Dermatology Case Studies

Clinical Assessment of a Lesion

He has attached a photograph of the mole:

Figure 8: Brown/pink, asymmetrical lesion with blurry borders

This is a mole which seems to be changing
Typical moles (melanocytic nevi) are stable and do not change over time
This mole, because it is changing, seems likely to be an atypical mole, which raises concerns and would require to be assessed by a specialist
The ABCDE rule is a system for determining whether a mole or growth may be cancerous

Click each of letters of the mnemonic to reveal the assessment:

A is for Asymmetry

A melanocytic nevus (benign mole) is usually symmetrical and the photograph shows that this mole continues to be almost symmetrical
It is the other changes which are a source of concern

B is for Border irregularity

A melanocytic nevus (benign mole) has smooth, even borders, whereas a melanoma often has irregular, blurry, or jagged edges and hard-to-define border
In this case the border is relatively smooth and would not, of itself cause concern
It is the other changes to this mole which are a cause for concern

C is for Colour variability and/or Changing colour

A typical melanocytic nevus (typical benign mole) usually has a single shade of colour or two colours with one occurring inside the other or regularly repeated (generally pink, brown, or tan)
You can clearly see that this mole has slightly irregular colouring with two dark patches and a lighter patch
This means it is an atypical mole which is concerning

D is for Different

Most people have a 'signature nevus' - all their melanocytic nevi resemble each other
A melanoma appears unique and very different from the patient's other lesions
A pigmented lesion that is obviously different from the others is sometimes called an 'ugly duckling', 'black sheep', 'lone ranger', or 'odd-mole-out' and must be considered suspicious even if it does not fulfil the ABCDE criteria
How similar this is to his other moles could be a useful question if to ask this patient for further clarification or if you are seeing him face-to-face

E is for Evolving (changing)

A melanocytic nevus (benign mole) is usually stable and does not change in size, shape, or colour
An atypical mole is one which is changing and needs to be checked by a specialist
Change in size, colour, shape, or structure may be noted over months to years
In this case the patient is telling you that this mole seems to be getting bigger, changing in colour, itching and becoming slightly crusty
All changes are a cause for concern
This mole needs to be assessed by a specialist