Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi
H. Kittler et al., Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi, J AM ACAD D, 43(3), 2000, pp. 467-476
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.