Dermatoscopy has emerged as an important diagnostic adjunct in the clinical evaluation and diagnosis of pigmented lesions. Despite widespread use in Europe, dermatoscopy is not routinely taught in US residency training. In the current medical environment, dermatologists are expected to be expert in the clinical differentiation between malignant and nonmalignant pigmented lesions. Historically, however, diagnostic accuracy of difficult lesions is about 75% for general dermatologists and only 80% for dermatologists with greater experience. Dermatoscopy provides an additional tool by which clinicians may incorporate a formal method of evaluating problematic lesions and potentially improve diagnostic accuracy.