How to Evaluate Pigmented Skin Lesions with the 3-Point Checklist [Part 2]

The video below is the second part of a webinar run by experienced skin cancer doctor Hamilton Ayres on Dermoscopy and the 3-Point Checklist. Dr Ayres goes through several case studies and explains how to apply the 3 Point Checklist and the dermoscopic criteria “Asymmetry, Atypical Network, Blue-White Structures” to evaluate pigmented skin lesions.


The program includes theory and surgical practical sessions on:

  • Skin anatomy and histology
  • Diagnosis with dermoscopy
  • Benign and malignant skin lesions
  • Melanoma management
  • Dermatopathology
  • Topical treatment options
  • punch and shave biopsies
  • Elliptical excisions and suturing
  • Workflow and medicare billing

Our team of industry leaders and experienced skin cancer doctors will guide you in your learning and skills practice throughout the weekend and beyond. Upon completion of the course, you will receive unlimited access to additional online learning resources and alumni webinars with course revisions, case discussions and Q&A with the instructors.

Professional Certificate of Skin Cancer Medicine

Skin cancer is one of the most common dermatological conditions seen in general practice – and it is not overly complex to manage if you have the right skill set. This certificate course has been specifically designed for time-poor general practitioners wishing to acquire the knowledge required to safely and confidently diagnose and treat commonly encountered skin lesions.


  1. Online theoretical component + one-day practical workshop: Complete the theoretical course component at your convenience online and attend a one-day practical workshop with skills practice under supervision on a Saturday or Sunday in one of the four locations across Australia.
  2. Entirely online: Receive instant access to the course contents online and complete all lectures and online activities online with independent skills practice at your office/home.

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2 comments on “How to Evaluate Pigmented Skin Lesions with the 3-Point Checklist [Part 2]

  1. Dr. Ayres, If there is a pigmented lesion that is too big to be completely excised and we consider it suspicious, could we define where in the lesion to perform a significant biopsy through dermoscopy?

    1. Hi Dr Gutiérrez, here is Dr Ayres’ response:

      Good question. The short answer is YES, you can. But the partial biopsy should never be used to EXCLUDE skin cancer. It should only be used to confirm a strong suspicion. Partial biopsies are a compromise, but I can think of a few instances over the past few years where I have been forced to perform partial biopsies to confirm melanoma. Once, on a large mid shin birthmark which was 3 x 3cm, containing a suspicious 3 x 4mm pigmented focus of chaotic pigmentation. The patient wouldn’t let me remove her entire melanocytic birthmark (“But it’s been there my whole life!”) but she let me excise the suspicious focus of pigmentation as defined by dermoscopy.

      I performed incisional excision-biopsy if you know what I mean. Once invasive melanoma was confirmed, the patient needed the entire birthmark removed and a keystone flap was used to repair the defect.

      The other more recent example was when I was monitoring a large cheek solar lentigo (4 x 3cm) which was stable with no clues, and a large dark seb included within it. When a dark suspicious 1 x 1cm area appeared laterally on routine review, I performed shave removal of the lateral half of the lesion which contained some of the original area of solar lentigo, the dark seb K, and the entire new pigmented area. Histology confirmed the presence of solar lentigo, deeply pigmented seb K and early evolving lentigo maligna melanoma in situ. Of course, we can’t trust the original solar lentigo, so arrangements have been made for excision of the entire 4 x 3cm area.

      In both of these examples, however, if the results had come back as containing NO melanoma, that would NOT exclude the possibility of melanoma being present in the parts that were not biopsied. Luckily (?) I was right about there being melanoma in each.

      – Hamilton

      Thank you,
      Abbie | HealthCert Education