What are the key clinical features to identify a suspicious mole that may indicate melanoma?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

To identify a suspicious mole that may indicate melanoma, key clinical features are assessed using the 7-point checklist or the ABCDE system ,.

  • 7-point checklist: A score of 3 or more on this checklist warrants an urgent referral via a suspected cancer pathway for an appointment within 2 weeks ,,. The presence of any major feature from this checklist is an indication for referral ,. Minor features should increase suspicion ,.
  • ABCDE system: Any features identified using the ABCDE system are also an indication for referral ,.

Other features that suggest a suspicious lesion and warrant urgent referral include:

  • Dermoscopy suggesting melanoma ,.
  • New pigmented lines in the nail, especially if associated with nail damage, or a lesion growing under the nail ,.
  • A new, persistent skin condition that is growing, pigmented, or vascular in appearance, where the diagnosis is unclear ,.
  • Any doubt about the lesion, or a history of recent change ,.
  • A pigmented or non-pigmented skin lesion that suggests nodular melanoma ,.

When assessing a lesion, important historical information includes how long it has been present, changes in size, colour, or shape, and symptoms such as itching or bleeding ,. Examination should note the lesion's location, size, elevation (flat, palpable, nodular), and description (e.g., irregular margins, irregular pigmentation, ulceration), along with any palpable lymph nodes ,.

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