Sunday, August 29, 2010

The BLINCK Algorithm

The mnemonic, BLINK, refers to 5 questions that should be asked when assessing a skin lesion:
B – Benign: Is the lesion immediately recognisable as a common benign tumour, on clinical and dermatoscopic examination, with other similar lesions being present on that part of the body e.g. typical solar lentigo, seborrheic keratosis, haemangioma or dermatofibroma?
If ‘yes’, no further action is required.
If ‘no’, then proceed to the following 4 questions.

L – Lonely: Is this lesion, clinically and dermatoscopically, the only one of its type on that region of the body, i.e. an "outlier" or “ugly duckling”?
‘Yes’ scores 1
I – Irregular: For pigmented lesions, is the lesion dermatoscopically irregular, that is, does it have an asymmetrical pigmentation pattern and more than one colour? For non-pigmented lesions, is there an irregular vascular pattern?
‘Yes’ scores 1

N – Nervous and/or Change: Is the patient nervous that the lesion may be a skin cancer? Does the patient, or another observer, feel that the lesion is changing?
N.B. Only a total score of 1 can be given if either or both of these last two questions are answered ‘yes’
K – Known clues
Does the lesion definitely have any one of the following dermatoscopic “clues” to malignancy?

• Atypical network – unmistakable variation in thickness of network line
• Pseudopods or streaks – segmental
• Black dots, globules or clods – irregular and peripheral
• Eccentric structureless zone
• Blue or grey colour – irregular distribution
• Vessels: 1. Polymorphous 2. finely focused and arborising 3.glomerular shaped
• Acral lesions – 1. parallel ridge pattern 2. diffuse irregular brown/black pigmentation

‘Yes’ to any one of these scores 1 (maximum score of 1)
A score of 2 or more out of 4 requires biopsy.