Comparative analysis of total body and dermatoscopic photographic monitoring of nevi in similar patient populations at risk for cutaneous melanoma

Abstract

Background: Our previous experience monitoring nevi in high-risk patients using serial digital epiluminescence microscopy (DELM) photography achieved low biopsy rates but was limited by melanomas presenting as new lesions or arising from nevi that had not been photographed.

Objective: To determine whether biopsy rates, efficiency of melanoma detection, and melanoma origin (de novo vs nevus derived) differed in a similar patient population monitored using total body (TB) photography.

Methods: One thousand seventy-six patients (including 187 from a prior cohort) underwent TB photography and were monitored using photographs obtained at the initial visit. Risk factors and median monitoring periods for these patients were comparable with those of patients previously monitored using DELM photography.

Results: Two hundred seventy-five biopsies were performed in 467 patients on follow-up visits. Of 12 melanomas detected on follow-up, five were invasive, five presented as changing lesions and two as new lesions, nine arose de novo, and the remainder were nevus derived.

Conclusions: In our experience with both approaches, monitoring patients at risk for melanoma using TB photography was associated with lower biopsy rates and lower nevus-to-melanoma ratios than using DELM and facilitated detection of new and changing lesions. In both cohorts, the majority of melanomas detected on follow-up arose de novo.

Fig 1

Histologic distribution of melanocytic lesions biopsied in this study. (A) Breakdown of total (548) biopsies by initial and follow-up visits. (B) Breakdown of 275 biopsies performed on follow-up visits by whether lesions were judged to be changing or new (based on comparison to baseline photographs).

Fig 2

Analysis of melanomas detected in this study. (A) DN with severe dysplasia, MIS, and invasive melanomas (MM) categorized by presentation and role of photography in the decision to biopsy. (B) The 28 melanomas in the study are categorized by detection on initial and follow-up visits, and broken down as to whether they arose de novo or from a pre-existing nevus.

Fig 3

Examples of lesions identified by photographic comparison in this study. Baseline photographs in left panel, and photographs taken of same region on follow-up visit (lesion of interest denoted by arrow) in right panel. Dates of each photograph are indicated. (A) Invasive melanoma (depth 0.20 mm) detected as changing lesion on the back of a 41-year-old male. It had been three years since the previous visit. (B) Lentigo maligna (MIS) detected as a new lesion on the cheek of a 47-year-old male. It had been eight months since the previous visit. (C) DN with severe dysplasia identified as a new lesion on the back of a 50-year-old female. It had been 15 months since the previous visit.