Special Report 10.1586/17469872.1.3.361 © 2006 Future Drugs Ltd ISSN 1746-9872 361 www.future-drugs.com Do we detect a new spectrum of biologically benign melanomas in the dermoscopy era? Giuseppe Argenziano † and Iris Zalaudek † Author for correspondence Department of Dermatology, Second University of Naples, Via S. Pansini, 5–80131 Naples, Italy Tel.: +39 081 566 6675 Fax: +39 081 566 6675 argenziano@tin.it KEYWORDS: dermoscopy, digital dermoscopy, epidemic, follow up, incidence, melanoma Current trends in the melanoma epidemic reveal a dramatic increase of local and in situ melanoma, whereas advanced disease and mortality rates remain relatively stable. Owing to these epidemiological data, the question arose of whether or not a new spectrum of melanomas characterized by a less aggressive biological behavior does exist. Proving the existence of biologically benign melanoma is difficult or even impossible, as once melanoma is removed, its natural history will remain unclear, at least until metastasis eventually occurs. Today, digital dermoscopic imaging techniques permit a detailed documentation of lesions over time and, therefore, represent an optimal tool to disclose the natural evolution of a given lesion. To date, two cases of melanoma, followed up over 10 years, have been reported in the literature that might belong to the spectrum of biologically benign melanomas. In this review, we discuss the current literature on this topic and the impact of dermoscopy in the diagnosis and documentation of this unusual type of melanoma by providing four new cases. Expert Rev. Dermatol. 1(3), 361–367 (2006) Expert commentary Melanoma is one of the most aggressive tumors in humans. If advanced, there is almost no treatment available to change the unfavor- able course of the disease. However, melanoma has a great advantage that is not comparable to any other major cancer, namely its location on the skin. This tumor could therefore be easily discovered in its early phase of development by a simple skin inspection. When diagnosed early, melanoma is usually completely cured with the simple excision of the primary lesion. That is the reason why AB. Ackerman stated that no one should die from melanoma [1]. Usually, melanoma grows first horizontally within the skin and, after a variable number of months or years, may develop clones of cells that are able to grow vertically into the deep dermis and metastasize. Thus, there is reasona- ble time for a patient to see that a tumor is growing on his/her skin and for a doctor to diagnose and excise a melanoma before it becomes thick. However, there is evidence that not all melanomas harbor the same aggressive potential. Among the four most common types – lentigo maligna melanoma, superficial spreading melanoma, acral melanoma and nodular melanoma – the latter becomes thick faster due to its rapid vertical growth. This behavior renders early diagnosis almost impos- sible in most cases. On the other side of the spectrum, lentigo maligna represents the less aggressive form of melanoma, which is charac- terized by a slow horizontal growth within the epidermis over months or years, before chang- ing into the vertical growth phase and reaching the potential to metastasize [2]. Although some argue that this categorization is somehow arti- ficial [3,4], it is a matter of fact that these four types of melanoma exhibit different biological behaviors. The concept that melanoma is a family of tumors characterized by different degrees of aggressiveness has, therefore, been well known for a long time. Over the past 20 years, the incidence of melanoma has risen faster than any other major cancer. In 2002, the incidence was about six-times that in 1950 [2]. Some authors suggest that this rising incidence may be more apparent than real and argue that some lesions CONTENTS Expert commentary Five-year view Key issues References Affiliations For reprint orders, please contact reprints@future-drugs.com