There is no doubt that dermatopathology is the most important method to decide if a melanocytic lesion is benign or malignant; however, like most morphologic examinations, dermatopathology is subjective. A recent study demonstrated that the pathologic diagnosis of melanocytic skin lesions has a high variability. Reports with false-positive or false-negative diagnoses are relatively common. The pathologic examination of melanocytic lesions also has observer-independent limitations and one has to accept that some melanocytic lesions cannot be classified as benign or malignant with confidence by dermatopathology alone. If a confident diagnosis is not possible a dermatoscopic-pathologic correlation may be helpful. This, however, is only possible if dermatoscopic images are available and if the dermatopathologist knows how to interpret dermatoscopic structures. A dermatoscopic-pathologic correlation is not useful in all difficult melanocytic lesions but it should be considered in difficult flat pigmented lesions. In these cases dermatoscopy may provide even more important additional information than molecular findings.
Keywords: Dermatooncology; Dermatopathology; Dermoscopy/Dermatoscopy; Melanoma; Nevi.