Is dermoscopy useful for the diagnosis of melanoma?

I N 1985, at the Annual Meeting of the Austrian Society of Dermatology in Vienna, when giving a lecture on dermoscopy—at that time we used the term incident light microscopy—one of us (H.P.S.) was faced immediately with 2 queries: (1) Is dermoscopy really better than naked-eye examination for the diagnosis of melanoma? (2) Will dermoscopy ever be reimbursed? To answer the second question first: yes, dermoscopy has been reimbursed in Austria since 1987. The colleague asking this question was the person who later negotiated with the Austrian Gebietskrankenkasse and convinced them that dermoscopy should be reimbursed because it represents an innovative clinical method with benefits to individuals at risk for developing melanoma, in particular those with numerous acquired melanocytic nevi. However, the first question—whether dermoscopy is really better than naked-eye examination for the diagnosis of melanoma—certainly has not been so easy to answer. The work of Bafounta et al in this issue provides the best answer up to now to this perplexing question that was asked as early as 1985. But first we will present the reasons why we are convinced that dermoscopy is useful in the diagnosis of melanoma. Dermoscopy opens up a new dimension of clinical morphology that can easily be visualized with rather inexpensive handheld instruments commonly called dermatoscopes. Figure 1 illustrates clinical and dermoscopic images of the same melanoma in situ. Feel free to make your own judgment about whether dermoscopy reveals morphologic structures not visible with the naked eye.