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Amelanotic Melanoma Mimic — SCE Dermatology MCQ

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HardSkin CancerAmelanotic Melanoma MimicSCE Dermatology

A rapidly enlarging friable red nodule on a finger bleeds repeatedly. Dermoscopy shows milky-red areas, white structureless zones and polymorphous vessels; pigment is absent. Pyogenic granuloma and amelanotic melanoma remain clinically indistinguishable. What should be arranged?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Urgent specialist assessment and complete excision biopsy for histology where feasible

Explanation lettering: B = shown as A · C = shown as B · A = shown as C

B is correct. Amelanotic melanoma can closely mimic pyogenic granuloma, particularly when a rapidly growing bleeding nodule contains atypical or polymorphous vessels. Absence of pigment does not reassure. A suspected melanoma normally requires urgent pathway assessment and complete full-thickness excision biopsy with a narrow clinical margin where anatomically feasible, preserving architecture and Breslow measurement. Destructive treatment without histology risks erasing the diagnosis; response of surface inflammation to antibiotics cannot exclude malignancy; superficial partial sampling may underestimate depth; and observation is unsafe for a rapidly changing nodular lesion. Histology is required because the clinical label remains uncertain, not because every uncomplicated pyogenic granuloma must automatically undergo identical surgery.

Reference: NICE HTG388 melanoma diagnostic practice: https://www.nice.org.uk/guidance/htg388/chapter/3-Clinical-need-and-practice