Documentation of Suspected Melanoma in Primary Care

Rationale for Appropriate Documentation

The British Journal of Dermatology recommends documenting lesions as "lesion suspicious for melanoma" or "pigmented lesion concerning for possible melanoma" pending specialist evaluation and histopathological confirmation 1, 2
Melanoma diagnosis requires histopathological confirmation, which can only be established after full-thickness excisional biopsy with pathological examination that includes Breslow thickness, Clark level, ulceration status, and surgical margin assessment 1, 3, 4
Clinical assessment alone has limited accuracy, with even experienced clinicians achieving diagnostic accuracy of only approximately 85% based on clinical examination alone, meaning 15% of clinically suspected melanomas are benign lesions 5, 6

The British Journal of Dermatology suggests using descriptive terminology that conveys clinical suspicion without premature diagnosis, such as "Pigmented lesion suspicious for melanoma" or "Atypical pigmented lesion concerning for possible malignant melanoma" 1, 3
Documenting specific concerning features, such as major signs (change in size, change in shape, change in color, diameter ≥7 mm) and minor signs (inflammation, sensory change, crusting or bleeding), is recommended 5, 6, 7

The British Journal of Dermatology recommends referring patients urgently to a dermatologist or surgeon/plastic surgeon with expertise in pigmented lesions, with systems enabling the patient to be seen within 2 weeks of receipt of the referral letter 1, 2, 3
Clearly stating in the referral letter which specific features prompted the referral and the patient's degree of concern is essential 5, 6

The British Journal of Dermatology advises against performing shave or punch biopsies, as they make pathological staging impossible and are not recommended for suspected melanoma 1, 2
Incisional biopsies are also not recommended, and attempts at excision should only be made by specialists who can perform full-thickness excision with 2-5 mm margins and subcutaneous fat 1, 2, 3

Avoid using definitive diagnostic terminology ("melanoma," "malignant melanoma") before histopathological confirmation, as recommended by the British Journal of Dermatology and Praxis Medical Insights 1, 2, 3, 4
Delaying referral while waiting for additional testing or photography should be avoided, as urgent specialist evaluation takes priority 1, 2, 3
Reassuring the patient that it's "probably nothing" should be avoided, even if trying to reduce anxiety, and instead maintain appropriate clinical concern while explaining the need for specialist evaluation, as suggested by the BMJ 5, 6