From the Guidelines
When evaluating a patient with possible melanoma, you should ask about the characteristics of the skin lesion using the ABCDE criteria: Asymmetry, Border, Color, Diameter, and Evolution, as well as inquire about symptoms, risk factors, and sun protection habits, as recommended by the most recent guidelines 1. To assess the likelihood of melanoma, the following questions should be asked:
- Characteristics of the skin lesion:
- Asymmetry: is the lesion irregular in shape?
- Border: are the edges irregular or poorly defined?
- Color: does it have varying colors or unusual pigmentation?
- Diameter: is it larger than 6mm?
- Evolution: has it changed in size, shape, or color over time?
- Symptoms:
- Itching
- Bleeding
- Pain
- Risk factors:
- Personal or family history of skin cancer
- Previous sunburns
- Excessive sun exposure
- Use of tanning beds
- Fair skin
- Numerous moles
- Immunocompromised status
- Timing and changes:
- When was the lesion first noticed?
- Have there been any changes since then?
- Sun protection habits:
- Use of sunscreen
- Protective clothing
- Avoidance of peak sun hours
- Previous skin examinations or biopsies:
- Have they had any previous skin exams or biopsies?
- What were the results? These questions help guide the physical examination and assess the likelihood of melanoma, which is critical for early detection and improved prognosis, as stated in the guidelines 1.
From the Research
Patient Questions for Possible Melanoma
To properly assess a patient presenting with possible melanoma, the following questions can be asked:
- What is the patient's history of sun exposure and use of protective clothing or sunscreen 2?
- Does the patient have a personal or family history of melanoma 2?
- What is the patient's Fitzpatrick skin type 2?
- Has the patient noticed any changes in the size, shape, or color of a mole or lesion 2?
- Has the patient experienced any symptoms such as itching, bleeding, or pain in the affected area 3?
- What is the patient's history of indoor tanning 2?
- Has the patient had any previous biopsies or removal of suspicious lesions 3?
- What is the patient's age and overall health status 2, 4?
- Has the patient noticed any other suspicious lesions or moles on their body 2?
- Is the patient aware of the ABCDE mnemonic and ugly duckling sign for identifying suspicious lesions 2?
Additional Questions for Diagnosis and Treatment
To further aid in diagnosis and treatment, the following questions can be asked:
- Is the patient a candidate for wide local excision or other surgical procedures 2, 3?
- Has the patient had any previous treatments for melanoma, such as immunotherapy or targeted therapy 4, 5, 6?
- What are the patient's expectations and concerns regarding treatment and prognosis 2, 3?
- Is the patient aware of the importance of follow-up care and surveillance for recurrence 2, 3?