October 2016 | Case of the Month

The diagnosis is melanoma.

The ABCD rule can be used by health professionals and patients to check for the main warning signs of melanoma:

A = Asymmetry. The two halves of the mole look different in shape and/or colour
B = Border. Look around the edge of the mole. Melanoma will often have an irregular, jagged, notched or blurred border
C = Colour. Several different colours or shades of colour, or a single colour that is different to other moles
D = Dimensions (changing size). Melanoma can spread outwards as a flat lesion, it can grow upwards as a hard lump and some do both

The EFG rule - nodular melanoma may lack the signs referred to above, and 50% of such lesions will be hypomelanotic (ie contain very little colour, so can be pink-red or skin-coloured). As such nodular melanoma (and other skin cancers) should be considered in any skin lesion demonstrating EFG:

E = Elevation, and
F = Firmness to touch (ie hard as opposed to soft and wobbly), and
G = Growth. Persistent growth for over one month

Of course the case shown was a relatively straightforward diagnosis, but it demonstrates that we need to do much more to educate patients and medical professionals to diagnose melanoma at an early stage. Indeed I would encourage anyone reading this article to approach their CCG and ask the question how much dermatology education is being provided? The PCDS provide many educational conferences a year (see 'PCDS Events' on the homepage) that provide high-quality education at a level appropriate to GPs and other Primary Care Health Professionals. Please keep an eye out in the events section for the ED1 (Essentially Dermatology 1) days that include talks on all the common skin conditions including skin cancer, the dates for next year will be released in due course.

Please click on the following link for more information on melanoma.