Review Question - QID 210809

Color/pigment variation is one of the key physical exam findings for a melanoma lesion which is a malignant skin pathology.

Melanoma is an aggressive skin malignancy of cells of melanocytic origin. Risk factors include extensive sun exposure, fair skin, and family history. The physical exam of a melanoma lesion is ABCDE:

1. Asymmetry
2. Border irregularity
3. Color variation
4. Diameter (6 mm or greater)
5. Elevation

Any patient presenting with an exam concerning for melanoma should undergo a biopsy to confirm the diagnosis and surgical excision to remove the lesion.

Incorrect Answers:
Answer 2: Flat lesion with symmetric hyperpigmentation is not typical of melanoma, which often presents as a raised lesion (E in ABCDE for Elevation). Similarly, irregular pigmentation is more specific for a diagnosis of melanoma versus just hyperpigmentation.

Answer 3: Hyperpigmented lesion with smooth borders is not typical of melanoma, which often presents as a lesion with irregular borders (B in ABCDE for Border irregularity). This would be more likely in a benign nevus.

Answer 5: Symmetrical ovoid lesion is not typical of melanoma, which often appears as an asymmetrical lesion (A in ABCDE for Asymmetry).

Answer 4: Tenderness to palpation or surrounding erythema/purulence is more suggestive of an infectious etiology such as cellulitis or an abscess than of a malignant process.

Bullet Summary:
The classic physical exam characteristics for a melanoma lesion are ABCDE: Asymmetry, Border irregularity, Color variation, Diameter (6mm or greater), and Elevation.