Roenigk

 
"The diagnosis of melanoma is usually based on the clinical appearance of a pigmented lesion in addition to a history of recent change, the latter being the most important clue. The following clinical criteria suggest the possibility of melanoma.
 
A change in the surface area of a nevus. Sudden enlargement.
 
A change in elevation of a lesion, with a flat mole becoming raised, palpable, nodular, or thickened.
 
A change in color, especially when brownish pigmentation becomes black.
 
A change in surface characteristics whereby a previously smooth cutaneous surface may become brown and scaly, with or without the occurrence of serous discharge or bleeding after minor trauma.
 
A change in sensation, e.g. the development of itching or tingling in an area of pigmentation.
 
A change in surrounding skin with signs of inflammation or appearance of satellite pigmentations."
 
Roenigk HH Jr. Office Dermatology. Baltimore: Williams & Wilkins, 1981:220.
 

Brief critique

 
All six "changes" referred to by Roenigk are beyond the capability of a morphologist to identify on the basis of a single examination ; those "changes" are derived from history or from photographs taken sequentially. In short, even though "clinical criteria suggest the possibility of melanoma," it still is only a possibility; they do not permit a morphologist to make that diagnosis with confidence.