What is the role of sequential digital dermoscopy imaging in melanoma diagnosis?

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Background

Sequential digital dermoscopy imaging (SDDI) or dermoscopy monitoring involves the capture and assessment of successive dermoscopic images, separated by an interval of time, of one or many melanocytic lesions to detect suspicious change.

This is performed in two settings: short-term dermoscopy monitoring (over a period of 3 months) for suspicious melanocytic lesions without evidence of melanoma, and long-term monitoring for surveillance (usually at intervals of 6–12 months).[1][2] Long-term monitoring is generally used in the surveillance of high-risk patients, usually with multiple dysplastic naevi. In contrast, short-term monitoring of individual suspicious naevi can be used in any patient setting (eg. mildly atypical lesions with a patient history of change or moderately atypical lesions with a patient history of no change).

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Summary of systematic review results

In one study the sensitivity for the diagnosis of melanoma using short-term dermoscopy monitoring was 94% (excluding lentigo maligna which requires longer interval monitoring) and the specificity 84%[3]. For long-term monitoring, three studies have shown a high specificity (95-96%) for the diagnosis of melanoma, but the sensitivity was not evaluated.[4][5][6]

Four level II studies[1][4][7][5] with more recent cohort studies [3][8] all conducted in a specialist setting show consistently that SDDI allows the detection of melanoma that lack dermoscopic evidence of malignancy. Furthermore, the impact of routinely using SDDI has been shown in multiple studies to be high in regards to the proportion of melanomas detected by the technique. In three studies (two prospective observational trials[4][9] and one retrospective cohort[10]) of moderate-high risk patients in a specialist setting, SDDI allowed the detection of 34-61% of the patients' melanomas, in two studies (one prospective observational trial[11] and one retrosepctive cohort[8]) in routine dermatological practice between 12-55% of melanomas detected and in 52% in a self-referring dermoscopy telemedicine setting (retrospective study)[12]. Short-term SDDI allowed the detection of 33% of the patients'melanomas in a clinical trial of primary care physicians[13], however routine long-term SDDI of multiple naevi in lower risk patients is less efficacious[14][15][16]. Finally, SDDI has been shown in two prospective observational trials in both a specialist (both short and long-term monitoring)[11] and primary care setting (short-term monitoring)[13] to significantly reduce the benign:melanoma excision ratio and the number of excised benign melanocytic lesions.


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Only flat or slightly raised lesions should undergo dermoscopy monitoring. Nodular lesions should not be monitored.


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The interval for short-term monitoring is 3 months where any change leads to excision. Where lentigo maligna is in the differential diagnosis it is recommended an additional 3 months of monitoring performed, i.e. total of 6 months.


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The usual interval for long-term monitoring is 6-12 months. Unlike short-term monitoring, certain specific changes are required for excision to be indicated.

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Evidence summary and recommendations

Evidence summary Level References
Four level II studies and more recent cohort studies show consistently that sequential digital dermoscopic imaging (SDDI) allows the detection of suspicious dermoscopic change in melanomas that lack dermoscopic evidence of melanoma at a particular time. II, III-2 [1], [4], [7], [5], [3], [8]
The routine use of SDDI in both specialist and primary care allows the detection of a significant proportion of patients’ melanomas. Long-term SDDI of multiple naevi in lower risk patients, while allowing detection of melanoma, is less efficacious. II, III-2 [13], [4], [8], [10], [9], [11], [14], [15], [16]
SDDI has been shown to reduce the benign:malignant ratio of excised melanocytic lesions and reduce the number of patients referred for biopsy in both specialists and primary care. II [13], [11]

Recommendations

Evidence-based recommendationQuestion mark transparent.png Grade
To assess individual melanocytic lesions of concern, recommend the use of short-term sequential digital dermoscopy imaging (dermoscopy monitoring) to detect melanomas that lack dermoscopic features of melanoma.
B


Evidence-based recommendationQuestion mark transparent.png Grade
To assess individual or multiple melanocytic lesions in routine surveillance of high risk patients, recommend the use of long-term sequential digital dermoscopy imaging (dermoscopy monitoring) to detect melanomas that lack dermoscopic features of melanoma.
B


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References

  1. 1.0 1.1 1.2 Kittler H, Guitera P, Riedl E, Avramidis M, Teban L, Fiebiger M, et al. Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging. Arch Dermatol 2006 Sep;142(9):1113-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16982998.
  2. Salerni G, Terán T, Puig S, Malvehy J, Zalaudek I, Argenziano G, et al. Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the International Dermoscopy Society. J Eur Acad Dermatol Venereol 2013 Jul;27(7):805-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23181611.
  3. 3.0 3.1 3.2 Altamura D, Avramidis M, Menzies SW. Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopy monitoring for the diagnosis of melanoma. Arch Dermatol 2008 Apr;144(4):502-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18427044.
  4. 4.0 4.1 4.2 4.3 4.4 Haenssle HA, Krueger U, Vente C, Thoms KM, Bertsch HP, Zutt M, et al. Results from an observational trial: digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma. J Invest Dermatol 2006 May;126(5):980-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16514414.
  5. 5.0 5.1 5.2 Robinson JK, Nickoloff BJ. Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol 2004 Jan;140(1):49-56 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14732660.
  6. Kittler H, Pehamberger H, Wolff K, Binder M. Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000 Sep;43(3):467-76 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10954658.
  7. 7.0 7.1 Menzies SW, Gutenev A, Avramidis M, Batrac A, McCarthy WH. Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol 2001 Dec;137(12):1583-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11735708.
  8. 8.0 8.1 8.2 8.3 Salerni G, Terán T, Alonso C, Fernández-Bussy R. The role of dermoscopy and digital dermoscopy follow-up in the clinical diagnosis of melanoma: clinical and dermoscopic features of 99 consecutive primary melanomas. Dermatol Pract Concept 2014 Oct;4(4):39-46 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25396084.
  9. 9.0 9.1 Moloney FJ, Guitera P, Coates E, Haass NK, Ho K, Khoury R, et al. Detection of primary melanoma in individuals at extreme high risk: a prospective 5-year follow-up study. JAMA Dermatol 2014 Aug;150(8):819-27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24964862.
  10. 10.0 10.1 Salerni G, Carrera C, Lovatto L, Martí-Laborda RM, Isern G, Palou J, et al. Characterization of 1152 lesions excised over 10 years using total-body photography and digital dermatoscopy in the surveillance of patients at high risk for melanoma. J Am Acad Dermatol 2012 Nov;67(5):836-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22521205.
  11. 11.0 11.1 11.2 11.3 Tromme I, Sacré L, Hammouch F, Legrand C, Marot L, Vereecken P, et al. Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study. Br J Dermatol 2012 Oct;167(4):778-86 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22564185.
  12. Rademaker M, Oakley A. Digital monitoring by whole body photography and sequential digital dermoscopy detects thinner melanomas. J Prim Health Care 2010 Dec 1;2(4):268-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21125066.
  13. 13.0 13.1 13.2 13.3 Menzies SW, Emery J, Staples M, Davies S, McAvoy B, Fletcher J, et al. Impact of dermoscopy and short-term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: a sequential intervention trial. Br J Dermatol 2009 Dec;161(6):1270-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19747359.
  14. 14.0 14.1 Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W. Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol 2003 Jul;149(1):79-86 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12890198.
  15. 15.0 15.1 Haenssle HA, Korpas B, Hansen-Hagge C, Buhl T, Kaune KM, Johnsen S, et al. Selection of patients for long-term surveillance with digital dermoscopy by assessment of melanoma risk factors. Arch Dermatol 2010 Mar;146(3):257-64 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20231495.
  16. 16.0 16.1 Fuller SR, Bowen GM, Tanner B, Florell SR, Grossman D. Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma. Dermatol Surg 2007 Oct;33(10):1198-206; discussion 1205-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17903152.

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Appendices