Abstract
As melanomas grow, they become more obvious and more deadly. As physicians, one of our goals is to identify and excise melanomas as early as possible. It is anticipated that 51, 400 new melanomas will be diagnosed in the United States this year.
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It is also estimated that there are 4 billion melanocytic nevi,
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or roughly 90, 000 nevi, for every melanoma. Although it is critical not to miss an early melanoma, it is also important not to indiscriminately remove benign nevi given the scarring, medical costs, and associated surgical risks. Distinguishing an early melanoma from a benign nevus can present quite a challenge, and many factors must be considered in deciding whether a lesion should be excised. These factors include a reported history of change by the patient, the anxiety level of the patient, patient or family history of melanoma, physical examination revealing irregular features (visible or palpable), how different the lesion is from the average size of the patient's lesions, and documentation of change. Dermatoscopy allows for a more detailed visual physical examination of a lesion and thereby may allow for identification of structural details that will favor a malignant or benign diagnosis. Sometimes even with dermatoscopy, however, identification of a malignant lesion can be difficult.
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This review illustrates lesions in which the dermatoscopic diagnosis of melanoma or not melanoma can be a challenge.
