[Clinical differential diagnosis of pigmented skin changes and contribution of epiluminescence microscopy]

The differential diagnosis of skin pigmented lesions is an everyday challenge for the physician. The main goal is the early diagnosis of malignant melanoma because its prognosis is directly correlated with its thickness at the time of the excision. Identification criterion of invasive melanoma have been recognized in the past, like bleeding or ulceration. More subtle clinical criterion have been identified and are summarized in the ABCDE rule (Asymmetry, irregular Border, variegation in Colour, Dimension and Enlargement). A knowledge of the various kind of skin pigmented lesions should help the physician to differentiate benign lesions from suspicious or frankly malignant ones, in order to set up the indication for an histological procedure or for a subsequent follow-up of the patient. More recently, skin surface biomicroscopy, or dermoscopy, has revealed invisible structures to naked eye, allowing to enhance the clinical diagnosis of skin pigmented lesions, but a specific education is needed.