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Dermoscopy

Limitations of Dermoscopy

Dermoscopy can enhance the ability to diagnose melanoma. Knowledge and experience are required. Even experienced users differ substantially in their interpretation of pigmented lesions with the dermoscope. It is easy to be lured into a false sense of security especially in early cases of melanoma that have not developed the classic characteristic of malignancy. About 10% of melanomas have no characteristic dermoscopy findings. The dermoscopy feature most common in thin melanomas (Breslow thickness of <0.75 mm) is an irregular pigment network. Atypical nevi often have hyperpigmentation and bridging of the rete ridges, which give them a similar appearance by dermoscopy. Dermoscopy criteria for melanoma variants such as amelanotic melanomas, desmoplastic melanomas, lentigo maligna melanoma, or nevoid melanoma are lacking. A report of change in a lesion is an important risk factor for melanoma. The decision to perform a biopsy of a lesion of moderate to high clinical suspicion for melanoma before dermoscopy observation should not be changed by the lack of dermoscopy criteria for melanoma.