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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

https://doi.org/10.1016/j.jaad.2011.04.008Get rights and content

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.

Section snippets

Study population

A total of 629 patients included in the surveillance program with TBP and digital dermatoscopy at the Melanoma Unit of Hospital Clinic of Barcelona, Spain, were followed up between January 1999 and December 2008.

The criteria for patient inclusion in our follow-up program include: moderate to severe atypical mole syndrome (AMS) (defined by >100 nevi and/or >10 clinically atypical according to ABCD criteria, and/or any histologically dysplastic nevi), personal and/or familial history of MM,

Results

The surveillance program cohort consisted of 618 patients with a mean age of 37 years (mean SD ± 13.3 years) at time of inclusion in the program; 45.5% were men. According to inclusion criteria, the vast majority of the patients (n = 556) had AMS and only 7.1 (n = 44) had less than 50 nevi associated to other high-risk conditions. Of the patients, 277 had a personal history of MM, including 73 with a history of multiple primary MMs, before the beginning of the study; 8 patients with giant

Discussion

Various strategies have been suggested for MM detection in patients at high risk, such as skin self-examination,12, 13 total cutaneous examination,14 and the use of TBP3, 15, 16, 17, 18, 19 and dermatoscopy.20, 21 It has been well demonstrated that clinical examination is inaccurate for the diagnosis of incipient MM22 whereas dermatoscopy has been shown to improve the diagnostic accuracy of nearly all cutaneous tumors including melanoma.20, 21, 23

During the last few years, increasing evidence

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    Funding sources: The research at the melanoma unit in Barcelona is partially funded by grants 03/0019, 05/0302, and 06/0265 from Fondo de Investigaciones Sanitarias, Spain; by the CIBER de Enfermedades Raras of the Instituto de Salud Carlos III, Spain; by the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) 2009 SGR (Suport a grups de recerca) 1337 of the Catalan Government, Spain; by the European Commission under the Sixth Framework Programme, contract No. LSHC-CT-2006-018702 (GenoMEL); and by the National Cancer Institute of the US National Institutes of Health (CA83115). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

    Conflicts of interest: None declared.

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