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. 2012 Jul;67(1):e17-27.
doi: 10.1016/j.jaad.2011.04.008. Epub 2011 Jun 16.

Benefits of total body photography and digital dermatoscopy ("two-step method of digital follow-up") in the early diagnosis of melanoma in patients at high risk for melanoma

Gabriel Salerni  1 , Cristina Carrera, Louise Lovatto, Joan Anton Puig-Butille, Celia Badenas, Estel Plana, Susana Puig, Josep Malvehy
Affiliations

Benefits of total body photography and digital dermatoscopy ("two-step method of digital follow-up") in the early diagnosis of melanoma in patients at high risk for melanoma

Gabriel Salerni et al. J Am Acad Dermatol. 2012 Jul.

Abstract

Background: Early detection of melanoma is the best way to improve prognosis. Digital follow-up (DFU) programs of populations at high risk could be an efficient strategy for detecting early melanomas with low morbidity.

Objective: We sought to report the added value of the use of the "two-step method" (digital total body photography and digital dermatoscopy).

Methods: This was an analysis of the surveillance of 618 patients at high risk for melanoma included in our DFU program from 1999 to 2008.

Results: A total of 11,396 lesions were monitored (mean 18.44/patient) during a median follow-up of 96 months (median 10 visits/patient). A total of 1152 lesions, 1.86 per patient, were excised. Almost 70% (798) were lesions previously registered at least twice, whereas 356 (30%) were detected and removed in the same visit. During follow-up, 98 melanomas (8.5% of excised lesions) were diagnosed in 78 patients (12.6%). In all, 53 melanomas were in situ (53.3%), whereas invasive (45) showed a Breslow index of less than 1 mm (median 0.5 mm) and none were ulcerated.

Limitations: Because there are no control groups we cannot determine if the combined use of total body photography and digital dermatoscopy is more beneficial than these techniques used separately.

Conclusion: DFU with total body photography and dermatoscopy in a selected population at high risk demonstrated the early detection of melanomas with a low rate of excisions. Long-term follow-up is required to allow the detection of slow-growing melanomas. Based on our 10-year experience, melanomas can be diagnosed at any time, suggesting that in a population at high risk for melanoma, DFU should be maintained over time.

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Figures

Figure 1
Figure 1
Lesions excised during the study * corresponded to 6.8% of all monitored lesions
Figure 2
Figure 2
In situ melanoma developed over melanocytic nevus in a 23 year-old patient, with personal and familial history of melanoma, diagnosed due to changes in digital follow-up. Body-mapping images displaying no clinical change (A and B) and dermoscopy records in chronological order until excision after 29 months and 7 visits of follow-up (C to I).
Figure 3
Figure 3
Superficial spreading malignant melanoma, Breslow 0.5 mm, Clark level III detected as a new lesion during total-body mapping comparison in the abdomen of a 48 years-old male, carrier of CDKN2A mutation, with history of personal melanoma and familial melanoma and atypical mole syndrome. Body-mapping records showing the appearance of the lesion (A to G), clinically symmetric and with regular borders. Dermoscopy image (H) showing atypical pigment network, inverted pigment network and bluish hue.
See this image and copyright information in PMC

References

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