Characteristic Clinical Features of Melanoma in Patients With Excised Skin Lesions

The aim of this study was to assess the risk of melanoma in patients with excised skin lesions (ESLs) considering their clinical features.

A total of 126 cases of ESLs were collected between December 2021 and April 2025. The clinical features of 109 benign skin lesions (BSLs), 10 non-nodular melanomas (NNMs), and seven nodular melanomas (NMs) were analyzed according to the ABCDE criteria, the ABCDE-EFG method, and the 7-point checklist (7-PCL) scale.

In univariate analysis, compared to BSLs, NNMs presented more common irregular borders (p=0.029), color variegation (p=0.015), diameter greater than 6 mm (p=0.031), evolution in size, shape or color within six months (p=0.005), rapid growth within six weeks/atypical skin lesion de novo (p=0.019). NMs, compared to BSLs, were more likely to show evolution in size, shape or color within six months (p=0.003), elevation (p=0.003), firm to touch (p<0.001), and rapid growth within six weeks/atypical skin lesion de novo (p<0.001). In the Firth's penalized logistic regression, rapid growth within six weeks/atypical skin lesion de novo was significantly more frequent in NNMs compared to BSLs [odds ratio (OR)=31.36, 95% confidence interval (CI)=1.42-11350.06, p=0.028], and in both NNMs and NMs compared to BSLs (OR=27.32, 95% CI=3.64-540.48, p<0.001). Color variegation (OR=25.06, 95% CI=2.80-681.62, p=0.002) and evolution in size, shape or color within six months (OR=6.02, 95% CI=1.21-55.19, p=0.027) were also found to be significant in differentiating for both NNMs and NMs compared to BSLs. However, in multivariate analysis, for NMs alone, no clinical features were significantly more frequent compared to BSLs.

The most important clinical features increasing the risk of melanoma were rapid growth within six weeks/atypical skin lesion de novo, color variegation and evolution in size, shape or color within six months, but not for NMs cases alone in the Firth's penalized logistic regression.