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dermatologymediumSBA

A 48-year-old reports that a pigmented lesion on their upper back has enlarged over four months. It is asymmetrical, has an irregular border and contains several shades of brown and black. It is not inflamed and has not bled.

Which is the single most likely diagnosis that must be excluded?

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Reference ranges

Common adult laboratory intervals. Use the ranges supplied in the question when they differ. Children and pregnancy may have different ranges.

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Renal & electrolytes
Test	Range	Units
Sodium	133–146	mmol/L
Potassium	3.5–5.3	mmol/L
Urea	2.5–7.8	mmol/L
Creatinine · male	59–104	µmol/L
Creatinine · female	45–84	µmol/L
Bicarbonate · serum	22–29	mmol/L
Calcium · albumin-adjusted	2.20–2.60	mmol/L
Magnesium	0.70–1.00	mmol/L
Phosphate	0.80–1.50	mmol/L

Haematology
Test	Range	Units
MCV	83–100	fL
Haemoglobin · male	130–170	g/L
Haemoglobin · female	120–150	g/L
White blood cells	4.0–11.0	×10⁹/L
Neutrophils	1.5–8.0	×10⁹/L
Lymphocytes	1.0–4.0	×10⁹/L

Liver, inflammation & thyroid
Test	Range	Units
ALT · male	10–60	IU/L
ALT · female	10–40	IU/L
ALP	30–130	IU/L
CRP	<5	mg/L
Bilirubin	<21	µmol/L
TSH	0.38–5.33	mU/L
Free T4	8.0–18.0	pmol/L
Free T3	3.7–6.6	pmol/L

Arterial blood gases
Test	Range	Units
pH	7.35–7.45	—
PaCO₂	4.6–6.4	kPa
PaO₂	11.0–14.4	kPa
Lactate · at rest	0.5–2.2	mmol/L
Ionised calcium	1.15–1.33	mmol/L