title: Dermoscopy features of melanoma incognito: indications for biopsy.
abstract: BACKGROUND
  To avoid missing melanoma, the current practice is to biopsy all suggestive skin lesions. Although most cases of melanoma exhibit clinical clues leading to the correct diagnosis, melanoma can mimic benign lesions. Dermoscopy has been shown to increase the diagnostic accuracy of clinically equivocal lesions, but little is known about its ability to detect melanoma in the context of lesions that appear clinically benign.
  
  
  METHODS
  We present 7 difficult-to-diagnose melanomas, in which additional clues provided by dermoscopy increased the index of suggestion and led us to perform a biopsy.
  
  
  RESULTS
  Our cases highlight the following 7 management rules: 1) Dermoscopy should not be used only for suggestive skin lesions. 2) Biopsy lesions missing clinicodermoscopic correlation. 3) Biopsy lesions with unspecific pigment pattern. 4) Biopsy lesions with spitzoid features. 5) Biopsy lesions with extensive regression features. 6) In patients with multiple nevi, biopsy lesions changing after short-term follow-up. 7) Biopsy pink lesions with an atypical vascular pattern.
  
  
  CONCLUSIONS
  The reported series of cases is small. Dermoscopy has not been rigorously compared with handheld magnification (as with a x7 loupe).
  
  
  CONCLUSIONS
  Dermoscopy can increase the index of suggestion to perform biopsy in difficult-to-diagnose melanomas.
authors.affiliation: Department of Dermatology at Second University of Naples, Naples, Italy. argenziano@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ferrara
authors.forename: Robert
authors.initials: R
authors.lastname: Johr
authors.forename: David
authors.initials: D
authors.lastname: Langford
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000473:pathology; D046169:Dermoscopy / Q000592:standards*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009506:Nevus / Q000473:pathology; D009508:Nevus, Pigmented / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology*