Dermoscopy features of melanoma incognito: indications for biopsy.
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.
Argenziano
Giuseppe
G
Department of Dermatology at Second University of Naples, Naples, Italy. argenziano@tin.it
Zalaudek
Iris
I
Ferrara
Gerardo
G
Johr
Robert
R
Langford
David
D
Puig
Susana
S
Soyer
H Peter
HP
Malvehy
Josep
J
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*