Discrepancies in dermatoscopy — pathology correlation of pigmented skin lesions

Various dermatoscopic algorithms are used to diagnose skin lesions. There are specific dermatoscopic structures that suggest malignancy. Despite constant progress in dermatoscopy, the method has its limitations. There is a group of pigmented lesions that we cannot name in dermatoscopy, or even determine whether they are benign or mali­gnant. Many benign lesions are excised. The article aims to explain the factors that may cause the discrepancies be­tween dermatoscopic and histopathologic diagnoses of pigmented skin lesions. The reasons for the discrepancies are complex. Different structures are evaluated in dermatoscopy (pigment distribution) and histopathology (architecture and morphology of melanocytes). Every single dermatoscopic structure can be seen both in benign and malignant lesions. Some early melanomas lack specific dermatoscopic criteria. Finally, there is no consensus among pathologists regarding the final diagnosis in the group of melanocytic lesions. Despite its limitations, dermatoscopy significantly increased melanoma detection, especially in the early stages.