The purpose of epiluminescence microscopy (ELM), also referred to as dermoscopy, dermatoscopy, or skin surface microscopy, is to complement the clinical examination of pigmented skin lesions (PSLs) to improve the differential diagnosis between nonmelanocytic and melanocytic lesions and the recognition of early cutaneous malignant melanoma (CMM).<sup>14 Pehamberger H., Binder M., Steiner A. , e al. In vivo epiluminescence microscopy: Improvement of early diagnosis of melanoma J Invest Dermatol 1993 ;  100 : 356S-362S

Cliccare qui per andare alla sezione Riferimenti</sup>

In three sections, this article addresses the relationship between Breslow thickness and ELM features of CMM. Section one suggests the essential theoretical background of the association between Breslow thickness and ELM features of the disease. The main events of histogenesis, <sup>3 Clark W.H., Elder D.E., Guerry D. Displastic nevi and malignant melanoma Pathology of the Skin London: Prentice-Hall International (1990).  682-754

Cliccare qui per andare alla sezione Riferimenti, 4 Clark W.H., Elder D.E., Van Horn M. The biologic forms of malignant melanoma Hum Pathol 1986 ;  17 : 443-450  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 6 Friedmann R., Heilmann E., Gottlieb G. , e al. Malignant melanoma: Clinicopathologic correlations Cancer of the Skin Philadelphia: Saunders (1991).  148-176

Cliccare qui per andare alla sezione Riferimenti</sup> particularly in the intraepidermal phase and the initial invasion of dermis, can be considered the rationale for interpreting the ELM characteristics of CMM in relation to tumor thickness.

The second section briefly reviews previous clinical studies that have reported the relationship between thickness and ELM presentation. Generally, such a crucial issue has been the subject of a limited number of specific reports. Some studies have formally considered the prevalence of ELM features according to thickness<sup>1 Argenziano G., Fabbrocini G., Carli P. , e al. Epiluminescence microscopy: Criteria of cutaneous melanoma progression J Am Acad Dermatol 1997 ;  37 : 68-74  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 5 Dummer W., Blaheta H.-J., Bastian B.C. , e al. Preoperative characterization of pigmented skin lesions by epiluminescence microscopy and high-frequency ultrasound Arch Dermatol 1995 ;  131 : 279-285

Cliccare qui per andare alla sezione Riferimenti</sup>; others have focused on a detailed morphologic analysis of ELM structures and features in relation to thickness, with no statistical evaluation of the observed differences between thin and thick lesions.<sup>8 Kenet R.O., Kang S., Kenet B.J. , e al. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy: Grading protocol and atlas Arch Dermatol 1993 ;  129 : 157-174

Cliccare qui per andare alla sezione Riferimenti, 10 Menzies S.W., Crotty K.A., McCarty W.H. The morphologic criteria of the pseudopod in surface microscopy Arch Dermatol 1995 ;  131 : 436-440

Cliccare qui per andare alla sezione Riferimenti, 11 Menzies S.W., Ingvar C., Crotty K.A. , e al. Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features Arch Dermatol 1996 ;  132 : 1178-1182

Cliccare qui per andare alla sezione Riferimenti</sup> Some reports have addressed the ELM characteristics of CMM as a function of the histologic type of the lesion, <sup>23 Stolz W., Braun-Falco O., Bilek P. , e al.   Color Atlas of Dermatoscopy Oxford: Blackwell (1995). 

Cliccare qui per andare alla sezione Riferimenti</sup> or have compared in situ lesions with invasive CMM<sup>13 Oguchi S., Saida T., Koganehira Y. , e al. Characteristic epiluminescent microscopic features of early malignant melanoma on glabrous skin: A videomicroscopic analysis Arch Dermatol 1998 ;  134 : 563-568  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 16 Shulz H. Auflichtmikroskopische charakteristika kleiner maligner melanome Hautarzt 1997 ;  48 : 904-909

Cliccare qui per andare alla sezione Riferimenti</sup>; although indirectly, the latter type of studies has provided useful and important details for the purposes of this review.

The third section consists of selected iconographic material from the Skin Cancer Clinic of Ravenna<sup>19 Stanganelli I., Bauer P., Bucchi L. , e al. Critical effects of intense sun exposure on the expression of epiluminescence microscopy features of acquired melanocytic nevi Arch Dermatol 1997 ;  133 : 979-982

Cliccare qui per andare alla sezione Riferimenti, 20 Stanganelli I., Rafanelli S., Bucchi L. Seasonal prevalence of digital epiluminescence microscopy patterns in acquired melanocytic nevi J Am Acad Dermatol 1996 ;  34 : 460-464  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 21 Stanganelli I., Rafanelli S., Crisanti E. , e al. Correlation between the histopathology and the epiluminescence microscopy features of malignant blue nevus Dermatol Surg 1996 ;  22 : 846-848  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 22 Stanganelli I., Seidenari S., Serafini M. , e al. Diagnosis of pigmented skin lesions by epiluminescence microscopy: Determinants of accuracy improvement in a nationwide training programme for practical dermatologists Public Health 1999 ;  113 : 237-242  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and is aimed at providing thickness-specific ELM images to further clarify the ELM features of CMM in different growth phases. The images have been captured with digital ELM equipment consisting of a Leica Wild M-650 stereomicroscope (Leica AG, Heerbrugg, Switzerland), a Sony 3CCD DXC-930P color video camera, an AT-Vista Videographics adapter, an IBM personal computer, a Sony Trinitron Analog PVM-2043MD monitor, and the DBDERMO MIPS software (Dell'Eva/Burroni, Florence/Siena, Italy).<sup>19 Stanganelli I., Bauer P., Bucchi L. , e al. Critical effects of intense sun exposure on the expression of epiluminescence microscopy features of acquired melanocytic nevi Arch Dermatol 1997 ;  133 : 979-982

Cliccare qui per andare alla sezione Riferimenti, 20 Stanganelli I., Rafanelli S., Bucchi L. Seasonal prevalence of digital epiluminescence microscopy patterns in acquired melanocytic nevi J Am Acad Dermatol 1996 ;  34 : 460-464  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 21 Stanganelli I., Rafanelli S., Crisanti E. , e al. Correlation between the histopathology and the epiluminescence microscopy features of malignant blue nevus Dermatol Surg 1996 ;  22 : 846-848  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 22 Stanganelli I., Seidenari S., Serafini M. , e al. Diagnosis of pigmented skin lesions by epiluminescence microscopy: Determinants of accuracy improvement in a nationwide training programme for practical dermatologists Public Health 1999 ;  113 : 237-242  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The digital images were processed at 768 × 576 pixels and 16 bytes per pixel.