Intended for healthcare professionals

Practice 10-Minute Consultation

Pigmented skin lesions

BMJ 2024; 385 doi: (Published 10 June 2024) Cite this as: BMJ 2024;385:e077845
  1. Richard Barlow, dermatology registrar, patient with xeroderma pigmentosum12,
  2. Ali Shah, general practitioner3,
  3. Padma Mohandas, consultant dermatologist3
  1. 1Birmingham Queen Elizabeth Hospital, Birmingham, UK
  2. 2Patient author
  3. 3Whipps Cross Hospital, London
  1. Correspondence to P Mohandas pmohandas{at}

This is part of a series of occasional articles on common problems in primary care. The BMJ welcomes contributions from GPs.

What you need to know

  • Pigmentation may arise from different structures and cells within the skin, including melanin, keratin, and vasculature, and can be categorised by typical colouration and texture

  • Using the ABCDE rule can help diagnose melanoma

  • When using dermoscopy, look for specific patterns and features that may suggest whether a lesion is benign or malignant

A 74 year old white man with fair skin that burns and tans easily has a pigmented lesion on the upper back that his partner noticed three months ago. It is slowly enlarging. The man is retired from office work. He grew up in Africa, and historically enjoyed a lot of outdoor activities. He has no family history of melanoma. Examining the entirety of the back, the lesion stands out compared with his other lesions, most of which appear as stuck on, and have macroscopic crumbly keratotic cerebriform surfaces. The lesion in question has no associated tenderness or induration. It is raised with an irregular border and asymmetry of colour.

Dermatological presentations account for about a quarter of primary care consultations in the UK,1 with concerns about pigmented lesions and skin cancer comprising a large proportion. As a result, specialist dermatology services in the UK receive more than one million new referrals each year, about 50% of which relate to pigmented skin lesions2 (box 1). About 6% of patients with a pigmented skin lesion are diagnosed subsequently with melanoma or squamous cell carcinoma via urgent skin cancer referral pathways.6

Box 1

Global epidemiology of skin cancer

In the UK, dermatology specialist services receive more referrals via specialised urgent skin cancer target pathways than any other specialty. This is partly explained by skin cancer being the commonest cancer in the UK.3 …

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