Identification of Clinically Featureless Incipient Melanoma Using Sequential Dermoscopy Imaging

Abstract

To examine the role of sequential dermoscopy imaging in detecting incipient melanoma and to elucidate the impact of length of follow-up on the relevance of observed changes.Design: Baseline and follow-up images of melanomas and melanocytic nevi excised only because of changes across time were inspected on a computer screen and assessed according to prospectively defined criteria. Lesions were stratified into 3 groups according to the length of follow-up.Setting: Three hospital-based referral centers in Europe and Australia.Patients: Four hundred sixty-one patients selected for digital dermoscopy monitoring.Main Outcome Measures: Description and comparison of dermoscopy features and changes in melanomas and melanocytic nevi at baseline and after follow-up. Results:We inspected baseline and follow-up images of 499 melanocytic skin lesions from 461 patients. The histopathologic diagnosis was melanoma in 91 cases and melanocytic nevus in 408. Most melanomas (58.2%; n=53) were in situ, and the median thickness of invasive melanomas was 0.38 mm. Dermoscopy features of melanomas and nevi did not differ significantly at baseline. After follow-up of 1.5 to 4.5 months, 61.8% of the melanomas showed no specific dermoscopy features for melanoma. This value declined to 45.0% after follow-up of 4.5 to 8.0 months and to 35.1% after more than 8.0 months. We could not differentiate melanomas and changing nevi by means of observed changes or dermoscopy features when follow-up was shorter than 4.5 months. With longer follow-up, melanomas tended to enlarge asymmetrically with architectural and color changes, and nevi tended to enlarge symmetrically without architectural and color changes.Conclusions: Sequential dermoscopy imaging detects incipient melanomas when they are still featureless. Interpretation of changes observed during follow-up depends on the length of follow-up.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Kittler et al [44] histopathologically examined 499 pigmented lesions after various follow-up intervals (1.5-4.5 months, 4.6-8.0 months and > 8 months). Upon excision, 92 lesions proved to be melanomas.…”

A guide for dermatology nurses to assist in the early detection of skin cancer

“…This technique has been shown to reduce unnecessary excisions of benign lesions [40] and to allow detection of melanomas that lack diagnostic clinical or dermoscopic features at baseline. [41,42] Dermoscopic mole monitoring is used for flat non-palpable lesions only; raised lesions should never be monitored. …”

Early detection of cutaneous melanoma by sequential digital dermatoscopy (SDD)

“…Sequential digital dermatoscopy (SDD) by imaging in defi ned time intervals provides information on the dynamic changes of pigmented lesions. Certain morphologic alterations, such as asymmetric growth, already point to the presence of an initial cutaneous melanoma, even though further melanoma-typical dermatoscopic or clinical criteria are not yet fulfi lled [8][9][10] .…”

“…Sequential digital dermatoscopy (SDD) by imaging in defi ned time intervals provides information on the dynamic changes of pigmented lesions. Certain morphologic alterations, such as asymmetric growth, already point to the presence of an initial cutaneous melanoma, even though further melanoma-typical dermatoscopic or clinical criteria are not yet fulfi lled [8][9][10] .It is sensible to differentiate between two strategies of sequential digital dermatoscopy. Short-term follow-up involves one-time control of an individual lesion with higher-grade atypia after maximally three months; an excision should be performed in the event of any dynamic alterations [ 11,12 ] .…”