Review Question - QID 106242

The patient in this question stem is likely concerned about malignant melanoma. Of the major monitoring criteria for melanoma lesions, multicolored or multishade (i.e. multicolored lesions) pigment is of significant concern.

Melanoma is a skin malignancy well known for its metastatic potential and high mortality rate once it becomes metastatic. Patients should be aware of the ABCDE skin surveillance criteria for concerning lesions: (1) Asymmetry, (2) Border, (3) Color, (4) Dimension, and (5) Evolution. Of the answer choices listed above, solid black coloration is least concerning for melanoma.

Shenenberger reports that cutaneous malignant melanoma accounts for up to 5% of all skin cancers but 75% of all skin cancer deaths. Persons with an increased number of moles, atypical or dysplastic nevi, or a family history of the disease are at increased risk compared with the general population. The authors presents the ABCDE mnemonic as an important tool to assist in the evaluation of potential melanomas for patients and health care professionals.

Tseng and Martinez report that lesion location has an impact on survival. A review of over 27,000 cases in the SEER database, showed that the 10-year rates of overall survival (OS) and and melanoma specific survival (MSS) were 56.1% and 84.7%, respectively. On multivariate analysis, they observed scalp/neck primary site to be associated with an increased risk of overall (HR 1.20, CI 1.14-1.26; p < 0.001) and melanoma-specific mortality (HR 1.64, CI 1.49-1.80, p < 0.001) relative to melanomas of the face. Tumors of the lip had poorer MSS (HR 1.55; CI 1.05-2.28, p = 0.03) but not OS (HR 1.03, CI 0.80-1.34; p = 0.80).

Illustration A: Provides a visual comparison of the ABCD criteria for melanoma surveillance compared to benign lesions.

Incorrect Responses:
Answer 1: Lesions with asymmetric shape are more concerning for malignancy that those with symmetry such as circle- or oval-shaped lesions.
Answer 2: Smooth borders are a better prognostic sign than irregular borders on skin lesions.
Answer 3: Fast-growing lesions are more concerning for malignancy than slow-growing lesions.
Answer 5: New onset pruritis and bleeding from a skin lesion meets the "Evolution" criteria for the ABCDE surveillance mnemonic and would be concerning for malignant changes.