- •
Detecting melanoma, particularly in patients with numerous or atypical nevi, can be challenging for even the most skilled dermatologists.
- •
Mole mapping involves using noninvasive imaging technology to enhance monitoring of new or changing melanocytic lesions.
- •
Total-body photography and sequential digital dermoscopy imaging, together known as digital follow-up, are 2 prominent forms of noninvasive imaging technology used in mole mapping.
- •
Noninvasive imaging technologies have been found to improve
Mole Mapping for Management of Pigmented Skin Lesions
Section snippets
Key points
Noninvasive imaging technology categories
TBP is a series of approximately 25 images of the entire skin surface that can be used as an adjunct to total-body skin examinations (TBSE), patient self–skin examinations (SSE), and dermoscopy. Photographic documentation serves as a baseline comparison for future TBSEs and allows a physician or patient to detect new lesions and any naked-eye changes in preexisting lesions. Once new or changing lesions have been identified by TBP, dermoscopy and SDDI can be used to further examine a suspicious
Challenges in melanoma screening
Diagnosis of melanoma is often multifactorial and incorporates patient history, gross and dermoscopic appearance, comparison with neighboring lesions, and identification of change. Although change can be the key and even sole sign of a melanoma,15 not all new or changing lesions are melanomas.16 Malignant features are particularly difficult to discern during early stages of melanoma growth, when preventing morbidity and mortality is more likely. One study found that dermoscopists were able to
Value of digital follow-up
Noninvasive imaging technology helps dermatologists catch early-stage melanomas while improving diagnostic accuracy.23, 24 As both stand-alone modalities and in combination, TBP and SDDI can confer specific clinical benefits.
TBP is particularly helpful in detecting changes in lesions that often do not follow the classic ABCDE (asymmetry, border irregularity, color variegation, diameter >6 mm, evolving) criteria. Feit and colleagues25 reported that 74% of melanomas detected in patients with TBP
Digital follow-up expansion
Since the advent of TBP in the late 1980s, noninvasive imaging technology has steadily grown.7 In 2000, 62% of dermatologists in academic institutions reported using TBP. In 2010, this proportion increased to 71%.34 That same year, a study surveying 49 US dermatology departments found two-thirds use TBP as a screening method. Of those who used TBP, one-third used digital TBP alone, one-third used digital with printed images of TBP, and the last third used printed TBP images alone.35 In 2013,
Current challenges and future directions of digital follow-up
Despite the impressive advances in this field, it seems that imaging modalities are concentrated largely in academic centers treating high-risk patients.36 More work needs to be done to improve usability and access to DFU. Limitations to using these new technologies include logistical constraints—additional time required and secure software to organize and store images—lack of knowledge regarding the utility of the technique, lack of training, and cost.34, 39
DFU is perceived by many
Summary
Identification of melanoma, particularly in patients with numerous or atypical nevi, is a challenge for even the most skilled dermatologists. Augmenting the clinical and dermoscopic examination with TBP and SDDI can improve diagnostic accuracy, detect earlier-stage melanomas, and reduce costs. Although barriers to adoption of these screening techniques exist, it is clear that noninvasive imaging technology is already revolutionizing the ways in which physicians and patients participate in
References (44)
- et al.
Systematic skin cancer screening in Northern Germany
J Am Acad Dermatol
(2012) - et al.
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
J Am Acad Dermatol
(2012) - et al.
Characterization of 1152 lesions excised over 10 years using total body photography and digital dermoscopy in the surveillance of patients at high risk for melanoma
J Am Acad Dermatol
(2012) - et al.
Practice gaps in dermatology
Dermatol Clin
(2016) - et al.
Evaluation of the American Academy of Dermatology's National skin cancer early detection and screening program
J Am Acad Dermatol
(1996) - et al.
The melanoma epidemic: more apparent than real?
Mayo Clin Proc
(1997) Intervention strategy to prevent lethal cutaneous melanoma: use of dermatologic photography to aid surveillance of high-risk persons
J Am Acad Dermatol
(1998)- et al.
Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi
Eur J Cancer
(2005) - et al.
Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update
J Am Acad Dermatol
(2010) - et al.
Methods and rates of dermoscopy usage: a cross-sectional survey of US dermatologists stratified by years in practice
J Am Acad Dermatol
(2014)
Annual report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer
Cancer
Analysis of trends in US melanoma incidence and mortality
JAMA Dermatol
Is dermoscopy useful for the diagnosis of melanoma?
Arch Dermatol
Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting
Br J Dermatol
A pooled analysis of melanocytic nevus phenotype and the risk of cutaneous melanoma at different latitudes
Int J Cancer
Total-body photographys of dysplastic nevi
Arch Dermatol
The use of whole body photography in pigmented lesion clinic
Dermatol Surg
Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions
Arch Dermatol
Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging
Arch Dermatol
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
Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria
JAMA
Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma
Arch Dermatol
Cited by (18)
Optimizing clinical and dermatopathology images with the iPhone operating system (IOS) 16 background removal feature
2023, Journal of the American Academy of DermatologyCitation Excerpt :While clinic spaces are relatively homogenous, factors such as floors, walls, lighting, and equipment potentially contribute to subpar images. With the rise of practices like mole mapping for evaluation of numerous pigmented lesions over time, techniques increasing the signal to noise ratio are valuable.1 Dermatopathology images can also have discolorations or dust on the slide.
Synchronous and metachronous melanomas diagnosed at early stages in a patient with dysplastic nevus syndrome
2023, Anais Brasileiros de DermatologiaTechnological advances for the detection of melanoma: Advances in diagnostic techniques
2020, Journal of the American Academy of DermatologyCitation Excerpt :Studies have shown a 3.3-fold reduction in unnecessary biopsy procedures and improved specificity for melanoma diagnosis with SDDI.22,23 Although TBP and SDDI can be used independently, diagnostic advantages are greater when combined.24,25 TBP allows for localization and identification of new lesions, while SDDI enhances surveillance of preexisting lesions.
Telecare within different specialties
2019, Fundamentals of Telemedicine and TelehealthEmerging imaging technologies in dermatology: Part I: Basic principles
2019, Journal of the American Academy of DermatologyCitation Excerpt :Total-body digital photography (TBDP) images the entire skin surface at 1 static time. The main utility is monitoring patients with numerous melanocytic lesions to identify changing or newly developing lesions, thus improving biopsy efficiency.6,7 Photographs should be obtained by using standardized methods for optimal comparison, which is a major advantage of commercial systems.
Emerging imaging technologies in dermatology: Part II: Applications and limitations
2019, Journal of the American Academy of DermatologyCitation Excerpt :Clinicians have different quality devices, and equipment upgrades are expensive.9,22 Most insurance companies do not cover TBDP, and costs to patients can be prohibitive.23 Photo acquisition times can be lengthy.10
Disclosure Statement: The authors have no disclosures to make.