{"id":10559,"date":"2026-08-12T00:10:12","date_gmt":"2026-08-12T08:10:12","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10559"},"modified":"2026-07-02T11:08:02","modified_gmt":"2026-07-02T19:08:02","slug":"pance-question-of-the-day-pigmented-lesion","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion","title":{"rendered":"PANCE\u00ae Question of the Day: Pigmented lesion"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_86 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-pigmented-lesion\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for the PANCE\u00ae with this scenario involving a pigmented lesion on this patient&#8217;s upper back. Does it need further evaluation? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 29-year-old man presents to the dermatology clinic\u00a0with a <strong>pigmented lesion on his upper back<\/strong>. The patient is fair-skinned and has a history of frequent sun exposure as a lifeguard and multiple childhood sunburns. Physical examination reveals\u00a0numerous\u00a0nevi on sun-exposed skin.\u00a0On his upper back, there is an\u00a0<strong>asymmetrical raised lesion with irregular borders and a uniform dark color<\/strong>.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following features is <em>most indicative<\/em> of the need for further evaluation of the lesion?\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Border irregularity of the lesion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Patient\u2019s occupation as a lifeguard<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Location on the upper back<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Uniformity of the color of the lesion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Raised appearance of the lesion<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!&nbsp;<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Border irregularity of the lesion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct: <\/strong>See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Patient\u2019s occupation as a lifeguard<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> While a lifeguard&#8217;s profession increases the risk of sun exposure and potential skin malignancies, it is not part of the determination for further evaluation. The appearance and features of the lesion itself are more pertinent to the diagnosis and evaluation of suspected melanoma.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Location on the upper back<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> While the upper back is a frequent site for melanomas, location alone is not an indication for further evaluation of lesions that are suspicious for melanoma as melanomas like acral lentiginous melanoma can appear on less sun-exposed areas, like the palms and soles.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Uniformity of the color of the lesion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Uniformity of color is generally reassuring and less suspicious for melanoma. Melanomas often display a variety of colors within one lesion, including black, brown, tan, red, blue, or white. Therefore, the consistent coloration of a lesion does not typically warrant immediate concern, but other characteristics of this lesion like asymmetry and irregular borders raise suspicion for melanoma.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Raised appearance of the lesion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Raised appearance can be seen in both benign and malignant lesions. In this patient asymmetry and border irregularity raise suspicion for melanoma.\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"690\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/08\/image-3.png\" alt=\"Table summarizing clinical features that raise suspicion for melanoma. It outlines the ABCDE criteria\u2014asymmetry, border irregularity, color variation, diameter of 6 mm or greater, and evolution over time\u2014and includes a 7-point checklist of major and minor warning signs such as changes in size, shape, or color, itching, bleeding, and sensory symptoms. The table also highlights the &quot;ugly duckling&quot; sign, where one skin lesion appears noticeably different from the patient's other moles.\" class=\"wp-image-10562\" style=\"aspect-ratio:1.3565096554698357;width:475px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/08\/image-3.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/08\/image-3.png?resize=300,221 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/08\/image-3.png?resize=768,566 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient, with significant&nbsp;<strong>sun exposure<\/strong>&nbsp;history and&nbsp;previous&nbsp;instances of&nbsp;<strong>sunburns<\/strong>,&nbsp;presents with&nbsp;a&nbsp;<strong>skin lesion<\/strong>&nbsp;that is&nbsp;<strong>asymmetrical with irregular borders<\/strong>. These features raise suspicion for&nbsp;<strong>melanoma<\/strong>, and further investigation with a&nbsp;<strong>biopsy&nbsp;<\/strong>is needed.&nbsp;<strong>Risk factors<\/strong>&nbsp;for melanoma include personal or family history of cutaneous malignancy, immunosuppression, fair skin, a tendency to sunburn, chronic sun exposure, and history of&nbsp;previous&nbsp;sunburns.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Melanoma is a malignant tumor arising from melanocytes that often presents with unique clinical characteristics that distinguish it from benign skin lesions. Clinically, the<strong>&nbsp;ABCDE criteria<\/strong>&nbsp;can serve as a&nbsp;<strong>guide for identifying suspicious lesions that need to be biopsied:<\/strong>&nbsp;<strong>A<\/strong>symmetry,&nbsp;<strong>B<\/strong>order irregularity,&nbsp;<strong>C<\/strong>olor variegation,<strong>&nbsp;D<\/strong>iameter over&nbsp;6mm, and&nbsp;<strong>E<\/strong>volution (change in size, color, or shape of a pre-existing lesion or report of a new growing lesion). Patient-reported symptoms such as itching, bleeding, or sensory changes in the lesion should heighten the suspicion of malignancy. Additionally, when a lesion<strong>&nbsp;looks conspicuously different&nbsp;<\/strong>(<strong>\u201cugly duckling\u201d sign<\/strong>) from<strong>&nbsp;surrounding nevi<\/strong>&nbsp;(nevus phenotype) on the patient, then biopsy should be performed. Patients&nbsp;also may&nbsp;have systemic signs of malignancy including fatigue, bone pain, and unintentional weight loss.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The presence of one or more\u00a0<strong>ABCDE criteria\u00a0<\/strong>(<strong>Asymmetry, Border irregularity, Color variation, Diameter\u00a0> 6\u00a0mm, and Evolution<\/strong>) in a pigmented skin lesion raises suspicion for\u00a0<strong>melanoma\u00a0<\/strong>and\u00a0warrants\u00a0<strong>biopsy<\/strong>.\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Review this Osmosis content: <\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Melanoma:_Clinical_sciences\">Melanoma: Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Swetter\u00a0SM, Thompson JA, Albertini MR, et al. <strong>NCCN Guidelines\u00ae Insights: Melanoma: Cutaneous, Version 2.2021.<\/strong> J Natl\u00a0Compr\u00a0Canc\u00a0Netw. 2021;19(4):364-376. Published 2021 Apr 1. doi:10.6004\/jnccn.2021.0018<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\/pa\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><strong><em>Get your&nbsp;<a href=\"http:\/\/osmosis.org\/plans\/pa\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;today to discover why millions of clinicians and caregivers love learning by Osmosis.<\/em><\/strong><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient presents with a pigmented skin lesion after years of significant sun exposure. Can you identify what feature most strongly supports further evaluation in this PANCE-style clinical case?<\/p>\n","protected":false},"author":208,"featured_media":10563,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,38,1371,37,1366],"tags":[3249,3251,2967,489,3108,3250,445,3247,1599,967,3246,742,3245,3248],"class_list":["post-10559","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa","category-questions","tag-abcde-criteria","tag-biopsy","tag-board-exam-prep","tag-clinical-reasoning","tag-clinical-vignette","tag-dermatologic-disorders","tag-dermatology","tag-melanoma","tag-pance-prep","tag-physician-assistant-education","tag-pigmented-lesions","tag-preventive-medicine","tag-skin-cancer","tag-skin-examination"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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