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The purpose of epiluminescence microscopy (ELM), also referred to as dermoscopy, dermatoscopy , or skin surface microscopy , is to complement the clinical examination of pigmented skin lesions (PSLs) to improve the differential diagnosis between nonmelanocytic and melanocytic lesions and the recognition of early cutaneous malignant melanoma (CMM). 14 In three sections, this article addresses the relationship between Breslow thickness and ELM features of CMM. Section one suggests the essential theoretical background of the association between Breslow thickness and ELM features of the disease. The main events of histogenesis, 3, 4, 6 particularly in the intraepidermal phase and the initial invasion of dermis, can be considered the rationale for interpreting the ELM characteristics of CMM in relation to tumor thickness. The second section briefly reviews previous clinical studies that have reported the relationship between thickness and ELM presentation. Generally, such a crucial issue has been the subject of a limited number of specific reports. Some studies have formally considered the prevalence of ELM features according to thickness 1, 5 ; others have focused on a detailed morphologic analysis of ELM structures and features in relation to thickness, with no statistical evaluation of the observed differences between thin and thick lesions. 8, 10, 11 Some reports have addressed the ELM characteristics of CMM as a function of the histologic type of the lesion, 23 or have compared in situ lesions with invasive CMM 13, 16 ; although indirectly, the latter type of studies has provided useful and important details for the purposes of this review. The third section consists of selected iconographic material from the Skin Cancer Clinic of Ravenna 19, 20, 21, 22 and is aimed at providing thickness-specific ELM images to further clarify the ELM features of CMM in different growth phases. The images have been captured with digital ELM equipment consisting of a Leica Wild M-650 stereomicroscope (Leica AG, Heerbrugg, Switzerland), a Sony 3CCD DXC-930P color video camera, an AT-Vista Videographics adapter, an IBM personal computer, a Sony Trinitron Analog PVM-2043MD monitor, and the DBDERMO MIPS software (Dell'Eva/Burroni, Florence/Siena, Italy). 19, 20, 21, 22 The digital images were processed at 768 × 576 pixels and 16 bytes per pixel.