Dermoscopy in the prevention and early diagnosis of melanoma: a biological perspective.

Dermoscopy allows us to visualize structures and colors in pigmented lesions that are not visible to the naked eye. By comparing serial dermoscopic images of a mole, we can appreciate changes occurring long before any instability would be apparent on evaluation of conventional macroscopic images. One of the primary objectives of digital dermoscopy is to facilitate the storage and later comparison of serial images of atypical moles.1 Instability in such moles, as evidenced by increasing atypia, may give rise to a suspicion that the lesion is an incipient melanoma or a mole evolving towards melanoma. There are basically 4 possible scenarios in the diagnosis of a melanoma using dermoscopy. The first of these is the need to establish a morphologic differential diagnosis between a possible melanoma and a nonmelanocytic lesion, such as a seborrheic keratosis or basal cell epithelioma.2 In this case, the differential diagnosis is strictly morphologic. The greater diagnostic accuracy of dermoscopy compared to the unaided eye will help to prevent many unnecessary or unnecessarily urgent biopsies and excisions. And, more importantly, the use of dermoscopy will help to prevent the inadequate or delayed treatment of a melanoma.