What is the role of sequential digital dermoscopy imaging in melanoma diagnosis?
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). 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).
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%. For long-term monitoring, three studies have shown a high specificity (95-96%) for the diagnosis of melanoma, but the sensitivity was not evaluated.
Four level II studies with more recent cohort studies 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 and one retrospective cohort) 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 and one retrospective cohort) in routine dermatological practice between 12-55% of melanomas detected and in 52% in a self-referring dermoscopy telemedicine setting (retrospective study). Short-term SDDI allowed the detection of 33% of the patients' melanomas in a clinical trial of primary care physicians, however routine long-term SDDI of multiple naevi in lower risk patients is less efficacious. Finally, SDDI has been shown in two prospective observational trials in both a specialist (both short and long-term monitoring) and primary care setting (short-term monitoring) to significantly reduce the benign:melanoma excision ratio and the number of excised benign melanocytic lesions.
Only flat or slightly raised lesions should undergo dermoscopy monitoring. Suspicious nodular lesions should not be monitored but should be excised.
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.
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.
Evidence summary and recommendations
|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||, , , , , |
|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||, , , , , , , , |
|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||, |
|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|
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