Melanoma — SCE Dermatology MCQ

Correct answer: C — Evolution (change over time)

The correct answer is C, Evolution (change over time). In the ABCDE mnemonic for assessing pigmented lesions, Evolution refers to any change in a mole's size, shape, colour, surface, or symptoms (such as bleeding or itching), and this is regarded as the most sensitive single feature for detecting melanoma, particularly in lesions that may not yet fulfil the other criteria. UK guidance on recognising melanoma emphasises that a new mole or an existing one that is growing, changing colour, or becoming irregular is the first sign that should prompt urgent assessment. This is why history of change, obtained directly from the patient or by serial photography, carries such weight in triage and referral decisions on the two week wait pathway. Why the other options are wrong: B. Erythema: redness is not part of the ABCDE system; it is a feature more relevant to inflammatory or infected lesions, not the pigmented lesion assessment tool. D. Exophytic growth: this describes a lesion growing outward from the skin surface, a morphological descriptor used in general lesion assessment, but it does not correspond to any letter in ABCDE. E. Edge irregularity: this concept is already captured by B (Border irregularity) in the mnemonic, not E, so including it under E would duplicate a criterion. A. Elevation: raised surface can be a feature noted on examination but is not the standardised E criterion; it is sometimes mentioned informally but is not the accepted definition taught in UK melanoma recognition guidance. Key point: E in ABCDE stands for Evolution, meaning any change in size, shape, colour or symptoms, and is the criterion most likely to prompt urgent melanoma referral even when other features are borderline.

Reference: NHS, Melanoma skin cancer: Symptoms (ABCDE checklist for moles), nhs.uk; Royal Marsden NHS Foundation Trust, Skin cancer diagnosis, https://www.royalmarsden.nhs.uk/information-gps/gp-resources/skin-cancer/skin-cancer-diagnosis