• Hans Skvara, Ligia Teban, Manfred Fiebiger, Michael Binder, and Harald Kittler.
• Department of Dermatology, Division of General Dermatology, University of Vienna Medical School, Vienna, Austria.
• Arch Dermatol. 2005 Feb 1; 141 (2): 155-60.

ObjectiveTo compare dermoscopic features of melanocytic nevi with those of early melanomas that were not excised initially because of their uncharacteristic clinical and dermoscopic appearance.DesignRetrospective study of the baseline images of 325 melanocytic skin lesions that were observed by digital dermoscopy and finally excised because of changes over time.SettingA dermatologic clinic and a dermatologic department at a university hospital.Main Outcome MeasuresComparison of baseline images of melanomas and melanocytic nevi by pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist.ResultsBaseline dermoscopic images of 262 melanocytic nevi and 63 melanomas from 315 patients were included in the analysis. The patterns of dermoscopic features observed in the baseline images of melanocytic lesions finally diagnosed as melanomas during follow-up did not differ substantially from the patterns observed in the baseline images of melanocytic nevi. Pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist failed to achieve adequate diagnostic accuracy for melanoma. In retrospect, no dermoscopic feature or pattern of features could be identified that reliably differentiated between melanomas and melanocytic nevi at the time of the first presentation.ConclusionDermoscopy depends on the appearance of classic dermoscopic features and is therefore limited in the diagnosis of very early and mainly featureless melanomas.

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