Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma

Abstract

Background: Atypical nevi are a common risk factor for melanoma.

Objectives: The objective was to determine the utility of monitoring dermoscopic photographs of atypical nevi in a high-risk population.

Methods: Over a 4.5-year period, digital dermoscopic photographs were taken of clinically atypical nevi at initial and follow-up visits, such that side-by-side comparisons could be made.

Results: A total of 5,945 lesions were monitored in 297 patients over 3 to 52 months (median, 22 months), and 324 lesions were biopsied. Photographic (dermoscopic) changes were noted in 96 of 5,945 (1.6%) lesions, which included 64 dysplastic nevi (67%), 25 common nevi (26%), and 1 melanoma (1.0%). Of 6 melanomas biopsied during the follow-up period, only 1 was detected by dermoscopic photographic change at follow-up.

Conclusions: Most clinically atypical melanocytic nevi are stable over time, and lesions exhibiting dermoscopic changes are most likely to be dysplastic nevi. Although dermoscopy is a useful tool for clinical examination, the sensitivity of dermoscopic monitoring is limited by melanomas that may arise in normal skin or in clinically benign nevi that were not initially photographed.

Figure 1

Serial dermoscopic images of nevi. (A) Photos of stable clinically atypical nevus on upper back of a 40-year-old male, taken 10/12/00, 8/22/02, and 9/11/03 when biopsy demonstrated dysplastic nevus with mild atypia. (B) Photos of changing lesion on scalp of 53–year-old male, taken on 11/10/99, 11/15/01, and 7/31/03 when biopsy revealed dysplastic nevus with moderate atypia. (C) Photos of changing lesion on thigh of 41-year-old female, taken on 3/29/01, 10/11/01, and 9/12/02 when biopsy demonstrated nevus without dysplastic features. (D) Photos of changing lesion on the right breast of a 39-year-old female, taken 11/15/00, 11/15/01, and 2/13/03 when excision demonstrated melanoma-in-situ.

Figure 2

Role of photography in lesions biopsied at follow-up visits. The 324 lesions biopsied at follow-up visits were categorized as indicated. Number of lesions indicated in parentheses adjacent to bars.

Figure 3

Histologic diagnoses of lesions biopsied at follow-up visits. Lesions were categorized as (A) not previously photographed, (B) changed per prior photograph, (C) unchanged per prior photograph, and (D) unclear if changed. Number of lesions indicated in parentheses above bars. CN, common nevus; DN, dysplastic nevus; MIS, melanoma in situ; MM, invasive melanoma.