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Review
. 2009 May;60(5):719-35; quiz 736-8.
doi: 10.1016/j.jaad.2008.10.065.

Strategies for early melanoma detection: Approaches to the patient with nevi

Agnessa Gadeliya Goodson  1 , Douglas Grossman
Affiliations
Review

Strategies for early melanoma detection: Approaches to the patient with nevi

Agnessa Gadeliya Goodson et al. J Am Acad Dermatol. 2009 May.

Abstract

Given its propensity to metastasize and the lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. Although there are no noninvasive techniques for the definitive diagnosis of melanoma, and the "gold standard" remains biopsy with histologic examination, a variety of modalities may facilitate early melanoma diagnosis and the detection of new and changing nevi. This article reviews the general clinical principles of early melanoma detection and various modalities that are currently available or on the horizon, providing the clinician with an up to date understanding of management strategies for their patients with numerous or atypical nevi.

Learning objective: After completing this learning activity, participants should understand the clinical importance of early melanoma detection, appreciate the challenges of early melanoma diagnosis and which patients are at highest risk, know the general principles of early melanoma detection, be familiar with current and emerging modalities that may facilitate early melanoma diagnosis and the detection of new and changing nevi, know the advantages and limitations of each modality, and be able to practice a combined approach to the patient with numerous or clinically atypical nevi.

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Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
Summary of key features of signature nevi.
Figure 2
Figure 2
Summary of modalities for melanoma detection. See text for additional details. Images obtained from following websites: SolarScan, http://www.medgadget.com/archives; Vivascope-3000, http://www.lucid-tech.com/medical-imagers; MoleMate, http://www.astronclinica.com/products; Melafind, http://www.eosciences.com; SkinDex-300, http://www.isis-optronics.de/en/skindex and OCT image reprinted from Ref. with permission from Elsevier; DermaScan C, http://www.cortex.dk; MoleMaxII, http://www.dermamedicalsystems.com; Dermagraphix, http://digitale-photographie.info/body-mapping_en.asp
Figure 3
Figure 3
Basic diagnostic algorithm for dermoscopy. First, a determination is made whether the lesion is melanocytic. Based on dermoscopic features, melanocytic lesions can be classified as benign, suspicious, or malignant. Benign melanocytic lesions can be monitored, suspicious lesions should be biopsied or monitored closely, and malignant-appearing lesions should be biopsied. If non-melanocytic lesions have recognizable dermoscopic features of benign neoplasms, biopsy is not necessary. However, if non-melanocytic lesions cannot be otherwise identified, they should be biopsied to rule out amelanotic melanoma.
Figure 4
Figure 4
Algorithm for initial evaluation of patients who may be at increased risk for melanoma. See text for details.
Figure 5
Figure 5
Algorithm for management of established patients with nevi. See text for details.
See this image and copyright information in PMC

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