Digital mole monitoring
From dermoscopedia
Introduction
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].
References
- ↑ Babino et al.: Melanoma diagnosed on digital dermoscopy monitoring: A side-by-side image comparison is needed to improve early detection. J Am Acad Dermatol 2021;85:619-625. PMID: 32652193. DOI.
- ↑ Stolz et al.: Improvement of monitoring of melanocytic skin lesions with the use of a computerized acquisition and surveillance unit with a skin surface microscopic television camera. J Am Acad Dermatol 1996;35:202-7. PMID: 8708021. DOI.
- ↑ Altamura et al.: Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopy monitoring for the diagnosis of melanoma. Arch Dermatol 2008;144:502-6. PMID: 18427044. DOI.
- ↑ Altamura et al.: Dermoscopic changes in acral melanocytic nevi during digital follow-up. Arch Dermatol 2007;143:1372-6. PMID: 18025360. DOI.
- ↑ 5.0 5.1 Argenziano et al.: Slow-growing melanoma: a dermoscopy follow-up study. Br. J. Dermatol. 2010;162:267-73. PMID: 19785607. DOI.
- ↑ 6.0 6.1 Argenziano et al.: Fast-growing and slow-growing melanomas. Arch Dermatol 2007;143:802-3; author reply 803-4. PMID: 17576955. DOI.
- ↑ Banky et al.: Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol 2005;141:998-1006. PMID: 16103329. DOI.
- ↑ Bauer et al.: Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 2005;152:87-92. PMID: 15656806. DOI.
- ↑ Kittler & Binder: Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi. Arch Dermatol 2001;137:1590-5. PMID: 11735709. DOI.
- ↑ Kittler & Binder: Follow-up of melanocytic skin lesions with digital dermoscopy: risks and benefits. Arch Dermatol 2002;138:1379. PMID: 12374553. DOI.
- ↑ Kittler et al.: Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging. Arch Dermatol 2006;142:1113-9. PMID: 16982998. DOI.
- ↑ Dawid et al.: Evaluation of the ability of patients to identify enlarging melanocytic nevi. Arch Dermatol 2002;138:984-5. PMID: 12071837. DOI.
- ↑ Fuller et al.: Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma. Dermatol Surg 2007;33:1198-206; discussion 1205-6. PMID: 17903152. DOI.
- ↑ Haenssle et al.: Results from an observational trial: digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma. J Invest Dermatol 2006;126:980-5. PMID: 16514414. DOI.
- ↑ Zalaudek et al.: Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study. Arch Dermatol 2011;147:663-70. PMID: 21690528. DOI.
- ↑ Menzies et al.: Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol 2001;137:1583-9. PMID: 11735708. DOI.
- ↑ Robinson & Nickoloff: Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol 2004;140:49-56. PMID: 14732660. DOI.
- ↑ Schiffner et al.: Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol 2003;149:79-86. PMID: 12890198. DOI.
- ↑ Terushkin et al.: Changes observed in slow-growing melanomas during long-term dermoscopic monitoring. Br J Dermatol 2012;166:1213-20. PMID: 22283805. DOI.
- ↑ Kittler et al.: Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000;43:467-76. PMID: 10954658. DOI.
- ↑ Kittler et al.: Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol 2000;136:316-20. PMID: 10724192.
