Diagnosis

By Mia Wangsmo Steffenssen MD, Mike Mikkelsen Lorenzen, MD and Pia Sjøgren MD

The ugly duckling ‘concept’ may help to identify melanomas. Benign nevi tend to resemble one another and melanomas often do not fit the individual’s naevus pattern.

Dermoscopy by an experienced physician enhances the clinical accuracy in diagnosing melanomas. (Dermoscopy chapter under development).

However, the diagnosis is based on a full-thickness excisional biopsy, processed by an experienced pathology institute.

Prognostic factors

Breslow thickness – most important prognostic factor!

Ulceration

Thick melanoma: ≥ 4 mm

Moderate melanoma: 1-4 mm

Thin melanoma: ≤ 1 mm

Dermal mitoses

Morphologic type of melanoma

Sex

Age

ABCDE Rule

Asymmetry. Drawing a line through, where it does not make a mirror reflection.

Border. Irregular borders that are difficult to define.

Color. The presence of more than one color (blue, black, red, brown), uneven distribution of color.

Diameter. Greater than 6 mm in diameter.

Evolving. Recent changes in color/size. Bleeding, itching.