Digital mole monitoring

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Description This chapter explains digital mole monitoring
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Status update August 25, 2021
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Digital mole monitoring of atypical melanocytic lesions is a well-known, particularly useful strategy that helps recognize melanomas which may may lack the specific dermatoscopic features at baseline [1][2].

Basic principle of digital dermoscopes

A hand-held dermatoscope is attached to a digital video camera. The camera is connected to a monitor, that displays the dermoscopic image in real time. A computer allows to capture and store the images from the camera.

Digital dermoscopy can improve diagnostic sensitivity for early melanoma by identifying changes in lesions over time that indicate impending or incipient malignancy and it can reduce the number of biopsies of benign lesions that are biologically indolent (senescent, not changing) [3].

Benefits of digital mole monitoring

  • Simpler monitoring of lesions
  • Images of the same lesion obtained at different points are easy to compare
  • Enables to diagnose small, inconspicuous and featureless melanomas by detecting change over time
  • Helpful for high risk individuals with multiple pigmented lesions
  • Patient participation in the examination [4][5][6]

Indications and contraindications

  • Digital monitoring should be reserved for small and flat melanocytic lesions, that demonstrate no obvious clues to melanoma.
  • Regardless of how one uses monitoring, knowing which lesions are unsafe to monitor is essential. Monitoring is performed on potential melanomas.
  • Monitoring by digital monitoring is especially suitable for patients with multiple nevi. For these high risk patients, lesions to be monitored are selected randomly. It is recommended to evaluate and re-image as many lesions as possible at each consultation.
  • When examining patients with multiple nevi, it is recommended to dispense with the documentation of melanocytic lesions that are smaller than 3mm in diameter.
  • Nodular melanomas can grow rapidly even in the early stages of evolution. Nodular lesions that cannot be diagnosed as benign with absolute certainty must be excised at the initial consultation [5][6][7][8][9][10][11].

Interpretation of changes

Distinctions are made on the basis of changes in size, color and structure[12][13][14][15].

Changes in size

  • Symmetrical: the shape of the lesions remains the same
  • Asymmetrical: the shape changes

Changes in color

  • A pre-existing color (usually brown) appears lighter or darker
  • A new color is seen

Changes in structure

  • Disappearance of an existing pattern
  • Appearance of a new pattern
  • Presence of basic elements of a pattern in greater or reduced numbers (such as dots or clods)

Short Term Monitoring

every three months or less

  • Performed for suspicious lesions.
  • It enables early detection of featureless melanomas while decreasing the need of excision of clinically suspicious benign lesions.
  • Any morphologic changes seen at the three-month follow-up requires excision [16][17].

Significant change Non-significant change
Any change other than non-significant changes Global change in pigmentation
Loss or appearance of milia-like cysts

Benign Lesions

  • Lesions remaining unchanged at 2-5-4.5 months are mostly confirmed benign at further follow-up.

Non-lentigo maligna type lesions

  • Lesions observed to change during the short-term interval of 2.5-4.5 months.

Lentigo maligna Lesions

  • The changes in lentigo maligna melanoma can develop very gradually and thus a longer follow-up interval is required. A monitored interval between 6-12 months is recommended.

Long Term Monitoring

every six months to one year

  • It is mainly used for randomly selected lesions with no features to suggest malignancy, typically in patients with multiple nevi.
  • Long-term follow-up changes observed in melanomas are different from those observed in nevi.
  • Melanomas more frequently grow asymmetrically (changes in size and shape), whereas nevi more frequently grow symmetrically (in size but not in shape).
  • Structural changes and color changes are more frequently observes in melanomas than in nevi [18][19].

Classification of Changes

Significant change Non-significant change
Asymmetric enlargement Darker or lighter overall appearance
Focal changes in pigmentation or structure Change in number or distribution of brown globules
Regression features Decrease in number of black dots
Change in color Disappearance of inflammatory reaction
Disappearance of small foci of pigment network within central portion of the lesion and replacement by diffuse brown pigmentation

Management approach for nevi with peripheral grim of globules

In contrast to melanomas, enlarging melanocytic nevi typically show symmetrical enlargement without structural changes. The dermoscopic sign of peripheral rim of brown globules is highly characteristic for symmetrically enlarging melanocytic nevi in youth. Once these nevi enter senescence, the peripheral globules are no longer visible and the nevus will usually manifest a reticular or homogenous pattern.

<20 years old 20–50 years old >50 years old
Reassure Follow-up to ensure normal growth and behavior (STMM) Digitally monitor until senescent. If not able to digitally monitor then consider biopsy

Growing nevus or melanoma?

  • Nevi stop growing at some time whereas melanomas do not.
  • In adults, the proportion of nevi that show significant changes in the course of a year is less than 5%.
  • Changes in color almost never occur in nevi. Significant structural changes are mainly observed in melanomas.
  • Most nevi do not change over one year. Monitoring for intervals longer than one year is not recommended.
  • The longer the monitoring period, the more noticeable the changes [20][21].


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