Theoretically, the clinical and dermoscopic diagnosis of melanocytic skin lesions is rather easy, because reliable and reproducible criteria exist allowing the differentiation between the many faces of benign and malignant melanocytic skin lesions to be made with confidence. Obviously, there are a certain number of lesions defying clinical and also dermoscopic diagnosis, and in those instances histopathology, especially when performed by well-trained and competent dermatopathologists, is the ultimate standard for diagnosis.
Real life, however, is different and, at least in our opinion, a definitive clinical and dermoscopic diagnosis, also when using reliable and repeatable criteria is often difficult and sometimes simply a guessing game. This statement is true not only for the clinical and dermoscopic diagnosis of melanocytic skin lesions, but also for the histopathologic ones. Especially in the realm of junctional melanocytic proliferations, whether situated on sun-damaged skin or not, the border between benign lesions, e.g., junctional type of Clark nevus, and malignant lesions, e.g., melanoma in situ or lentigo maligna, can be drawn neither with competence nor with indoctrination.
In order to underline our assertion several examples of melanocytic proliferations, either purely or predominantly junctional, will be exhibited that dermoscopically as well as histopathologically withstand this distinction. The proposal for unifying these melanocytic proliferations under the umbrella of the term MIN (‘melanocytic intraepidermal neoplasia’) as recently suggested [Skov L, Clemmensen O, Baadsgaard O. Lancet 1997; 350:1264 - Slater D. Lancet 1998; 351:522], has been abandoned by pathologists and dermatologists for several reasons, presumably also because simplification of a complex and perplexing issue is not really wanted by the scientific community.
Nevertheless, patients with single and, even more, with multiple melanocytic skin lesions have to be managed by physicians with carefulness and responsibility and, in our estimation, dermoscopy is a helpful tool to achieve this goal. Melanocytic skin lesions within this ‘gray zone’ simply should be excised or followed up closely by using the newly available digital technologies. So, the visionary statement of A.B. Ackerman ‘No one should die of malignant melanoma’ may be realized in the very near future.