The Medical Journal of Australia has revealed three new signs that should be taken into account when approaching the diagnosis of life-threatening melanoma. According to research from Cancer Council Australia, “approximately two in three Australians will be diagnosed with skin cancer by the time they are 70”; when new skin cancer research emerges from a country where the disease is so pervasive, we should probably listen up.
For years now, melanomas have typically been checked with the ABCD method: asymmetry, border irregularity, colour variegation, diameter of more than six millimetres (approximately 0.24 inches). However, not all melanomas will abide by these rules and some of the more irregular spots could go undiagnosed.
The Medical Journal of Australia recently published a summary of new guidelines from Cancer Council Australia, which could help health professionals spot dangerous cutaneous melanomas. These methods are fittingly called EFG, or elevated, firm and growing.
The EFG method advises, among other things, that any shape on the skin that has continued to grow for more than one month should be removed and/or referred to an expert for diagnosis.
As a result of these findings, a whole new chapter on atypical melanoma presentations will be part of the evidence-based clinical practice guidelines for the management of cutaneous melanoma. These guidelines, last published in 2008, are currently being updates by a working group from Cancer Council.
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Dr Victoria Mar, Consultant Dermatologist, co-authored the chapter with others from the Victorian Melanoma Service at the Alfred Hospital, Monash University Department of Public Health and Preventative Medicine, the Peter MacCallum Cancer Centre, the Melanoma Institute Australia, and the University of Sydney.
“Because thick, life-threatening melanomas may lack the more classical ABCD features of melanoma, a thorough history of the lesion with regard to change in morphology and growth over time is essential,” the authors write.
“Melanomas are generally distinguished from benign lesions by their history of change … Therefore, careful history-taking is important, and any lesion that continues to grow or change in size, shape, colour or elevation over a period of more than one month should have a biopsy taken and be assessed histologically or referred for expert opinion.”
The authors also recommend that “suspicious raised lesions” should be removed rather than simply monitored for change.
What do you think of these new guidelines?