# A 55-year-old client presents to the dermatology clinic for evaluation of a skin lesion on the back. Which assessment finding would be most concerning and require immediate physician notification? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540667 > language: ko > subject: Adult Health ## 문제 A 55-year-old client presents to the dermatology clinic for evaluation of a skin lesion on the back. Which assessment finding would be most concerning and require immediate physician notification? ## 보기 1. A symmetrical, uniformly colored mole with smooth borders measuring 4 mm in diameter 2. An asymmetrical, irregularly bordered lesion with varied coloration and a diameter of 8 mm **✔ 정답** 3. A small, pink, dome-shaped papule with a pearly appearance and visible blood vessels 4. A scaly, rough patch of skin with slight redness in a sun-exposed area **정답: 2** ## 해설 The lesion in option 2 meets multiple ABCDE criteria (asymmetry, irregular border, color variation, diameter >6mm), indicating high suspicion for melanoma requiring immediate notification. Other options describe benign or less urgent findings. ## 심화 해설 Clinical Reasoning and the ABCDE Rule The most concerning assessment finding that requires immediate physician notification is an asymmetrical, irregularly bordered lesion with varied coloration and a diameter of 8 mm. This lesion demonstrates multiple classic features of malignant melanoma as defined by the globally recognized ABCDE screening criteria. The ABCDE acronym was developed as a simple, naked-eye standard for nondermatologist health care professionals and the public to enhance the early detection of cutaneous melanoma, a critical factor for survival outcomes [1]. The rule breaks down as follows: Breakdown of the ABCDE Criteria * A - Asymmetry: One half of the mole does not match the other half. A line drawn through the middle would not create two mirror-image halves. * B - Border irregularity: The edges are ragged, notched, or blurred. The pigment may be streaming from the edge, unlike a benign lesion with a smooth, well-defined border. * C - Color variation: The lesion contains multiple shades of brown, black, tan, and sometimes areas of white, red, or blue. A uniform, single shade of color is a reassuring sign. * D - Diameter: A diameter greater than 6 mm (the size of a pencil eraser) is a key warning sign, although melanomas can be diagnosed at smaller sizes. * E - Evolution: Any change in size, shape, color, elevation, or a new symptom such as bleeding, itching, or crusting is a significant indicator. Applying the Rule to the Answer Choices * Option 1 describes a symmetrical, uniformly colored mole with smooth borders and a diameter of 4 mm. This presentation is consistent with a benign nevus and lacks any of the ABCDE warning signs. * Option 2 is the correct answer because it explicitly lists four of the five ABCDE criteria: asymmetry, border irregularity, color variation, and a diameter of 8 mm (greater than 6 mm). This combination of features represents the highest index of suspicion for melanoma and warrants an urgent referral to a dermatologist for dermoscopy or biopsy [1]. * Option 3 describes a small, pink, dome-shaped papule with a pearly appearance and visible blood vessels (telangiectasias). This is a classic description of a basal cell carcinoma. While it requires treatment, it is typically slow-growing and rarely metastasizes, making it less immediately life-threatening than a potential melanoma. * Option 4 describes a scaly, rough patch of skin with slight redness in a sun-exposed area, which is characteristic of an actinic keratosis. This is a common precancerous lesion that can progress to squamous cell carcinoma but does not represent the same level of acute concern as a lesion with multiple ABCDE features for melanoma. The ABCDE rule continues to be the global standard for the initial triage of pigmented lesions because it provides a systematic, non-device-assisted method to identify lesions suspicious for melanoma, the most aggressive form of skin cancer [1]. A lesion meeting multiple criteria, particularly in a client over 50, requires immediate escalation to facilitate early diagnosis and intervention.References (research sources) - [1]Advances in the noninvasive diagnosis of melanoma-40 years beyond the ABCDs.Research articleBurshtein J, Witkowski A, Zakria D, Shah M, Rosenberg A, DeBusk L, Ludzik J, Pellacani G, Rigel D. (2026) · DOI: 10.3322/caac.70065 ## 임상 시나리오 ABCDE Skin Lesion AssessmentRapid Triage for Suspected Melanoma Apply the ABCDE rule to every skin lesion assessment. Any lesion exhibiting Asymmetry, Border irregularity, Color variation, or a Diameter greater than 6 mm is a red flag. The presence of multiple criteria strongly suggests malignant melanoma. Prioritize notification. A lesion with varied coloration and an irregular border that is 8 mm in diameter requires immediate physician notification for urgent dermatology referral and probable biopsy. Do not delay. CautionDo not confuse a suspicious melanoma with a basal cell carcinoma (pearly, telangiectatic papule) or actinic keratosis (rough, scaly patch). While needing treatment, these do not carry the same emergent risk of metastasis. ## 핵심 개념 - **ABCDE Rule** — A clinical screening tool for melanoma assessing Asymmetry, Border irregularity, Color variation, Diameter >6mm, and Evolution. - **Melanoma** — A highly malignant skin cancer arising from melanocytes, with high metastatic potential if not detected early. - **Asymmetry** — A lesion where one half does not match the other half in shape, a key warning sign for malignancy. - **Border Irregularity** — Edges of a lesion that are ragged, notched, or blurred, indicating potential uncontrolled growth. - **Basal Cell Carcinoma** — The most common, locally invasive skin cancer, often appearing as a pearly papule, but rarely metastasizes. ## 같은 주제 문제 - [A nurse is assessing a client with suspected skin cancer. 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