Diagnosis

The clinical diagnosis of classical MM is straightforward, but early changes may be subtle. Various clinical guides have been developed such as the ABCDE rule (A = asymmetry, B = irregular border, C = irregular colour, D = diameter >5 mm and E = elevation) and the seven-point checklist which may be useful as reminders of the main features of MM on clinical examination and history. The main clinical features are of a pigmented lesion with an irregular edge and irregular pigmentation, over 95% of patients giving a history of change in size, shape or colour, and fewer than 50% describing a change in sensation or bleeding of the lesion.8,9 Dermatoscopy has gained ground as an aid to diagnosis, but training and experience are required to maximise its usefulness.10

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