The seven point melanoma checklist.

There is no single feature that is a reliable guide in the recognition of Malignant Melanoma.

• Itch
• Size
• Increasing size
• Shape
• Colour variation
• Inflammation
• Crusting or bleeding

Itch.  

This is the only common symptom. Early melanomas are not painful.

Size. 

Most early melanomas have reached a diameter of around 1.0cm before they are recognised. Most benign pigmented moles are 1cm or less in diameter.

Increasing size. 

A growing pigmented lesion in a patient over 35yrs is likely to be a malignant melanoma. Benign pigmented moles in adults over the age of 35yrs do not grow.

Shape. 

Most melanomas have a very irregular outline and there is sometimes a very definite notch on the edge.

Colour variation. 

Most malignant melanomas show a lot of pigment variation and speckling. This patch look is usually brown, but may be red due to inflammation. There may be a blue/white tinge in the centre of the lesion. This is the ‘red white blue’ pigmentation not seen in benign moles.

Inflammation. 

Many early melanomas have a red inflammatory flare around the edge.

Crusting or bleeding. 

Slight oozing causing crusting is very common in early malignant melanomas. This can cause clothing to stick.

If four or more of these seven points are present, the diagnosis is positive in 90% of cases. The other 10% are mainly dysplastic naevi which may have a predisposition to transform into malignant melanomas.

If two or fewer points are present the diagnosis is almost certainly not malignant melanoma.

If the score is three or more a specialist opinion should be sought.