How can I differentiate between melanoma and benign skin lesions during a routine examination?

During a routine clinical examination in General Practice, differentiating between melanoma and benign skin lesions primarily involves using established assessment tools and identifying suspicious features.

• Assessment Tools:
• The 7-point checklist is recommended by NICE for assessing pigmented lesions ¹,². People with a score of 3 or more on this checklist should be referred urgently using a suspected cancer pathway for an appointment within 2 weeks ¹,²,⁴.
• The ABCDE system can also be used to assess pigmented lesions ¹,². The presence of any major feature in the 7-point checklist or any features of the ABCDE system is an indication for referral ¹,².
• Suspicious Features and Referral Criteria:
• An urgent referral via a suspected cancer pathway (for an appointment within 2 weeks) is indicated if a suspicious pigmented lesion has a weighted 7-point checklist score of 3 or more ¹,²,⁴.
• Dermoscopy suggesting melanoma also warrants an urgent referral ¹,². While dermoscopy is primarily used in secondary or tertiary care by trained professionals, its findings are critical for diagnosis ³.
• Nail changes, such as a new pigmented line in the nail (especially if associated with damage) or a lesion growing under the nail, are concerning signs ¹,².
• A new persistent skin condition, particularly if it is growing, pigmented, or vascular in appearance and the diagnosis is unclear, should raise suspicion ¹,².
• Any doubt about the lesion or a history of recent change necessitates an urgent referral ¹,².
• A pigmented or non-pigmented skin lesion that suggests nodular melanoma should also prompt consideration for a suspected cancer pathway referral ¹,²,⁴.
• Important Note for Primary Care:
• If a lesion is suspected to be melanoma, an urgent referral to a dermatologist or other suitable specialist with experience in melanoma diagnosis should be made, and excision in primary care should be avoided ¹,².