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Melanoma — MCCQE Part 1 MCQ

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ModerateSkin LesionMelanomaMCCQE Part 1

54-year-old woman presents with changing pigmented lesion. It is asymmetric with irregular border, colour variation and recent growth. Which of the following is the most appropriate next step?

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Correct answer: B — Arrange urgent excisional biopsy with appropriate margins

Arrange urgent excisional biopsy with appropriate margins is best because ABCDE features suggest melanoma. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Do not shave-biopsy a suspicious melanoma when excision is feasible.

Reference: Canadian Dermatology Association melanoma guidance