Dermatology Assessment Report

Dermatology — Pigmented Lesion ABCDE Analysis

Report ID: MAA-DRM-9E2B71
Generated: May 30, 2026
Analysis: AI-Powered Image Interpretation

Patient Profile

Sex / Age:
Female, 41 years
Skin type (Fitzpatrick):
Type II — fair skin, often burns, occasionally tans
Lesion location:
Mid-back, right scapular region
Reported change:
Lesion present "as long as I can remember", but the patient noticed it has darkened and grown over the past 4 months. Occasional itch.
Risk factors:
Childhood blistering sunburn (×2), 30+ benign nevi total, family history of melanoma (paternal aunt at 50)
Image:
Standardized clinical photograph with ruler reference

Summary Overview

Pigmented melanocytic lesion on the mid-back demonstrating multiple ABCDE features of concern: asymmetry, irregular border, color variegation, diameter 8 mm, and reported evolution. The combination of features and the patient's reported recent change classifies this as a clinically suspicious lesion warranting excisional biopsy for histopathology.

5/5
ABCDE Features
8 mm
Diameter
High
Suspicion

ABCDE Criteria Assessment

A — Asymmetry:
Present (lesion not mirror-symmetric across either axis)
B — Border:
Irregular, notched, partially blurred
C — Color:
Variegated brown / dark brown / focal black; one hypopigmented area suggests possible regression
D — Diameter:
8 mm (above the 6 mm threshold for concern)
E — Evolution:
Reported recent darkening and growth — most important feature [Abbasi NR, JAMA 2004]

Detailed Image Findings

AsymmetryPresent
When the lesion is divided in half, the two halves are not mirror images. Asymmetry is the most consistent feature of melanoma at the macroscopic level.
BorderIrregular
Borders are notched and partially indistinct, with one segment appearing to fade into surrounding skin — these features are uncommon in benign melanocytic nevi.
ColorVariegated
Multiple shades of brown with a focal area of darker pigment and a possible lighter, depigmented zone suggesting regression. Multi-color presentation is a strong dermoscopic and clinical clue [Argenziano G, Lancet Oncol 2003].
Diameter8 mm
Above the 6 mm threshold often used as a screening cut-off. Diameter alone is non-specific, but raises the index of suspicion when combined with other features.
EvolutionReported
Reported change in size and color over 4 months is the single most predictive ABCDE element. Any new or changing pigmented lesion in an adult should be evaluated [Abbasi NR 2004; Tsao H, J Am Acad Dermatol 2015].
"Ugly Duckling" SignLikely
Patient reports this lesion looks different from her other moles. The "ugly duckling" sign — a lesion that stands out from the surrounding nevi — has high predictive value [Grob JJ, Arch Dermatol 1998].

Differential Diagnosis

  • Melanoma (in situ or invasive)High Concern
    Multiple ABCDE features + reported evolution + Ugly Duckling sign + risk factors (Fitzpatrick II, prior blistering sunburn, family history) [Tsao H 2015].
  • Atypical (dysplastic) nevusModerate
    Cannot be reliably distinguished from melanoma without histology; biopsy is the only definitive method.
  • Pigmented basal cell carcinomaLow
    Possible mimic of pigmented melanocytic lesions; less likely given uniformly pigmented and melanocytic appearance.
  • Benign compound or dysplastic nevus with secondary irritationLow
    Reported change argues against a stable benign diagnosis. Image alone cannot exclude malignancy.

Analytical Summary & Recommendations

Imaging impression

Clinically suspicious pigmented lesion on the back, fitting multiple ABCDE features and the Ugly Duckling sign in a patient with melanoma risk factors and reported lesion evolution.

Recommended next steps

  • Refer to dermatology within 2 weeks for in-person examination and dermoscopy
  • Excisional biopsy with narrow margins (1–3 mm) is the recommended diagnostic approach for suspected melanoma — preserves architectural features for accurate Breslow thickness measurement [NCCN Melanoma Guidelines 2025; Marghoob AA, J Am Acad Dermatol]
  • Avoid shave biopsy when melanoma is suspected — it can transect the lesion and obscure depth
  • Total body skin examination at the same visit, given multiple risk factors and many existing nevi
  • Discuss monthly self-skin examination and rigorous photoprotection (broad-spectrum SPF 30+, hat, sun-protective clothing)
  • Consider genetic counseling if a strong family history is confirmed (multiple first-degree relatives with melanoma)
⚠ Important
A suspicious pigmented lesion is not the same as a diagnosis of melanoma — many suspicious lesions ultimately turn out to be benign. However, definitive evaluation (biopsy + histopathology) should not be delayed; early-stage melanoma has excellent outcomes when treated promptly.

Key Questions for Your Dermatologist

  • Should the biopsy happen at the same visit, or is a separate appointment needed?
  • What kind of biopsy is most appropriate for this lesion, and what should I expect afterwards?
  • How soon will I receive the histopathology result?
  • Given my risk factors, how often should I have full-body skin checks?
  • What sunscreen/photoprotection should I use, and what should I avoid?

What This Means for You

The mole on your back has several features that make it suspicious — irregular shape, irregular border, multiple colors, diameter over 6 mm, and most importantly, a change you have noticed over the past 4 months. Combined with your skin type, prior blistering sunburns, and family history, this lesion needs in-person evaluation by a dermatologist and a biopsy.

This does not mean you have melanoma. Many lesions that look suspicious on photos turn out to be benign or borderline (atypical) moles. But the only way to know for sure is to remove it and have it examined under a microscope. The recommended technique is a small excision (usually under local anesthesia) so the entire lesion is preserved for accurate analysis.

Please do not delay this. Early-stage melanoma, when caught and treated promptly, has very high cure rates. While you wait for the appointment, take a high-quality photograph of the lesion next to a ruler so any changes can be tracked.

In the meantime: protect your skin from sun (broad-spectrum SPF 30+, hat, long sleeves), examine your skin once a month, and report new or changing lesions promptly.

Analysis Confidence 82%

Image-based analysis identifies multiple suspicious ABCDE features and ugly-duckling concern. Photographic analysis cannot replace dermoscopy and histopathology — definitive diagnosis requires biopsy.

References

  1. Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004;292(22):2771–6.
  2. Tsao H, Olazagasti JM, Cordoro KM, et al. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015;72(4):717–23.
  3. Argenziano G, Soyer HP, Chimenti S, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol 2003;48(5):679–93.
  4. Grob JJ, Bonerandi JJ. The "ugly duckling" sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 1998;134(1):103–4.
  5. NCCN Clinical Practice Guidelines in Oncology — Melanoma: Cutaneous. National Comprehensive Cancer Network 2025.
  6. USPSTF. Skin Cancer Screening — Recommendation Statement. JAMA 2023;329(15):1290–1295.