Melanoma: How to spot the clues in the clods

Clod-pattern lesions can indicate melanoma in high-risk patients

Diagnostic algorithms assist the clinician to triage lesions systematically and to identify those that require (excision) biopsy. An algorithm is also a useful structure on which to organise accumulated experience.

But no algorithmic method is 100% specific; even apart from the human failings of examiners, all methods miss malignancies. 

Every malignancy starts as a minute lesion, too small even to be seen. Even once visible, early melanomas commonly lack the dermatoscopic features to identify them as malignant. 

The smallest published in situ