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

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

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 ,. 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 ,,.
    • The ABCDE system can also be used to assess pigmented lesions ,. The presence of any major feature in the 7-point checklist or any features of the ABCDE system is an indication for referral ,.
  • 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 ,,.
    • Dermoscopy suggesting melanoma also warrants an urgent referral ,. While dermoscopy is primarily used in secondary or tertiary care by trained professionals, its findings are critical for diagnosis .
    • 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 ,.
    • A new persistent skin condition, particularly if it is growing, pigmented, or vascular in appearance and the diagnosis is unclear, should raise suspicion ,.
    • Any doubt about the lesion or a history of recent change necessitates an urgent referral ,.
    • A pigmented or non-pigmented skin lesion that suggests nodular melanoma should also prompt consideration for a suspected cancer pathway referral ,,.
  • 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 ,.

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Educational content only. Always verify information and use clinical judgement.