Dermatoscopic diagnosis of malignant melanoma.

Sir, I read with interest the report by Lorentzen et al. describing their evaluation of the ABCD rule compared to simple dermatoscopy in the diagnosis of malignant melanoma (1). As the authors mention, propagation of the ABCD rule is due to its didactic qualities. Another important reason for the attempt to determine exact clinical criteria of a melanomasuspicious, pigmented skin lesion is scienti®c interest in the biology of this tumour. Nachbar, Stolz et al. (2, 3) as well as Kenet et al. (4, 5) tried to ®gure out what exact parameters affect the decision of a clinically experienced physician to diagnose a malignant melanoma. To my opinion, these algorithms are of tremendous value despite the fact that due to its complexness these rules will probably never enter daily clinical routine. The sensitivity of clinical diagnosis of malignant melanoma of 9 observers was higher when applying only dermatoscopy compared to the strict application of the ABCD rule following dermatoscopic examination. This seems to be irrelevant as the authors cannot show any modi®cation of the ABCD rule which would result in an even better correlation than already observed. One useful approach for the generation of a better dermatoscopic ABCD-rule than that already proposed by Stolz et al. would be its evaluation compared to other rules. Lorentzen et al (1) stated that ``A comparison of Stolz's and Kenet's different diagnostic strategies will be performed'' in a following article. This will be of interest.