Early detection of melanoma in daily dermatological practice
We invite you to participate in the Dermatology Days in Sibiu from October 30th to November 1st, where we will have a very interesting presentation by our guest from Slovenia.
Medical doctors as well as many especially younger dermatologists, often feel unsure about the diagnosis of pigment changes on the skin. They are afraid of missing melanoma.
The importance of early detection of skin melanoma cannot be overstated. When melanoma is found and treated early, the chances for long-term survival are excellent. Five-year survival rates for patients with early–stage melanoma exceed 90–95%. As melanoma progresses, it becomes increasingly more devastating and deadly. It is important that a medical doctor is able to detect suspicious lesion or early melanoma.
The main question and challange is, how can a dermatologist, who is not working in daily rutine with melanocitic nevi and melanoma patients, in the short time that he/she has for inspection, not overlook suspicious nevus, or melanoma?
Our opinion is that the basis of early diagnosis remains clinical examination of moles, where we follow the rule A (asymmetry), B (borders), C (colour), D (diameter /different) and E (evolution). New criteria are F (firm) and G (growing). If we find three of the five (seven) mentioned criteria, it is necessary to excise the lesion, or at list to sent patient to a center of excellence. In recent years, special attention is paid to the evolution, which means that patients where the history of changing, increasing or new-onset of pigmented lesion is positive, need controls at 3-6 months,
The gold standard is nowadays in daily dermatological practice, also dermoscopic examination of pigmented lesions. Dermoscopy is a modern non-invasive technique. It increases the precision and the distinguishing benign from malignant cutaneus neoplasms. Dermascopic diagnosis is based on a combination of criteria and in the last years developed algorithms. This method introduces a new dimension of the morphology and clinical dermatology. It can be time consuming and usually helps only when observers experience is high.
The simplest algorithm, suitable for daily routine also for not dermatooncological subspecialised colleges is probably the so-called 3 point – checklist. Suspicious dermoscopic criteria are, asymmetry, atypical pigmented network and blue-white structures.
Understanding principles of clinical examination and basics of dermoscopy /example:3-point checklist/ can help to general dermatologist, to rise self-confidence and to improve diagnostic of early melanoma.
Igor Bartenjev,
Medical faculty University Ljubljana /Dermatologija Bartenjev, Ljubljana, Slovenia