A changing pigmented lesion on the back

Superficial spreading melanoma, Breslow 0.6 mm, non-ulcerated (pT1a)

Learning points

• The weighted 7-point checklist: change in size, shape and colour are major features; diameter ≥ 7 mm, inflammation, oozing and change in sensation are minor.
• Narrow-margin excisional biopsy is the UK standard for suspicious pigmented lesions. Avoid shave biopsy.
• AJCC 8 pT1a: Breslow < 0.8 mm, non-ulcerated. Stage IA. WLE with 1 cm margin per NICE NG14. No routine imaging.
• No SLNB is offered for stage IA melanoma; NG14 says to consider SLNB (as a staging procedure) for Breslow >0.8 mm with other high-risk features, or Breslow >1.0 mm, after shared discussion.