Short-term Digital Surface Microscopic Monitoring of Atypical or Changing Melanocytic Lesions

OBJECTIVE: To examine the outcome of short-term digital surface microscopic monitoring of suspicious or changing atypical melanocytic lesions. DESIGN: Digital surface microscopic (oil epiluminescence microscopy, and dermoscopy) images of clinically melanocytic lesions were taken with a color calibrated 3 CCD video instrument. In general, lesions were moderately atypical, flat or only slightly raised, without a history of change or surface microscopic evidence of melanoma, or were mildly atypical lesions with a history of change. Lesions were monitored during a 2.5- to 4.5-month period (median, 3.0 months). With the exception of overall change in pigmentation consistent with that seen in surrounding skin (solar exposure changes), any morphologic change after monitoring was considered an indication to excise. SETTING: Sydney Melanoma Unit, Sydney, Australia (a referral center). PATIENTS: A consecutive sample of 318 lesions from 245 patients (aged 4-81 years). MAIN OUTCOME MEASURE: Specificity for the diagnosis of melanoma. RESULTS: Of the 318 lesions, 81% remained unchanged. Of the 61 lesions that showed morphologic changes, 7 (11% of changed and 2% of total lesions) were found to be early melanoma (5 in situ and 2 invasive with a Breslow thickness of 0.25 mm and 0.28 mm, respectively). None of these melanomas developed any classic surface microscopic features of melanoma and therefore could be identified only by morphologic change. The specificity for the diagnosis of melanoma by means of short-term digital monitoring was 83%. CONCLUSION: On the assumption that all melanoma will change during the monitored period, surface microscopy digital monitoring is a useful adjunct for the management of melanocytic lesions.