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melanoma clinic below knee examination

Book in for an appointment that may aid in the early identification of leg and foot melanoma – using dermoscopy

If you are of European decent you are likely to get some form of skin cancer in your lifetime. Darker skinned people however have a tendency to develop a type of melanoma on the foot which is often overlooked.

Melanoma is a form of cancer. The term ‘cancer’ itself refers to abnormal proliferation of cells resulting in a tumour (lump) which can start in your skin. Melanocytes that produce skin pigment are often the offenders where malfunctioning melanocytes rapidly divide and multiply and spread to other parts of the body – this is a dangerous and often fatal process called metastasis. Melanomas are rare but the most dangerous form of skin cancer if detected at a late stage. Early detection is greatly increases survival rate which is 98% whereas those with late stage melanoma face a bleak prognosis.

When thinking if your mole is a melanoma think of the following rule. 


What are the ABCDE’s of Melanoma? 

This well used mnemonic in skin assessment is used to analyse moles and check for warning signs that may indicate melanoma.

Asymmetry: An indicator of ‘unfitness’ where the shape of one half does not match the other.

Border: The edges are often ragged, notched, blurred, or irregular in outline; the pigment may spread into the surrounding skin. If the edges are uneven they need to be checked

Colour: Can distinguish a normal mole from an abnormal one. The colour may be uneven and include shades of black, brown, or tan. Areas of white, grey, red, pink, and blue may also be seen. The more colours the greater the suspicion there may be a melanoma so this needs to be checked.

Diameter: In general if a mole is larger than 6mm it is a warning sign. This is about the size of a rubber on the end of a pencil. That said even if a mole is smaller than this it can still be dangerous.

Evolution: While it is important to note changes in regard size, shape, colour, or features is also wise to look for other changes as the mole evolves. This includes symptoms such as itching, tenderness, or bleeding or if it is evolving in any other way over time. This is why it is important to get them looked at.

Another E but this is for the EFG rule

Think the EFG rule as way to remember another type of melanoma that can be life-threatening. This is the rapidly growing type of melanoma known as a nodular melanoma, which represents about 20% of all cases of melanoma. This type of melanoma ‘pleases itself’ as to its personal appearance as the look of it does not neatly ‘fit’ to the ABCDE rule and ca as a result not be identified which means delays in care may occur which can be fatal. Using the EFG rule Nodular melanoma usually have all three of the below criteria:  

Elevated, Firm, Growing:  The moles don’t need to be dark or have any other colour to them, but the key giveaway is that they are raised, often very symmetrical, are firm to touch, and most importantly are changing/growing progressively. In the early stages, this change might just be a sense of change rather than visible – perhaps the mole is itchy, or just feels funny. This type of melanoma can affect anyone, but is generally much more common in men over 50. The concerning thing about nodular melanoma is that because they are growing fast, they can go deep very quickly (within a few months), which is why they are so dangerous and need early diagnosis and removal.

Nail pigmentation: The dermatoscope used to assess the skin can also be useful for assessing nail pigmentation as melanocytes can cause problems here too.

Subungal melanoma may be suspected clinically because of a wide (> 3 mm) new or changing pigment band in a single nail. Dermatoscope examination may reveal more details showing pigmented lines of varying colour, width and spacing. These lines tend to lose their usual tendency to run parallel to each other along the length of the nail. Subungal melanoma forms a non-pigmented lump under the nail plate, eventually resulting in its destruction.

Why is it important to get your lower limbs checked?


Feet and the shins and feet are exposed to sunlight and this is what can cause skin changes over time such that they become life-threatening. 

The main factor associated with risk of melanoma being present is that they can spread (metastasise). Delay in diagnosis is common with melanoma, particularly when it affects the toes. Some of these tumours may have already spread by the time they are diagnosed.

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