The Fitzpatrick skin phototype scale is helpful in determining how susceptible a person is to ultraviolet mediated damage, and therefore, their risk for skin cancer. There are six phototypes, as follows: - Type I: always burns, never tans (pale white; blond or red hair; blue eyes; freckles) - Type II: usually burns, tans minimally (white; fair; blond or red hair; blue, green, or hazel eyes) - Type III: sometimes burns mildly, tans uniformly (cream white; fair with any hair or eye color) - Type IV: burns minimally, always tans well (moderate brown) - Type V: very rarely burns, tans very easily (dark brown) - Type VI: never burns, never tans (deeply pigmented dark brown to darkest brown)
The ABCDE criteria for the evaluation of pigmented skin lesions are a useful tool for the early detection of cutaneous melanoma; they are as follows: - Asymmetry - Border irregularity - Color variegation - Diameter (>6 mm) - Evolution
Melanoma in situ is an early, non-invasive form of melanoma in which the tumor is confined to the epidermis. Wide local excision with a margin of 5 to 10 mm is generally sufficient. If the initial excision biopsy was performed with a margin of 1 to 3 mm, current guidelines recommend re-excision for at least 5mm around the original lesion. Following excision, the life expectancy of these patients does not differ from that of the general population.
The Glasgow weighted 7-point checklist (7PCL) is a tool to help general practitioners and patients identify skin lesions that might be a melanoma; this classifies signs into "major" and "minor" features, as follows: Major features (2 points for each present): - Change in size - Irregular colour - Irregular border Minor features (1 point for each present): - Diameter >7 mm - Inflammation - Oozing or crusting - Itching or a change in sensation A total score of 3 points or more should prompt referral to a dermatologist for further evaluation. Note that the 7PCL is more often used in the United Kingdom, as compared to the ABCDE rule, which is more popular in North America and Australia.
The ugly duckling sign is a useful screening tool for cutaneous melanoma. This is based on the general principle that in the same individual, non-malignant skin moles usually tend to resemble each other; melanomas deviate from this pattern. Note that this rule and the ABCDE criteria are complementary to each other and should be applied together.