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April 2006

Man Sees Only What He Knows

Arch Dermatol. 2006;142(4):530. doi:10.1001/archderm.142.4.530-a

I thank Lombardo1 for his stimulating comments on my article, “Dermoscopy Subpatterns of Nonpigmented Skin Tumors,”2 regarding the value of dermoscopy for the diagnosis. To his question, “Am I missing something . . . ?” I can only reply, yes—a new and fascinating dimension of morphologic structures that simply escapes the naked eye, however good this eye might be. This explains, for example, why dermoscopists are able to reduce the number of unnecessary excisions of benign skin tumors3 compared with the number of tumors found during clinical examination and to help pathologists in their diagnosis by selecting more representative areas of suspicious lesions for biopsy.4 Especially in the case of amelanotic melanoma or melanoma that looks clinically benign, the dermoscopic vascular pattern or a missing clinical-dermoscopic correlation might be the only clue to raise the index of suspicion and to avoid incorrect treatment and delayed diagnosis.5 Lombardo correctly points out the great value of a good pair of eyes, but why should we close them when looking through the dermatoscope? Certainly, we have to practice dermoscopy to become familiar with the patterns because, as Johann Wolfgang von Goethe said, “Man sees only what he knows.”

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