Images of early malignant melanomas to show major features: irregular pigmentation and irregular borders. The 7PCL was revised in 1989 to identify three major signs (change in size, shape and/or colour) and four minor signs (inflammation, crusting/bleeding, sensory change, diameter ≥7 mm) for suspected malignant melanoma the scoring was weighted (2 for major, 1 for minor signs), and again, any lesion scoring ≥3 warranting referral, 7, 8 ( Box 1 and Figure 1). 6 The checklist was adopted and widely disseminated by the Cancer Research Campaign to raise public awareness, but there were concerns that it under-identified early and nodular melanomas and over-identified certain benign lesions such as seborrhoeic keratoses. 5 The 7-point checklist (7PCL) was developed in Glasgow in the 1980s as guidance to help non-dermatologists (GPs and patients) detect features indicating possible melanoma, with the advice that each feature should score 1 and lesions with scores of ≥3 should be referred for specialist opinion (Original 7PCL). The majority of melanomas arise from pre-existing lesions, whereas some melanomas arise spontaneously patients and their GPs need to be able to distinguish these ‘normal’ changes from ‘abnormal’ changes that may indicate melanoma.ĭiagnostic aids are increasingly used in primary care for a variety of conditions. 4 A pigmented skin lesion is extremely common, with most people having between five and 20 which may vary in size, shape and colour, and an increase in number is associated with age, fair skin, and sunlight exposure. 3 Patients frequently present to their GPs with concerns about pigmented skin lesions (melanocytic naevus, ‘mole’) but few will be diagnosed as melanoma: even among higher risk groups such as males aged >60 years, less than 1 in 33 000 pigmented skin lesions are estimated to become malignant. 2 Distinguishing melanoma from other pigmented skin lesions in general practice can be challenging. 1 Melanoma is an important cause of mortality in the UK where there were 11 870 new cases and 2203 deaths in 2010. The thickness of a melanoma at diagnosis is a key determinant of patient outcome, therefore early detection and timely referral are crucial steps in the appropriate management of this skin malignancy.
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