CUTANEOUS MELANOMA: DERMOSCOPY IN EARLY DIAGNOSIS AND THE IMPACT OF BRESLOW THICKNESS ON OUTCOMES

Abstract

Cutaneous melanoma is less frequent than nonmelanoma skin cancers but accounts for a disproportionate share of skin-cancer mortality, making diagnostic timing clinically relevant. This critical narrative review examined the contribution of dermoscopy to early melanoma recognition and the prognostic meaning of Breslow thickness, emphasizing the connection between diagnostic practice, tumor depth, staging, and patient outcomes. Searches were performed in 2026 in PubMed/MEDLINE and the Cochrane Library and were complemented by contemporary clinical guidelines and institutional documents. Evidence from diagnostic meta-analyses shows that dermoscopy improves melanoma discrimination compared with unaided visual inspection, particularly when used by trained clinicians. In patients at increased risk, sequential digital dermoscopy and total-body photography can reveal subtle temporal changes and have been associated with a greater proportion of in situ or thin invasive melanomas. Breslow thickness remains a central component of the eighth edition of the American Joint Committee on Cancer staging system and informs prognosis and discussion of sentinel lymph node biopsy. However, the association between surveillance and thinner tumors should not be interpreted as proof of population-level mortality reduction, because screening studies remain vulnerable to selection, lead-time, length, and overdiagnosis biases. A risk-adapted strategy combining skilled dermoscopy, longitudinal imaging when indicated, timely biopsy, and accurate histopathologic measurement offers the most defensible pathway to earlier recognition without overstating the available evidence.