– A. Lallas –
Digital dermoscopy and monitoring of moles is very frequently used in our everyday practice. However, in order to profitably use it in daily practice, clinicians should pay particular attention to the 2 following issues:
- Not every lesion is appropriate to enter digital follow up. Digital monitoring has certain indications and contra-indications.
- Evaluating the morphologic changes during follow up visits requires knowledge and experience
Generally, digital documentation and follow up is indicated in patients with multiple atypical nevi. In the context of such individuals, digital documentation and monitoring has the dual advantage of facilitating melanoma recognition, while minimizing the number of unnecessary excisions of benign moles.
First, digital documentation allows the application of the comparative approach, which is based on the observation that the majority of an individual’s nevi display similar dermoscopic features, while melanoma deviates this “signature” pattern. Notably, melanoma in patients with multiple atypical nevi might be not the most atypical mole, but the one looking different from the majority of the lesions. The application of the comparative approach has been shown to increase melanoma recognition, while reducing the number of excisions of nevi that would be otherwise judged as suspicious.
Second, long-term digital monitoring allows the recognition of featureless melanomas that might otherwise escape detection. This is because a certain proportion of slow-growing melanomas does not display dermoscopic criteria suggestive of malignancy and can be only detected by morphologic changes during follow up visits.
In contrast, monitoring is generally not indicated for solitary lesions. Doubtful nodular solitary lesions should be excised. Flat lesions might be re-examined once after 3 to 6 months, but long-term monitoring of a solitary doubtful lesion is not reasonable.