What is the Glasgow 7-point checklist for melanoma?

The Glasgow 7-point checklist (also called the weighted 7-point checklist) is a clinical tool to assess pigmented skin lesions for possible melanoma. It has 3 major features (change in size, irregular shape, irregular colour) scored 2 points each, and 4 minor features (diameter 7mm or more, inflammation, oozing or crusting, change in sensation) scored 1 point each. A score of 3 or more warrants urgent referral. It is recommended by NICE and widely used in Australian and UK general practice.

What is the 3-point dermoscopy checklist for melanoma?

The 3-point checklist (Soyer et al., Dermatology 2004) is a simplified dermoscopy screening tool designed for non-expert and primary care use. It scores three criteria at 1 point each: asymmetry of pattern or structures across one or more axes, atypical pigment network (thick lines, irregular holes), and blue-white structures (veil, scar-like depigmentation, or blue-grey granules). More than one criterion present is suggestive of melanoma and warrants referral or excision biopsy. In validation studies it showed high sensitivity (91-96%) for non-experts, trading off some specificity, making it a practical rule-out tool in general practice.

What are the recommended excision margins for melanoma?

Australian and international guidelines recommend excision margins based on Breslow thickness: melanoma in situ requires a 5mm margin, melanoma up to 1mm thick requires a 1cm margin, melanoma 1-2mm thick requires a 1-2cm margin, melanoma 2-4mm thick requires a 1-2cm margin, and melanoma over 4mm thick requires a 2cm margin. These are clinical margins measured from the visible edge of the lesion.

What Breslow thickness is high risk?

Melanoma with a Breslow thickness greater than 1mm is considered higher risk. The 10-year survival rate drops from approximately 92% for melanomas under 1mm to 80% for 1-2mm, 63% for 2-4mm, and 50% for melanomas over 4mm. Sentinel lymph node biopsy is generally recommended for melanomas 0.8mm or thicker, or thinner melanomas with high-risk features such as ulceration or high mitotic rate.

What is the difference between clinical and pathologic melanoma stage?

Clinical stage (cTNM) is based on findings from the primary excision plus physical examination and imaging performed before any further surgery — Stage III is reported as a single group without subdivision. Pathologic stage (pTNM) additionally incorporates findings from sentinel lymph node biopsy or lymphadenectomy, which allows Stage III to be subdivided into IIIA, IIIB, IIIC or IIID based on the number of involved nodes, whether nodal disease was clinically detected or only found microscopically, and the presence of in-transit, satellite or microsatellite metastasis. Pathologic stage is more precise and is generally used to guide adjuvant treatment decisions.

Melanoma Scoring

Glasgow 7-point checklist, 3-point dermoscopy checklist, Breslow staging, full AJCC stage grouping, and excision margin guidelines.

📋 Source: Breslow thickness staging & full AJCC anatomic stage grouping (AJCC Cancer Staging Manual, 8th Edition — Gershenwald et al. CA Cancer J Clin. 2017;67(6):472-492). Glasgow 7-point checklist. 3-point checklist (Soyer HP et al. Dermatology. 2004;208(1):27-31). ABCDE criteria. Australian Clinical Practice Guidelines for Melanoma (Cancer Council Australia, 2019). Staging pathway cross-checked against Healius Pathology Network clinical guidance (Jul 2026).
Your doctor or healthcare provider knows your history and circumstances — always follow their personalised advice over general information.

⚠ Clinical decision support tool. Does not replace dermoscopy training, clinical judgement, or specialist opinion. When in doubt, refer or excise.

Major features (2 points each)

Change in size

The lesion is growing — getting bigger or expanding. Most important single feature. Applies to both new lesions and changes to existing moles.

Irregular shape

The lesion has an irregular or asymmetric outline. Most benign moles are round or oval with a smooth border.

Irregular colour

Two or more shades or colours within the lesion (brown, black, blue, grey, red, white). Most benign moles are one uniform colour.

Minor features (1 point each)

Diameter ≥ 7mm

The lesion is 7mm or larger at its widest point. Most benign moles are smaller than this. Note: early melanomas can be smaller.

Inflammation

Redness or swelling extending beyond the border of the lesion. Not just irritation from rubbing or scratching.

Oozing or crusting

The lesion is weeping, bleeding, or forming a crust — without a history of trauma to the area.

Change in sensation

The lesion is itchy, painful, or has altered feeling. Itching is the most common sensory change in melanoma.

out of 10

Select features above to calculate the score.

Score ≥ 3: Urgent referral recommended (suspected cancer pathway — 2-week wait in UK/NICE guidelines). In Australia, refer for urgent specialist review or perform excision biopsy.

Score 1–2: Use clinical judgement. Consider dermoscopy, monitoring, or referral if uncertain. A single major feature (score 2) warrants careful assessment.

Score 0: Low suspicion, but does not exclude melanoma. Nodular and amelanotic melanomas may not score on this checklist. Use the "ugly duckling" sign — any mole that looks different from the patient's other moles.

ℹ️ Designed for non-experts. The 3-point checklist is a simplified dermoscopy screening aid intended for primary care — it trades specificity for high sensitivity. It is not a substitute for dermoscopy training or specialist review.

Dermoscopic criteria (1 point each — max 3)

Asymmetry

Asymmetry of pattern or structures across one or more axes — colour and/or structural asymmetry within the lesion. The outline/silhouette itself is not considered, only the internal pattern.

Atypical network

A pigment network with thickened lines and irregular holes/meshwork, distributed asymmetrically within the lesion — rather than a fine, even, regular network.

Blue-white structures

Any shade of blue and/or white colour anywhere within the lesion — blue-white veil, white scar-like depigmentation, or blue-grey "pepper-like" granules.

out of 3

Select criteria above to calculate the score.

Score ≥ 2: More than one criterion present is suggestive of melanoma — refer for specialist dermoscopy review or perform excision biopsy.

Score 1: A single criterion alone is non-specific. Correlate with history (change, evolution) and clinical appearance; consider monitoring with photography or dermoscopy follow-up if not otherwise concerning.

Score 0: Low dermoscopic suspicion on this checklist, but it does not exclude melanoma — nodular and amelanotic melanomas can score 0. The "ugly duckling" sign and any history of change still warrant assessment.

📋 Evidence: Developed for non-expert/primary care use (Soyer HP et al. Dermatology. 2004;208(1):27-31 — PMID 14730233): 6 non-expert raters, 231 lesions, sensitivity 96% / specificity 33%. Zalaudek et al. 2006 (experts + non-experts, 165 lesions): sensitivity 91% / specificity 72%. Argenziano et al. 2006 (73 primary care physicians, 2,522 lesions): improved triage accuracy for referral decisions. Figures reflect dermoscopy-trained use — real-world sensitivity/specificity in untrained hands may differ.

Breslow Thickness — Enter Your Histology

Breslow thickness (mm)

Ulceration present?

Yes No

Melanoma in situ (no invasion)

Full AJCC Stage — Add Nodal & Metastatic Status

The T stage above carries through automatically. Add N (nodal) and M (metastatic) status from histopathology, sentinel node biopsy, or imaging to calculate the overall anatomic stage group.

No primary tumour found on excision (melanoma of unknown primary — overrides T stage to T0)

N — Regional lymph node / in-transit status

M — Distant metastasis

Enter Breslow thickness above (or tick "no primary tumour found") to calculate the combined stage.

📋 Source: AJCC Cancer Staging Manual, 8th Edition (Gershenwald JE et al. CA Cancer J Clin. 2017;67(6):472-492) • Cancer Council Australia Melanoma Guidelines (2019) • Healius Pathology Network, "Management of Primary Cutaneous Melanoma" (doc. PUB/MR/1023_V3, Jul 2026). This is a staging reference tool, not medical advice — the final stage grouping should be confirmed against the pathology report and discussed at melanoma MDT.

Breslow

Margin

SLNB

~Survival

In situ

5 mm

99%

≤0.8 mm

1 cm

Consider if ulcerated

~95%

0.8–1.0 mm

1 cm

Discuss/recommend

~92%

1.0–2.0 mm

1–2 cm

Recommended

~80%

2.0–4.0 mm

1–2 cm

Recommended

~63%

> 4.0 mm

2 cm

Recommended

~50%

Excision margins are clinical margins from visible edge (or scar if re-excision). Based on NHMRC Australian melanoma guidelines.

SLNB = Sentinel Lymph Node Biopsy. Provides staging for adjuvant therapy decisions.

T Stage

Thickness

Ulceration

Tis

In situ

N/A

T1a

<0.8 mm

T1b

<0.8mm + ulcerated, or 0.8–1.0mm

T2a

1.0–2.0 mm

T2b

1.0–2.0 mm

Yes

T3a

2.0–4.0 mm

T3b

2.0–4.0 mm

Yes

T4a

>4.0 mm

T4b

>4.0 mm

Yes

Ulceration upstages within each thickness category. Clark level no longer used in AJCC 8th edition.

Superficial spreading (70%) — most common. Flat or slightly raised, irregular border, variable colour. Grows radially before vertical invasion. Often on trunk (men) or legs (women).

Nodular (15%) — raised, dome-shaped, often dark but can be amelanotic (pink/red). Grows vertically early — often thicker at diagnosis. May not score on ABCDE or 7-point checklist. Look for EFG: Elevated, Firm, Growing.

Lentigo maligna (10%) — flat, irregular, on chronically sun-damaged skin (face, neck). Slow-growing. In situ form = lentigo maligna; invasive = lentigo maligna melanoma.

Acral lentiginous (5%) — palms, soles, under nails. Most common subtype in darker skin. Subungual melanoma = dark streak in nail (Hutchinson's sign = pigment extending to nail fold).

Amelanotic (<5%) — lacks pigment. Pink, red, or skin-coloured. Easily missed. High suspicion needed for persistent non-healing lesions.

ABCDE Rule for Melanoma

Clinical assessment mnemonic for pigmented lesions. Most useful for superficial spreading melanoma. Less reliable for nodular and amelanotic subtypes.

Asymmetry

One half doesn't match the other. Draw an imaginary line through the centre — benign lesions are usually symmetric.

Border irregularity

Edges are ragged, notched, scalloped, or poorly defined. Benign moles have smooth, even borders.

Colour variation

Multiple colours within the same lesion — shades of brown, black, red, white, or blue. Benign moles are usually one uniform colour.

Diameter > 6mm

Larger than a pencil eraser. However, early melanomas may be smaller — don't dismiss small lesions that meet other criteria.

Evolution

Any change in size, shape, colour, elevation, or new symptoms (itching, bleeding, crusting). This is the most important criterion. Any evolving lesion warrants assessment. Usually the hardest to judge from memory — the Mole Photo Tracker makes it visible with a ghost-overlay photo comparison over time.

EFG — For nodular melanoma

Nodular melanomas grow vertically and may not meet ABCDE criteria. Use the EFG mnemonic:

Elevated

The lesion is raised above the skin surface.

Firm

Firm to palpation — harder than surrounding skin.

Growing

Progressive enlargement over weeks to months. Nodular melanoma grows rapidly — any rapidly growing nodule warrants urgent assessment, even if symmetric and uniform.

Guidelines & Resources

Cancer Council Australia — Clinical Practice Guidelines for Melanoma. • Glasgow 7-point checklist: MacKie RM et al. BJD 1989;121(4):437-44. • ABCDE criteria: Friedman RJ et al. CA Cancer J Clin 1985;35(3):130-51. — Australian evidence-based melanoma guidelines including excision margins and SLNB recommendations.

Cancer Australia — Melanoma of the Skin — National guidelines, staging, and treatment pathways.

Cancer Council — Melanoma Patient Information — Shareable patient resource on melanoma types, diagnosis, and treatment.

Dermoscopedia — Seven Point Checklist — Detailed dermoscopic criteria with sample images.

Dermoscopedia — Three Point Checklist — 3-point checklist criteria and sample images. Original citation: Soyer HP et al. Dermatology. 2004;208(1):27-31.

NICE NG12 — Suspected Cancer: Recognition and Referral — UK guidelines recommending the weighted 7-point checklist for primary care referral.

MBS Online — Current Medicare item numbers for skin excisions (see our MBS Items tool).