Malignant melanomas are characterized by heterogeneity and asymmetry as well as by a higher density of blood vessels than benign pigmented tumours. The aim of this study was to evaluate the benefit of high-resolution laser Doppler perfusion imaging (LDPI) in the differential diagnosis of pigmented skin tumours. One-hundred-and-eighty-nine patients were examined with the LDPI, 22 with malignant melanomas, 39 with clinically suspicious dysplastic melanocytic naevi and 27 with basal cell carcinomas. Following examination, the tumours were excised and examined histologically. A control group of 101 melanocytic naevi showed clinically and, with epiluminescence microscopy, definitely benign criteria. These naevi were not excised. In malignant melanomas there was a 3.6+/-1.5 times higher perfusion than in healthy skin. The corresponding figures for clinically suspicious melanocytic naevi and basal cell carcinomas were 2.2+/-1.1 and 2.0+/-0.7, respectively. The increase in flow in malignant melanomas was significantly higher than in clinically suspicious melanocytic naevi and basal cell carcinomas (p < 0.001). All malignant melanomas showed at least 1.8 times higher flow values than healthy skin. When this value is taken as the basis for the diagnosis "benign or malignant", the LDPI proved a sensitivity of 100% and a specificity of 85%. If only the distinction between malignant melanomas and clinically suspicious naevi is considered, the specificity is reduced to 48%. There was no correlation between tumour thickness and increase in the mean perfusion of malignant melanomas (r = 0.14; p = 0.5). High-resolution LDPI can be used as an additional automatic screening method.