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Table 3 Perceived early signs and symptoms of Melanoma

From: Patient-identified early clinical warning signs of nodular melanoma: a qualitative study

Signs/ symptoms Nodular melanoma Superficial spreading melanoma Nodular melanoma
≤ 2 mm ≤ 2 mm >  2 mm
Asymmetry
 Round Round or roundish, circle or circular Circular, like a big circle Circular, like a big circle
 Oblong Not perfectly round, oblong Not perfectly round, jetted off  
Like a small kidney bean Not perfectly round, smaller in one direction  
 Square Square   Rectangular
Border
 Slightly irregular A little bit (or slightly) irregular Half-moon edge on the side of the border A little irregular
   Definite border, visible where it started and stopped
 Jagged Jagged Jagged border on one side  
  Jagged, uneven, undefined, melted into skin  
 Irregular coloration   Skin was a little bit pink, right on the border  
  [Pinkish with] a tan border  
Color
 White Little white dot   Interior looked white or grey-white
   Brownish white
   Darker white
 Beige Very light beige w/ black spot in the middle   Skin color shade
 Blue Bluish dark   
Bluish, multi-colored   
 Black Black freckle, like a black head   
Black dotted marks leaving a trail of brown   
 Pink Pinkish, looking like a pimple Pinkish Pink
  Pinkish with a tan border  
  Pinkish, pearlescent- like a reflection of a pearl  
  Pink bumpy/bubbly area with a black freckle on top  
   Dark pink
 Red Red   Red
Red, pinkish lesion Reddish Reddish, almost bright red
Tiny, little red spot   
 Brown   Light and dark brown, with darker spots inside  
Brown Brown Brown
Brownish or maroonish Brownish like a dark freckle A little brownish
Brownish dark   Dark brown
 Reddish brown Dark, reddish brown Brown and lighter /reddish Brown with some red
  Reddish brown Brown with some purple
 Dark Really dark with an even darker spot inside Dark, almost black Dark
Diameter
 Tiny dot Like a dot made with a pen Tiny, like lead on a pencil, the size of a dot  
Tiny, tiny little spots   
Tiny, tiny, tiny, like the head of a pin   
Like if you took a fine-tipped pen and you just put three dots on a piece of paper   
 < Pencil eraser Fairly small (1/8 of an inch) Very small (2 mm to 3–4 mm) Like a small pinhead used for sewing (1.5 mm)
Much smaller than a pencil eraser Much smaller than a pencil eraser Like the tip of a pen (2 mm)
Like a half of a pencil eraser Smaller than the size of a pencil eraser  
About 2/3 of a pencil eraser Half the size of a pencil eraser, very small  
 ~ Pencil eraser The size of a pencil eraser Almost the size of a pencil eraser The size of a pencil eraser
  The size of a pencil eraser or a little smaller Like a big pimple (1/4 of an inch
   About 1/4 in. round
 > Pencil eraser A little bigger than a pencil eraser Like two pencil-head erasers side-by-side A little bigger than the size of a pencil eraser
The size of my little finger’s fingernail The size of the little fingernail on your hand As big as a very small blueberry, maybe even smaller
Really tiny, smaller than 1 cm 1 cm diameter  
  Smaller than the size of a dime  
  A little bit smaller than my thumbnail The size of my thumbnail
  About the size of a dime, maybe bigger About the size of a dime
   The size of a penny
   The size of a quarter, large
   A little bigger than a quarter
   Approximately 2 cm
Elevation
 Slight Teeny little bump A little raised (1/8 of an inch; 1 mm) A little raised
Only slight [elevation] Elevated a little, you could feel it, definitely A little raised bump
Not huge, just slight [elevation] Could feel it- if you ran your finger over it A little bit raised but not grossly
Definitely more flat, but [also] raised a bit Not very much elevated, a little bumpy Elevated a little bit
Flat, less than 1 mm, a really tiny thing Like a little raised scar, bubbly a little bit A little bit elevated, some parts higher than others
A little bit elevated but small, small Rounded at the top, a tiny bubble like a tiny curve -also went down below the surface Could feel it, wasn’t flush with the skin (1/4 in. high)
Elevated above the skin like bumps on skin   The big the balloon was maybe 1/8 of an inch
Elevated, like a pimple   Raised at least a ¼ of an inch, maybe more
 Textured A little bit raised, puffy, just like a little bump A little bit bumpy with a rough texture Growing out of the skin, I could feel the crustiness
A little bit raised, puffed up A little raised, a little crusty Felt like a bee sting, no pain (the texture of it)
 Prominent Raised up and prominent   Raised, pronounced, thick (5 mm)
   Raised, like a swelling from a bee sting
Evolution [chronology]
 Asymmetry change From round to oblong [2 weeks] Changed shape [In a matter of weeks] Looked different from last time I checked [2 months]
  Not the same shape as in the past [6 months]  
 Border change Became more irregular [6–12 months] Got irregular [In a matter of weeks]  
  Some parts of the border became red [Over the last few years]  
 Color change From light beige to beige with a black spot [Over time] Became darker at the center  
From brownish to darker with brown tinges [2 weeks] From light brown to really dark [Really fast]  
  Got darker, from light to dark brown [6 months]  
Became a little bit dark Got a little darker [Slowly, over the years]  
   From brown to brown with purple in it [2–4 months]
From brown to black, in a dripping pattern [2 weeks]   From brown to black [4–5 months]
From bluish dark to almost black [3 months]   Blackened
 Diameter change Didn’t get too much bigger [2 weeks] Grew in size [Overnight] Got bigger, from 0.5 to 2 cm [4 weeks]
Grew quickly, all of a sudden [4–6 weeks] Got a little bigger [Over the last few years] Got bigger [3–4 months]
Got a little bit bigger, larger [3 months] Grew a little bit bigger [Slowly, over the years] Came back/grew after biopsy [4–5 months]
Got bigger, from 1 to 2 mm [6–12 months] Grew in size, from nothing to pencil eraser size [In a matter of weeks] Got slightly bigger [Almost 1 year]
Got (a little bit) bigger [Over time]   Kept getting bigger and bigger
Growing in size [12 months]   
 Elevation change Got raised [2 weeks]   Got higher [4 weeks]
   More raised [2 months]
  Got more density to it [Very quick] Became thicker [3.5 weeks]
Became more pronounced   Became more pronounced, protruding from the skin [Relatively quickly]
Became puffy [6–12 months]   Became bumpier, not smooth [2–4 months]
Puffed up [Over time]   
Physical signs and symptoms
 Itchy A little bit itchy   
Really itchy Itching a good deal  
Became itchy Became itchy [6 months] Became itchy [2 months]
 Bleeding Bleeding after shaving/ picking at it   Bleeding after shaving or squeezing [2–3 weeks]
Blood spots under the mole   Bleeding
 Weeping    Weeping pus
   Discharge
   Moist
 Multiple signs A little bit itchy and bleeding [Once] Itchy, scaling and flaky, cracking, bleeding Itchy, sore/sensitive, and bleeding- from towel drying
   Bleeding a little, open sore, scabbed over
  A little bit itchy and a little bit scaly Itchy and erupting [Periodically]
  Itchy, did not heal, looked like a keloid scar  
  Became dry, scaly, peeling [All of the sudden]  
  Sensitive and hurting/ sore, radiating pain [All of a sudden] Itchy and painful
   Oozing- from towel drying, sensitive, breaking open
Tactile sensations Did not feel right, it was purely tactile   Could feel it- by touching
  Hardened, became more solid [Over a few days] Hardened a little bit
   Felt like a hard pimple- by touching
   Felt like cracking a peanut open- after squeezing
  1. NM nodular melanoma, SSM superficial spreading melanoma
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