Which combination of features is most concerning for malignant melanoma?

• A. Asymmetry, irregular border, and color variation
• B. Symmetry, smooth border
• C. Uniform brown color
• D. Very small size

Answer: (A)

Look for features that signal malignant transformation in a pigmented lesion. Melanoma commonly presents with asymmetry, meaning one half doesn’t match the other; irregular, notched, or blurred borders; and variation in color within the same lesion (different shades of brown, black, red, blue, or white). When all three of these high-risk patterns appear together, the concern for melanoma is greatest and prompt evaluation is important.

Benign lesions, by contrast, tend to be symmetric, with smooth, well-defined borders and uniform color, making the other combination much less likely. Size alone isn’t reliable—some melanomas are small—so the presence of multiple suspicious features carries more weight than tiny size. If a lesion shows these concerning patterns, urgent assessment and possible biopsy are warranted.