Early cutaneous melanoma: clinical and dermoscopic criteria for early diagnosis

Abstract

Cutaneous melanoma is the most aggressive form of skin cancer, accounting for the majority of deaths related to cutaneous neoplasms despite its lower incidence. Early diagnosis is the main determinant of favorable clinical outcomes, particularly when lesions are identified at initial stages. This study aimed to analyze the main clinical and dermoscopic criteria used for the early diagnosis of cutaneous melanoma, highlighting their applicability and limitations. This is a qualitative narrative literature review conducted through a structured search in the PubMed, SciELO, and ScienceDirect databases, including studies published in the last 10 years. A total of 19 articles that met the predefined inclusion criteria were selected and critically analyzed, being organized into thematic categories. The results indicate that clinical criteria, such as the ABCDE rule and the “ugly duckling” sign, play an important role in initial screening; however, they present limited sensitivity in detecting early or atypical melanomas. Dermoscopy proved to be superior to clinical examination alone, increasing diagnostic accuracy, although its effectiveness depends on the examiner’s experience and may be limited in lesions with low expression of structural criteria. Dermoscopic algorithms contribute to the standardization of lesion assessment but are not fully effective in all clinical scenarios. In addition, thin melanomas and the so-called featureless melanoma represent significant diagnostic challenges and are often associated with false-negative results. Complementary methods, including digital dermoscopy, reflectance confocal microscopy, and artificial intelligence, show promising potential, although they still face limitations regarding standardization and clinical applicability. It is concluded that the early diagnosis of cutaneous melanoma requires an integrated approach combining clinical criteria, dermoscopy, and complementary methods in order to improve diagnostic sensitivity and specificity and reduce morbidity and mortality associated with the disease.