History Taking · Intermediate · Dermatology

Changing Mole on the Back

Practise this PLAB 2 history taking station on Suspected Melanoma. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Ms Laila Rashad, a 38-year-old woman, has come to see you because she has noticed that a mole on her back has changed over the past three months. She has read information online and is concerned it might be skin cancer. Please take a focused history of the changing lesion and discuss appropriate assessment and management.

Background notes: PMH: occasional tension headaches

What this station tests

  • ABCDE criteria applied systematically: Asymmetry, Border irregularity, Colour variation, Diameter >6mm, Evolution (change)
  • 2-week-wait urgent referral for suspected melanoma per NICE NG12
  • Not diagnosing melanoma in primary care: referring for specialist assessment, not making a definitive diagnosis
  • Proportionate communication: investigating thoroughly without diagnosing cancer prematurely
  • Sun protection and mole awareness education: SPF 30+, avoid sunbeds, self-monitoring

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

A changing mole requires ABCDE assessment and 2-week-wait referral if concerning. The candidate must take the history, assess risk factors, and communicate urgency without causing unnecessary panic. Ms Rashad is 38, presenting with a mole on her back that has changed over 3 months. She has read about melanoma online. Open with: 'Ms Rashad, you have done the right thing coming in. Tell me what changes you have noticed.'

Core approach

Apply the ABCDE criteria through history. Asymmetry: has the mole become uneven in shape? (Yes, one side looks different from the other.) Border: are the edges irregular or blurred? (Yes, edges have become jagged.) Colour: has the colour changed? (Yes, now has multiple shades including dark brown and black areas.) Diameter: how big is it? (Grown to approximately 8mm, >6mm threshold.) Evolution: has it changed? (Yes, grown and changed colour over 3 months.) This mole meets multiple ABCDE criteria.

Additional alarm features: any itching, bleeding, or crusting? Has it become raised? Any satellite lesions nearby? Any tender lymph nodes?

Risk factors: fair skin, history of sunburn (especially childhood), outdoor activities (hiking, cycling, tennis), high mole count (ask how many moles she has), family history of melanoma, previous skin cancer. She is a young woman who is active outdoors and has had sunburns.

She has researched ABCDE criteria online and is terrified. Acknowledge: 'I can see you have been worrying about this. Let me examine the mole carefully.'

Closing and safety netting

Communicate the plan clearly. 'The changes you have described, the growth, the irregular border, and the mixed colours, mean this mole needs specialist assessment. I am referring you on a 2-week urgent pathway to a dermatologist who can examine it with a dermatoscope and determine whether it needs to be removed.' Do not diagnose melanoma, but do not dismiss the concern.

Explain what happens next: 'The dermatologist will examine it closely, possibly take a photograph, and if there is any concern, they will remove it completely and send it for analysis. If it is removed, the pathology will tell us exactly what it is.' Reassure proportionately: 'Many moles that change turn out to be benign, but we always investigate changes like these to be safe.'

Sun protection advice: SPF 30+, avoid midday sun, no sunbeds. Safety net: 'If the mole bleeds, rapidly grows, or new moles appear before your appointment, come back.' Mole awareness: she should monitor other moles for changes.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for suspected melanoma. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: ABCDE criteria applied systematically. Alarm features checked (bleeding, itching, satellite lesions). Risk factors assessed (sun exposure, skin type, family history). Lymph nodes checked.

Costs marks: Not using ABCDE. Not checking alarm features. Not assessing risk factors.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: 2-week-wait referral arranged. Not diagnosing melanoma prematurely. Sun protection advice. Mole awareness education. Safety netting for rapid change.

Costs marks: Routine referral. Diagnosing melanoma. No sun protection advice. No safety netting.

Domain 3: Interpersonal Skills (Throughout)

Scores well: Validating her decision to come in. Proportionate communication (investigating, not diagnosing). Acknowledging her online research and fear. Explaining the pathway clearly.

Costs marks: Being dismissive. Being alarmist. Not acknowledging her anxiety. Being vague about next steps.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Diagnosing melanoma in the consultation. The GP's role is to identify concerning features and refer urgently. Saying 'I think this is melanoma' causes unnecessary distress before specialist assessment.
  2. Not applying ABCDE systematically. Candidates who look at the mole and say 'it looks concerning' without documenting which specific criteria are met provide an inadequate assessment.
  3. Not arranging 2-week-wait referral. A mole meeting multiple ABCDE criteria requires urgent referral per NICE. Candidates who arrange routine dermatology demonstrate inadequate urgency.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

What is the best way to take a suspected melanoma history in PLAB 2?

A changing mole requires ABCDE assessment and 2-week-wait referral if concerning. The candidate must take the history, assess risk factors, and communicate urgency without causing unnecessary panic. Ms Rashad is 38, presenting with a mole on her back that has changed over 3 months.

Where are marks won and lost in this suspected melanoma station?

Examiners reward: ABCDE criteria applied systematically. Alarm features checked (bleeding, itching, satellite lesions). Risk factors assessed (sun exposure, skin type, family history). Candidates are penalised for: Not using ABCDE. Not checking alarm features. Not assessing risk factors.

Where do candidates most often go wrong in this station?

Diagnosing melanoma in the consultation. The GP's role is to identify concerning features and refer urgently. Saying 'I think this is melanoma' causes unnecessary distress before specialist assessment.

Can I do well in this station without real-world experience of suspected melanoma?

Structure beats experience here. Focus on 2-week-wait urgent referral for suspected melanoma per NICE NG12. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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