Mastering Dermoscopy and Dysplastic Nevi

“The biggest take home from the dysplastic nevi is that they're not pre melanomas and that they're markers of risk, so drilling down into the data that's already been published and making sure that you're practicing according to that,” said Elizabeth Berry, MD, FAAD, in an interview at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.

Berry, an associate professor of dermatology and the director of the Multidisciplinary Melanoma Clinic and the Pigmented Lesions Clinic at Oregon Health and Science University, presented in the “Dermoscopy for the Non-dermoscopist" and “Dysplastic Nevi for Dummies” panels at AAD.

In her interview, Berry discussed the changing understanding of dysplastic nevi, noting they are markers of melanoma risk rather than premalignant lesions. She discussed the importance of an iterative learning approach in dermoscopy and the need for more data on managing severely dysplastic nevi.

Dermoscopy, or as Berry refers to it as, the “dermatologist’s stethoscope,” is an essential diagnostic tool for evaluating pigmented lesions. Berry discussed that while the learning curve can initially increase uncertainty, persistence leads to significant diagnostic improvement. She advised clinicians new to dermoscopy to focus on recognizing melanoma-specific structures and distinguishing them from benign mimics. An iterative learning approach—taking and reviewing biopsy photos—can enhance pattern recognition and clinical confidence.

Berry suggested a stepwise approach for those hesitant about using dermoscopy in biopsy decisions. Initially, dermoscopy should be used for observational learning rather than guiding biopsy selection. Over time, clinicians can integrate it into decision-making, improving their diagnostic accuracy. The continued practice of reviewing biopsy results alongside dermoscopic images reinforces learning and refines lesion assessment.

Berry also stressed the need for more data on severely dysplastic nevi management. Contrary to past beliefs, dysplastic nevi are not premalignant but rather markers of increased melanoma risk. Current guidelines indicate that mild to moderate dysplastic nevi, when biopsied with excisional intent, do not require re-excision regardless of margin status. However, questions remain regarding the safest monitoring strategies for severely dysplastic nevi.

Reflecting on AAD, Berry appreciates the exchange of ideas and the opportunity for collaboration. She noted that ongoing research and clinical discussions will be vital in refining the management of pigmented lesions and improving patient outcomes.

Berry’s key message to colleagues was that continued education, collaboration, and data-driven decision-making are key to improving melanoma detection and risk stratification.

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