GP CCE Cases · dermatological-presentations
Nodular melanoma — CCE clinical encounter
CCE-style clinical encounter: a 52-year-old man attends about a 'cyst' on his shoulder — a firm pink nodule growing over ten weeks. The candidate must recognise the nodular melanoma pitfall, excise with correct margins, counsel on sunscreen evidence, and set follow-up.
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Prompt
A 52-year-old outdoor tradesman attends about a lump on his left shoulder that appeared about ten weeks ago and has grown steadily. It is firm, dome-shaped, pink — not pigmented. He wants it removed 'because it catches on his shirt strap'. He works shirtless in summer, uses no sunscreen, and has never had a skin check. His father died of melanoma.
Objectives
- Recognise the nodular melanoma pitfall — fast-growing, amelanotic, firm and raised. [8]
- Excise rather than sample or freeze; state margins and orientation correctly. [3]
- Use dermoscopy appropriately as an adjunct, not a gatekeeper. [2]
- Deliver prevention counselling grounded in the Nambour randomised trial. [1]
- Set explicit post-excision pathways by histology. [3]
References4ShowHide
- [1]Green AC, Williams GM, Logan V, Strutton GM Reduced melanoma after regular sunscreen use: randomized trial follow-up. Journal of Clinical Oncology, 2011.PMID 21135266
- [2]Vestergaard ME, Macaskill P, Holt PE, Menzies SW Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. British Journal of Dermatology, 2008.PMID 18616769
- [3]Hayes AJ, Maynard L, Coombes G, et al. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomised trial. Lancet Oncology, 2016.PMID 26790922
- [8]Betti R, Vergani R, Tolomio E, et al. Factors of delay in the diagnosis of melanoma. European Journal of Dermatology, 2003.PMID 12695136