Suspicious Pigmented Lesions - How to do Clinical Diagnosis

The client may or may not have noticed these themselves. Whilst trying not to worry the client by suggesting that there is anything wrong, it is our responsibility to suggest that they allow their Doctor to have a look at the lesion "just in case".

The Plastic Surgery Working Group Panel have issued guidelines for the monitoring of suspicious pigmented lesions and it would be wise for us all to be aware of them:

Clinical Diagnosis

Pigmented lesions which are suspicious are best looked at in good light, with or without magnification, and should be assessed using the 7 point check list or ABCDE systems detailed below. The presence of any major feature in the 7 point check list, or any of the features in the ABCDE system, is an indication for referral. The presence of minor features should increase suspicion. It is accepted that some melanomas will have no significant features.

The checklist lesion system

Major Features, Minor Features

Change in size of lesion, InflammationIrregular Pigmentation Itch/altered sensationIrregular border Lesion larger than othersOozing/crusting of lesion

The ABCDE checklist lesion system

A.  Geometrical ASYMMETRY in two halves
B.  An irregular BORDER.
C.  At least two different COLOURS in lesion.
D.  Maximum DIAMETER > 6mm
E.  ELEVATION of lesion

Please note that it is always unwise to inadvertently treat pigmented lesions during the course of other treatments such as tattoo removal and depilation. If moles or lesions are present, please document these and be sure to cover them with white pencil prior to beginning laser treatment.