Melanoma: How to spot the clue of change

The dermatoscopic algorithm Chaos and Clues relies on the chaotic behaviour of malignant tissue to produce both asymmetry (chaos) and clues to malignancy (Figure 2).

Every melanoma starts as a minute lesion and the asymmetry may not be so evident early in its development. Because of this, Chaos and Clues has four exceptions in which asymmetry is not necessary to consider (excision) biopsy (Figure 2).

Malignant lesions are continuously changing, even if slowly, and stability over time is compelling evidence of benignancy.

Change can be revealed in a number of