CCE-CE-082

CASE INFORMATION

Case ID: CCE-DERM-003
Case Name: Sarah Thompson
Age: 34
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S82 – Naevus/Mole

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages the patient
1.2 Explores the patient’s concerns, ideas, and expectations
1.3 Provides clear and structured explanations about mole assessment and management
2. Clinical Information Gathering and Interpretation2.1 Takes a thorough dermatological and personal history
2.2 Assesses risk factors for skin cancer and examines relevant skin lesions
3. Diagnosis, Decision-Making and Reasoning3.1 Evaluates whether the mole is benign, suspicious, or requires further investigation
4. Clinical Management and Therapeutic Reasoning4.1 Provides a management plan based on the risk assessment
4.2 Discusses options for removal or monitoring if required
5. Preventive and Population Health5.1 Discusses sun protection, self-monitoring, and routine skin checks
6. Professionalism6.1 Provides patient-centred, non-judgmental care
7. General Practice Systems and Regulatory Requirements7.1 Documents lesion characteristics, risk assessment, and management plan
8. Procedural Skills8.1 Explains biopsy or excision options if indicated
9. Managing Uncertainty9.1 Addresses patient anxiety and uncertainty about the lesion
10. Identifying and Managing the Patient with Significant Illness10.1 Recognises and appropriately refers suspicious lesions

CASE FEATURES

  • Concerned about melanoma and wants reassurance or removal.
  • Patient presents with a changing mole on her back.
  • Recent growth, darkening, and slight irregularity noted.
  • No previous history of skin cancer but has multiple moles.
  • Fair-skinned, history of sunburns, works outdoors part-time.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Sarah Thompson, a 34-year-old primary school teacher, presents with concerns about a mole on her upper back that her partner recently noticed had become darker and slightly irregular.

Her dermatological history includes:

  • Lesion characteristics:
    • Noticed changes over the last 3 months.
    • Darker than before, slightly irregular border.
    • No bleeding, itching, or ulceration.
  • Sun exposure history:
    • Fair-skinned, Fitzpatrick Type II.
    • Works outdoors 2 days per week, wears sunscreen inconsistently.
    • Frequent sun exposure as a child, multiple sunburns in the past.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 34
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known drug allergies

Medications

  • None currently

Past History

  • No previous skin cancer or mole excisions.

Social History

  • Primary school teacher, part-time outdoor work.

Family History

  • Uncle had melanoma in his 50s.

Preventive Activities

  • Uses sunscreen occasionally but not consistently.

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, my partner noticed that a mole on my back looks different. Should I be worried?”

General Information

Sarah Thompson is a 34-year-old primary school teacher who has come in for a skin check due to a mole on her back that her partner noticed had changed.

She does not have a history of skin cancer but is fair-skinned and had multiple sunburns during childhood and adolescence. She works outdoors part-time and does not consistently use sun protection.

Sarah is slightly anxious but not overly distressed. She is open to medical advice but wants clear guidance on what needs to be done.

Specific Information

(To be revealed only when asked)

Mole Characteristics

(Sarah will provide these details if prompted.)

  • She first noticed changes around three months ago.
  • The mole appears darker and slightly more irregular in shape.
  • It does not itch, bleed, or feel painful.
  • The mole is on her upper back, near her right shoulder blade.
  • She does not recall it growing suddenly, but it seems more prominent now.

Sun Exposure and Skin Cancer Risk

(Sarah will describe the following if the candidate asks.)

  • Fair-skinned, Fitzpatrick Type II (burns easily, tans minimally).
  • Had multiple sunburns in childhood and teenage years.
  • Works outdoors two days a week and wears sunscreen “sometimes.”
  • Occasionally uses hats and sunglasses but is inconsistent.
  • Has never used tanning beds.

Family and Personal Medical History

  • No personal history of skin cancer or previous mole removals.
  • Uncle had melanoma in his 50s.
  • No history of immunosuppression or chronic illness.
  • No previous dermatology visits for skin concerns.

Concerns and Emotional Responses

Sarah is feeling mildly anxious but rational about her concerns. She is mostly looking for professional reassurance and clear next steps.

  • If the candidate explains the assessment well, she will feel reassured and follow recommendations.
  • If the candidate is vague or does not explain clearly, she will become more anxious and insist on removal.
  • If the candidate dismisses her concerns, she will feel frustrated and possibly seek a second opinion.

Sarah trusts the doctor’s expertise, but she will press for more information if explanations are unclear.

Questions for the Candidate

Sarah may ask some or all of the following:

  1. “How can you tell if a mole is dangerous?”
  2. “Is this definitely not melanoma?”
  3. “Do you think I should get it removed?”
  4. “What happens if I leave it alone?”
  5. “How often should I have skin checks?”
  6. “What can I do to prevent skin cancer?”

Possible Emotional Reactions

If the candidate provides a structured discussion and clear guidance:

  • Sarah will feel relieved and reassured.
  • She will trust the doctor’s recommendation and agree to either monitor the mole or have a biopsy if indicated.
  • She will be open to discussing regular skin checks and sun protection.

If the candidate is vague or dismissive:

  • Sarah may press for removal regardless of the assessment.
  • She may become more anxious and feel like her concerns aren’t being taken seriously.
  • If not given clear follow-up instructions, she may seek a second opinion elsewhere.

Expected Behaviour Based on Candidate Performance

If the candidate provides a patient-centred, well-structured discussion:

  • Sarah will be calm, reassured, and cooperative.
  • She will listen to advice on monitoring, biopsy, or removal.
  • She will ask about sun protection and future skin checks.

If the candidate is dismissive or unclear:

  • Sarah will become increasingly anxious and may demand immediate removal.
  • She will ask repetitive questions about melanoma because she feels uncertain about the explanation given.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including lesion changes, sun exposure, and skin cancer risk factors.

The competent candidate should:

  • Elicit details about the lesion, including:
    • Duration of changes (e.g., how long Sarah has noticed differences).
    • Specific changes (size, shape, colour, border irregularity, symptoms such as itching, bleeding, or ulceration).
    • Presence of other concerning lesions.
  • Assess sun exposure history, including:
    • Amount of time spent outdoors, use of sun protection, history of sunburns.
    • History of tanning bed use.
  • Explore personal and family history of skin cancer (especially melanoma).
  • Assess for general skin cancer risk factors, including:
    • Fair skin, light eye/hair colour, multiple moles.
    • Presence of freckles or easily burning skin.
    • History of immunosuppression.

Task 2: Conduct an assessment and explain whether the mole is benign, concerning, or requires further investigation.

The competent candidate should:

  • Use the ABCDE criteria to assess the mole:
    • A – Asymmetry
    • B – Border irregularity
    • C – Colour variation
    • D – Diameter >6mm
    • E – Evolving changes
  • Explain findings to the patient in a clear and non-alarming manner.
  • Use dermoscopy (if available) to assess for suspicious features.
  • Communicate whether the mole is:
    • Likely benign and can be monitored.
    • Atypical but low-risk, requiring short-term follow-up.
    • Suspicious and requiring biopsy or excision.

Task 3: Provide a structured management plan, including monitoring, biopsy, or excision options.

The competent candidate should:

  • If the lesion appears benign:
    • Reassure the patient and advise self-monitoring.
    • Consider clinical photography for future comparison.
    • Schedule a review if necessary.
  • If the lesion is suspicious:
    • Discuss options for biopsy (punch, shave, or excisional).
    • Explain rationale for biopsy (confirm diagnosis, guide further treatment).
    • Refer to dermatology or plastic surgery if required.
  • Provide clear follow-up instructions.

Task 4: Discuss sun safety, self-monitoring, and routine skin checks.

The competent candidate should:

  • Educate Sarah on sun protection, including:
    • Daily sunscreen use (SPF 50+), protective clothing, avoiding peak UV hours.
  • Explain self-skin checks, including:
    • How to look for new or changing lesions.
    • Using a mirror or asking a partner for hard-to-see areas.
  • Advise on regular professional skin checks, particularly given her:
    • Fair skin.
    • History of sunburns.
    • Family history of melanoma.

SUMMARY OF A COMPETENT ANSWER

  • Takes a detailed history of lesion changes, sun exposure, and skin cancer risk factors.
  • Uses the ABCDE method to assess the mole.
  • Clearly explains whether the mole is benign, atypical, or suspicious.
  • Provides a structured management plan based on the risk level.
  • Educates the patient on sun protection, self-monitoring, and follow-up.

PITFALLS

  • Failing to assess skin cancer risk factors, including sun exposure history.
  • Not explaining the rationale behind monitoring versus biopsy/excision.
  • Dismissing patient concerns without clear reasoning.
  • Not addressing sun protection and skin cancer prevention.
  • Providing inaccurate or incomplete information about mole assessment.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.3 Provides clear and structured explanations about mole assessment and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough dermatological and personal history.
2.2 Assesses risk factors for skin cancer and examines relevant skin lesions.

3. Diagnosis, Decision-Making and Reasoning

3.1 Evaluates whether the mole is benign, suspicious, or requires further investigation.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides a management plan based on the risk assessment.
4.2 Discusses options for removal or monitoring if required.

5. Preventive and Population Health

5.1 Discusses sun protection, self-monitoring, and routine skin checks.

6. Professionalism

6.1 Provides patient-centred, non-judgmental care.

7. General Practice Systems and Regulatory Requirements

7.1 Documents lesion characteristics, risk assessment, and management plan.

8. Procedural Skills

8.1 Explains biopsy or excision options if indicated.

9. Managing Uncertainty

9.1 Addresses patient anxiety and uncertainty about the lesion.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises and appropriately refers suspicious lesions.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD