Limitations of histopathologic analysis in the recognition of melanoma: a plea for a combined diagnostic approach of histopathologic and dermoscopic evaluation.

T HE ARTICLE PUBLISHED BY SKVARA ET AL 1 IN this issue of the ARCHIVES focuses on the limitations of dermoscopy in the diagnosis of very early and mainly featureless melanomas. The authors report that baseline dermoscopic patterns of 262 melanocytic nevi did not differ from those of 63 melanomas observed by digital dermoscopy and finally excised because of changes overtime. The authors wisely foresee that this basically featureless or “feature-poor” group of melanomas will be used by both sides in the digital dermoscopy controversy: proponents will cite them as evidence that follow-up with digital dermoscopy is necessary; opponents point to them as evidence that dermoscopy is unnecessary and that every clinically suspicious lesion must be excised. The authors acknowledge the strengths and limitations of both views, but the question remains whether dermoscopically featureless or feature-poor lesions warrant excision.