continuously growing papule or nodule over weeks to months can be melanoma without classic ABCD asymmetry.
Investigation priorities
Standardise urgent-referral assessment of a suspicious pigmented lesion.
Management branches
The weighted checklist scores 3 or more, dermoscopy suggests melanoma, or an ugly-duckling, nodular, acral or nail warning exists.
- Document history, measurements, morphology, patient’s comparison pattern and relevant risk factors without attempting destructive treatment.
- Make an urgent suspected-cancer referral using the local pathway and attach consented images only when secure systems and policy allow.