Nursing care
Melanoma nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
A mole is assessed for melanoma using ABCDE — asymmetry, irregular border, uneven colour, diameter over 6 mm, and evolving appearance — and a lesion that is changing is the one referred for biopsy. Melanoma is the most dangerous skin cancer because it can metastasise early, so timely recognition and referral drive outcomes more than any nursing intervention after diagnosis.
The clinical picture
Melanoma arises from melanocytes, the pigment-producing cells at the base of the epidermis, and it is the skin cancer most likely to spread to distant organs even from a small primary lesion. Risk climbs with cumulative ultraviolet exposure, a history of blistering sunburns, fair skin, a large number of moles, a family history of melanoma, and immunosuppression.
Clinically it can appear as a new pigmented lesion or as a change within an existing mole, and it does not always look dramatic in its earliest stage. Subtypes vary in behaviour: superficial spreading melanoma grows outward before it grows deep and carries a better prognosis if caught at that stage, nodular melanoma grows vertically from the start and can be missed because it lacks the classic asymmetric, flat appearance, and acral lentiginous melanoma occurs on palms, soles or under nails and is often diagnosed late because it is overlooked.
Assessment: what to look for and in what order
Apply the ABCDE framework to any pigmented lesion the patient raises concern about: Asymmetry, where one half does not match the other; Border irregularity, with ragged or poorly defined edges; Colour variation within the same lesion, including shades of brown, black, red or blue; Diameter greater than 6 millimetres, roughly the size of a pencil eraser; and Evolving, meaning any change in size, shape, colour, elevation, or new symptoms like itching or bleeding. Evolving is the single most decisive criterion, since a mole that is changing is the one that gets biopsied regardless of how it scores on the other four letters.
Beyond ABCDE, note whether the lesion is a new one appearing after age thirty rather than an existing mole, ask about bleeding, ulceration or crusting, and examine regional lymph nodes for enlargement, which can indicate spread. Document the lesion's location, size and appearance with dated photographs where possible, since this baseline record is what lets a later change be recognised.
Immediate interventions
The immediate nursing action for a suspicious lesion is referral for biopsy, not treatment at the bedside, since diagnosis and staging depend entirely on histology. Document the lesion thoroughly, including measurements and photography if your facility permits it, so the referral carries objective detail rather than a verbal description alone.
If the patient is anxious, provide clear, honest information about what a biopsy involves and how long results typically take, without speculating on diagnosis or prognosis ahead of pathology. Protect the lesion site from further trauma or sun exposure while awaiting biopsy, and if the lesion is bleeding or ulcerated, apply a simple non-adherent dressing and monitor for signs of infection in the meantime.
Ongoing nursing management
Once melanoma is confirmed, nursing management shifts to supporting the surgical excision or wide local excision that follows staging, including wound care and monitoring for infection or dehiscence at the surgical site. For thicker lesions, patients may undergo sentinel lymph node biopsy, and nurses monitor that site for seroma, lymphoedema or infection.
For patients receiving systemic therapy such as immunotherapy or targeted BRAF/MEK inhibitors for more advanced disease, monitor for treatment-specific effects, including immune-related adverse events like colitis, dermatitis or endocrinopathies with immunotherapy, and fever or rash with targeted agents. Psychological support matters throughout, since a melanoma diagnosis carries a heavier weight for many patients than other skin cancers because of its metastatic potential, and nurses are often the first to notice and respond to that distress.
Patient and family education
Teach patients to perform monthly self-skin checks using the ABCDE criteria, covering areas that are easy to miss, including the scalp, soles, between toes, and under nails, and to involve a partner or family member for hard-to-see areas like the back. Emphasise that any new or changing lesion should be reported promptly rather than watched for a period of months.
Reinforce sun protection: broad-spectrum sunscreen reapplied regularly, protective clothing, and avoiding peak ultraviolet hours, particularly for patients who have already had one melanoma, since their risk of a second primary is elevated. Explain the importance of attending follow-up surveillance appointments, which are typically more frequent in the years immediately after diagnosis, and encourage first-degree relatives of a patient with melanoma to have their own skin checked, given the familial risk pattern.
How this appears on the NCLEX
Exam questions on melanoma frequently present a description of a pigmented lesion and ask the test-taker to identify which feature is most concerning, expecting recognition of the ABCDE criteria, with particular weight on a lesion that has changed over time. A stem describing a mole that has recently grown, darkened or started to itch is testing whether the candidate flags it for biopsy referral rather than reassurance or routine monitoring.
Other recurring angles include prioritising sun-safety and self-examination education, recognising that biopsy and histology, not visual inspection alone, confirm diagnosis, and understanding the nurse's role in post-surgical wound and lymph node monitoring. Questions may also test risk factor recognition, expecting the test-taker to identify fair skin, sunburn history and family history as relevant to prioritising patient education.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our med-surg practice questions are the closest set to what this page covers.
One question from the med-surg set
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Common questions
What does the E in ABCDE stand for and why does it matter most?
E stands for Evolving, meaning any change in a lesion's size, shape, colour, elevation, or new symptoms such as itching or bleeding. It carries particular weight because a mole that is stable, even if slightly irregular, is far less concerning than one that is actively changing, and change is what typically prompts biopsy.
How is melanoma actually diagnosed?
Diagnosis requires a biopsy and histological examination, not visual inspection alone. ABCDE assessment and dermoscopy identify which lesions warrant biopsy, but only pathology confirms melanoma and determines its depth, which drives staging and treatment.
Why is melanoma considered more dangerous than other skin cancers?
Melanoma has a much higher tendency to metastasise to lymph nodes and distant organs, even from a relatively thin or small primary lesion, compared with basal cell or squamous cell carcinoma, which typically stay localised. Depth of invasion at diagnosis is one of the strongest predictors of outcome.
What is the nurse's role once a suspicious lesion is found?
The nurse documents the lesion, refers for biopsy, and supports the patient through that process rather than attempting to diagnose or treat it directly. After confirmed diagnosis, nursing care shifts to supporting surgical excision, monitoring the biopsy or excision site, and educating on surveillance and prevention.
How often should someone with a prior melanoma have skin checks?
Follow-up frequency is set by the treating team based on the melanoma's stage, but patients with a prior melanoma are typically seen more often in the first few years after diagnosis. They should also continue monthly self-checks between clinical visits given their elevated risk of a second melanoma.
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