How do malignant melanomas present and does this correlate with the seven-point check-list?
A pigmented-lesion clinic was established in the skin department at King's College Hospital to coincide with the British public-education campaign on malignant melanoma. One-hundred cases of malignant melanoma have subsequently been seen and evaluated prospectively with regard to the usefulness of the Glasgow seven-point check-list as a guide to diagnosis. The most-frequently reported patient observations were growth of the lesion (74%) and change in its colour (53%) (especially darkening). However, 50% of the lesions were smaller in size than the 1 cm referred to in the check list and 15% were less than 0.5 cm. Itching was noted in 24% and bleeding and crusting were remarked upon in 18% of cases. Abnormal shape was noted in 20% of the patients. Inflammation was visible in only 11%. Seventy-three per cent of our patients had early lesions (less than 1.5 mm Breslow thickness) and nearly half presented at the insistence of their relatives or friends or because of the family doctor's incidental diagnosis. They stated they would not otherwise have attended the hospital and many had noticed nothing untoward even on direct questioning. Half of the patients scored less than three on the check list and 10 out of the 22 cases of nodular melanoma might not therefore have been referred to our clinic. The check list has subsequently been revised and now provides a more-sensitive guide.
du Vivier
A W
AW
Department of Dermatology, King's College Hospital, London, UK.
Williams
H C
HC
Brett
J V
JV
Higgins
E M
EM
D000328:Adult; D003880:Dermatology / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology