Melanoma picked up on skin check

A patient being followed up for a melanoma several years earlier was found to have this small lesion on their back. It was new as far as the skin checker was concerned, but they weren’t aware of it.

Not very impressive, but new and with asymmetrical colours. ‘Pink and brown, make you frown.’ as the Australian skin cancer expert GPs say.

Dermoscopy is essential.

Dermoscopy accentuates the asymmetry, and reveals an atypical network with some thickening of the reticular lines.. Also, there is an asymmetrically located pink area with faint but visible pink dots. These represent dotted vessels, which are a sign of melanocytic lesion.

Using the first step of the 2 step algorithm, we ask ‘Is this melanocytic?‘ Yes, because we see reticular network and dotted vessels (both pointers to a melanocytic lesion, whether benign or malignant.)

We then move to the next step of the 2 step algorithm ‘Could it be a melanoma?‘ (or, to ask the same question a different way) ‘Can I be confident it is benign?’ The answer is a definite NO! because it is a new lesion in a high risk patient (*), is asymmetrical of colour, and there is chaos and thickened lines reticular on dermoscopy.

Histology confirmed a thin melanoma, thin enough for a 99.5% guarantee of a cure.

It is quite possible that a skilled check up saved this person’s life. They did not know it was there and it could have grown for maybe a year before starting to bleed, by which time it would have been much thicker and possibly spread.

Argument continues about the cost effectiveness and otherwise appropriateness of regular skin checks, but the US dermatology body advises annual checks for all adults (probably this is very cost effective for private dermatologists!!!) and in Australia 6 monthly checks for life are advised for all people who have had a melanoma. What is not in doubt is that melanomas detected on skilled skin checks tend to be thinner than those detected by the patient, and thicker melanomas are more likely to be fatal.

(*) Patients who have had a melanoma have an increased life long risk of getting another one or more, at least 8% over the next 5 years according to one study I have read. The risk factors (skin genetics, sun exposure) that led to the first melanoma continue to exist. One Italian study found that such patients’ melanomas were much thinner when discovered by routine skin checks that if the patient was discharged and left to their own devices.