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Correspondence
October 2010

Why the First Step Should Be Abandoned!

Author Affiliations

Author Affiliation: Department of Dermatology, University of Vienna Medical School, Vienna, Austria.

Arch Dermatol. 2010;146(10):1182-1183. doi:10.1001/archdermatol.2010.271

In contrast to the proposal by Marghoob and Braun,1 who revised the 2-step algorithm for dermoscopy, I do not recommend use of the 2-step algorithm at all because the first step (ie, the differentiation between melanocytic and nonmelanocytic lesions) is unnecessarily complex and unreliable. According to their proposal, the revised first step now has 7 levels. Apart from the time it would take per lesion to go through all 7 levels, an error in any of these levels will inevitably lead to a wrong final diagnosis.

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