Solitary, mole-like lesion that has changed in colour and shape The most important differential diagnostic criteria for distinguishing malignant melanoma from seborrheic keratosis and atypical pigmented naevus Seborrheic keratoses versus malignant melanoma If they are not, the patient must be referred with a clear and unambiguously formulated reference to a dermatologist or surgeon, who should see the patient within two weeks at the latest (9).
These are procedures that all GPs be competent in.
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If a doctor suspects, or cannot exclude the possibility of a diagnosis of malignant melanoma, the lesion should be excised in its entirety with at least 2 mm free margin, either with a punch (Video 2) or by means of an elliptical excision (Video 3). These signs can be compiled into the ABCDE rule (7)Īsymmetry (two parts of the mole have different shapes)Ĭolour (colour variation, often with black parts in the mole)Įvolving (the mole grows, or changes in some other way as described in the points above) There are a number of signs that may distinguish a malignant melanoma from a benign pigmented naevus. If the lesion is larger than 6 mm, an ordinary, elliptical excision should be preferred (Video 3). A histological examination will determine the diagnosis. The lesion should be excised with a free margin. Removal of small pigmented naevi, including atypical pigmented naevi, can be performed with the aid of a knife with a circular blade (Video 2). Because it may be difficult to distinguish an atypical pigmented naevus from a malignant melanoma, excisions should be performed in cases of doubt to obtain a definite diagnosis. These lesions are an indicator of a skin type that is prone to developing malignant melanoma, rather than a precursor to melanoma in themselves (2).ĭermatoscopy can be an aid in diagnosis, but requires both training and experience, which most GPs do not have (4). Persons with five or more atypical pigmented naevi have a five to ten times higher risk of developing cutaneous malignant melanoma than persons without them (3). They always have a macular (flat) component (2). Pigmented naevi with a diameter of > 5mm, irregular shape and varying colour are described in the dermatological literature as atypical or dysplastic pigmented naevi.
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