Selection of patients for long-term surveillance with digital dermoscopy by assessment of melanoma risk factors.
OBJECTIVE
To identify patients at increased melanoma risk who benefit from long-term surveillance with digital dermoscopy.


METHODS
Prospective, nonrandomized, observational study.


METHODS
University-based surveillance program.


METHODS
Six hundred eighty-eight patients prospectively categorized into defined melanoma risk groups and followed up (mean, 44.3 months) by clinical examinations, dermoscopy, and, for atypical nevi, sequential digital dermoscopy.


METHODS
Association between patient risk factors and detection of melanomas.


RESULTS
Odds ratios from a multivariate logistic regression analysis indicated a highly increased melanoma risk for patients with familial atypical mole and multiple melanoma (FAMMM) syndrome, atypical mole syndrome (AMS), or previous melanoma. Each digitally documented atypical lesion (range, 1-17 lesions per patient) denoted a significant 10% increase in melanoma risk. Patients with higher melanoma risk (1) showed a higher percentage of melanomas detected by digital dermoscopy (FAMMM syndrome group, 50%; AMS group, 22%), (2) more often developed multiple melanomas within shorter intervals, and (3) showed a ratio of melanoma to benign results for lesions excised because of dynamic changes of 1:15 (AMS group) or 1:4 (FAMMM syndrome group). Melanomas detected by digital dermoscopy were significantly thinner (0.41 mm in mean Breslow thickness) compared with melanomas detected by other means (0.62 mm; P = .04).


CONCLUSIONS
We suggest an individualized surveillance plan, with digital dermoscopy performed at follow-up intervals of 3 months for patients with FAMMM syndrome and 6 to 12 months (depending on additional risk factors) for those with AMS. Patients with multiple common nevi and no additional risk factors had no benefit from sequential digital dermoscopy.
Departments of Dermatology and Venereology, Georg-August-University Goettingen, Von-Siebold-Strasse 3, Goettingen, Germany. h.haenssle@med.uni-goettingen.de
Holger A
HA
Haenssle
Bianca
B
Korpas
Christian
C
Hansen-Hagge
Timo
T
Buhl
Kjell M
KM
Kaune
Steven
S
Johnsen
Albert
A
Rosenberger
Michael P
MP
Schön
Steffen
S
Emmert
D000328:Adult; D001706:Biopsy; D046169:Dermoscopy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors