JMIR Publications

ABSTRACT

Melanoma is a potentially dangerous skin tumor responsible for 90% of all skin cancer-related deaths. If diagnosed and treated early survival rate is very high (almost 99%). Dermatoscopy is a diagnostic method enabling the detection of morphological chaos even in early-stage melanomas, long before it becomes clinically evident. “Chaos and Clues” is a decision-making algorithm designed for pigmented skin lesions, indicating biopsy in order to confirm or discard possible malignancy if there is chaos in one of 3 aspects(distribution of colors, patterns, and border abruptness) and at least one clue to malignancy. The diagnosis seems feasible and easy. Nevertheless, some challenging melanomas exist and might be easily overlooked, displaying harmony of all 3 aspects, often resembling a wide range of benign tumors. In order to avoid missing a melanoma, we present a series of challenging cases and peculiar clinical scenarios but also provide solutions to overcome these diagnostic pitfalls: 1. When the lesion does not look like a melanoma-do sequential digital monitoring! 2. When all the lesions look like a melanoma-comparative approach is the answer! 3. When we don't see the lesion-undress your patients and make a thorough skin examination! 4. When the pathologist doesn't recognize it-apply the new golden standard for diagnosing skin cancer, integration of clinic, dermatoscopy, and pathology! 5. When it is an uncommon variant of melanoma-follow the rules and clues! Conclusion Implementing these solutions would certainly help clinicians to recognize melanoma in any shape and form, overcome the most difficult diagnostic pitfalls and avoid missing the deadliest skin cancer.