Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi

Background: Digital epiluminescence microscopy (DELM) has been reported to be a useful technique for the follow-up of melanocytic nevi. One of the pro mises of this technique is to identify modifications over time that indicat e impending or incipient malignancy and to facilitate surveillance of melan ocytic skin lesions, particularly in patients with multiple clinically atyp ical nevi. Objective: Our purpose was to report on patterns of modifications over time observed in benign melanocytic skin lesions and melanoma. Methods: A total of 1862 sequentially recorded DELM images of melanocytic l esions from 202 patients (mean age, 36.1 years; 54.0% female patients) with multiple clinically atypical nevi were included in the analysis. The media n follow-up interval was 12.6 months. Melanocytic lesions with substantial modifications over time (enlargement, changes in shape, regression, color c hanges or appearance of ELM structures known to be associated with melanoma ) were excised and referred to histopathologic examination. Results: A total of 75 melanocytic skin lesions (4.0%) from 52 patients (me an age, 33.3 years; 63.5% female patients) showed substantial modifications over time and were excised and referred to histopathologic examination. Ei ght changing lesions were histologically diagnosed as early melanomas. Thes e lesions frequently showed focal enlargement associated with a change in s hape as well as appearance of ELM structures that are known to be associate d with melanoma. In contrast, the majority of benign changing lesions (comm on and atypical nevi) showed symmetric enlargement without substantial stru ctural ELM changes. Six of the 8 patients in whom melanoma developed were u naware of the fact that the lesion had changed ol er time. Conclusion: We demonstrate that follow-up of melanocytic lesions with DELM helps to identify patterns of morphologic modifications typical for early m elanoma. DELM may therefore serve as a useful tool to improve the surveilla nce of patients with multiple atypical nevi.