B-QuiCK: Melanoma

B-QuiCK: Melanoma

Early detection

• Use any appropriate opportunity to examine a patient for suspicious lesions
• If a suspicious lesion is identified, determine the likelihood of melanoma:
  • Consider history of change, characteristics of the lesion including itching, bleeding or pain and symptom duration, family history and other risk factors for melanoma, e.g. age, significant exposure to sunlight, fair complexion
  • Use the ABCDEFG checklist in conjunction with dermatoscopy (using the Chaos and Clues method of pattern analysis) to examine the lesion. If dermatoscopy is not available and there is clinical concern, excise the lesion or refer the patient for further assessment.
• If the patient has a high concern lesion, check the rest of the body for other suspicious lesions
• Perform a narrow complete excisional biopsy with 2 mm margins, and sufficient depth to avoid transection at the base, on high concern lesions, or refer the patient to a dermatologist or surgeon for assessment or removal
• Monitor low concern flat lesions over three months using digital dermatoscopy and then as required. Advise patients to return if rapid changes are observed between appointments. Undiagnosed raised lesions (nodules) should be excised rather than monitored.

ABCDEFG checklist

• Asymmetry
• Border irregularity
• Colour variegation
• Different
• Evolution or elevation
• Firm
• Growing

Chaos and Clues

Check for any evidence of chaos, i.e. more than one pattern, asymmetry of colour, structure and border abruptness, and if identified, look for one or more clues to malignancy, e.g.:

• Eccentric structureless areas
• Grey or blue structures
• Large polygons
• Parallel lines on ridges (palms and soles), chaotic lines (nails)
• Segmental radial lines or pseudopods
• Peripheral black dots or clods
• Polymorphous vessels
• Thick lines that are reticular or branched
• White lines

Asymptomatic people at high risk

• Evaluate patients with a history of melanoma or other skin cancers, for melanoma risk factors, e.g. multiple naevi or actinic keratoses, to determine the most appropriate interval for while body skin examination
• Patients with ≥ 2 first-degree relatives with a history of melanoma when aged < 40 years and with a personal history of melanoma and/or multiple atypical naevi should be placed under long-term skin surveillance, ideally with a clinician experienced in dermatoscopy. A visual examination in conjunction with dermatoscopy and total body photography should occur every 12 months. Also consider referral to clinical genetics service.
• Encourage all patients at increased risk of melanoma to follow sun smart behaviours, regularly examine their skin and document any changes over time. If changes are observed or new lesions appear, advise patients to return for re-examination; emphasise that smartphone apps should not replace a skin examination by a clinician.