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No guidelines for patients examining pigmented lesions

Patients need a simple check-list to allow them to pick out a potential melanoma from among their other pigmented lesions. In an attempt to construct one, we have determined a layman's view of the incidence of the more obvious clinical features found in melanomas, non-melanoma skin cancer and benign lesions by asking 1395 consecutive patients attending our Pigmented Lesion Clinic to complete a questiormaire. Each patient stated if the lesion that had prompted the referral from their general practitioner was the largest on their body or if it had recently grown, changed colour, itched, hurt, scabbed or bled. In addition, they graded their current level of anxiety on a scale from o to 4 and recorded whether or not they thought the lesion was a skin cancer. The data were collected in the year following the 1987 public education campaign about melanomas. In the patients' opinion, none of the above features were more common in the 43 histologically proven melanomas than in either the 48 non-melanoma skin cancers or 1304 benign lesions. Of the 43 patients with melanoma, six thought that their lesion had none of the above features, 19 recorded one feature, 10 recorded two features, seven recorded three features and one recorded six features. There was a significant association between both the patients' level of anxiety and their belief that they had a skin cancer and the number of features they recorded. The results suggest that these clinical features cannot be used by the layman to differentiate between melanomas and benign pigmented lesions. If they had been relied upon, some melanomas would have been ignored. More research is needed to determine if other features might be more discriminatory or if better public education is needed to help patients detect the diagnostic signs used by trained observers.