Long Term Monitoring

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 Author(s): Florentia Dimitriou, Harald Kittler

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Author(s)	Florentia Dimitriou · Harald Kittler
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Long Term Monitoring

• 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 (change in size and shape), whereas nevi more frequently grow symmetrically (size but not in shape).
• Structural changes and color changes are more frequently observes in melanomas than in nevi.

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 insure normal growth and behavior (STMM)	Digitally monitor until senescent. If not able to digitally monitor then consider biopsy

References

1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
2. Argenziano, G., Kittler, H., Ferrara, G., et al., 2010, Slow-growing melanoma: a dermoscopy follow-up study. Br J Dermatol, 162, 267–73.
3. Argenziano, G., Zalaudek, I. & Ferrara, G., 2007, Fast-growing and slow-growing melanomas. Arch Dermatol, 143, 802–3; author reply 803–4.
4. Banky, J.P., Kelly, J.W., English, D.R., Yeatman, J.M. & Dowling, J.P., 2005, Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol, 141, 998–1006.
5. Dawid, M., Pehamberger, H., Wolff, K., Binder, M. & Kittler, H., 2002, Evaluation of the ability of patients to identify enlarging melanocytic nevi. Arch Dermatol, 138, 984–5. Fuller, S.R., Bowen, G.M., Tanner, B., Florell, S.R. & Grossman, D., 2007, Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma. Dermatol Surg, 33, 1198–206; discussion 1205–6.
6. Kittler, H. & Binder, M., 2001, Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi. Arch Dermatol, 137, 1590–5.
7. Kittler, H. & Binder, M., 2002, Follow-up of melanocytic skin lesions with digital dermoscopy: risks and benefits. Archives of Dermatology, 138, 1379.
8. Kittler, H., Guitera, P., Riedl, E., et al., 2006, Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging. Arch Dermatol, 142,
9. 1113–19.
10. Kittler, H., Pehamberger, H., Wolff, K. & Binder, M., 2000a, 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, 43, 467–76.
11. Kittler, H., Seltenheim, M., Dawid, M., et al., 2000b, Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol, 136, 316–20.
12. Schiffner, R., Schiffner-Rohe, J., Landthaler, M. & Stolz, W., 2003, Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compli- ance. Br J Dermatol, 149, 79–86.
13. Terushkin, V., Dusza, S.W., Scope, A., et al., 2012, Changes observed in slow-growing melanomas during long-term dermoscopic monitoring. Br J Dermatol, 166, 1213–20.
14. Zalaudek, I., Karin, S., Marghoob, A., et al., 2011, Frequency of dermoscopic nevus subtypes by age and body site: a Cross-sectional Study. Arch Dermatol, 147, 663–70.