GPs have role in early detection of melanoma

Melanoma is rare in childhood, but from the teens onwards, the incidence steadily rises with age. Exposure to ultraviolet light radiation is the main risk factor for developing melanoma. The first sign of a melanoma is usually an unusual looking freckle or mole. It may have a variety of colours including tan, dark brown, black, blue, red, light grey, or occasionally may lack pigment. Some melanomas are itchy or tender, and more advanced lesions may bleed easily or crust over. The British Association of Dermatologists suggests referring: a new mole appearing after the onset of puberty, or a long-standing mole, which is changing shape, colour or size; any mole which has three or more colours or has lost its symmetry; a mole which is itching or bleeding; or any new persistent skin lesion especially if it is growing, pigmented or vascular in appearance, and if the diagnosis is not clear. A new pigmented line in a nail, especially where there is associated damage to the nail, or a lesion growing under a nail should also be referred. Lesions which have a high index of suspicion for melanoma should not be removed in primary care. Patients should be referred urgently to secondary care with a history recording the duration of the lesion, change in size, colour, shape and symptoms.