Elsevier

Dermatologic Clinics

Volume 31, Issue 4, October 2013, Pages 565-577
Dermatologic Clinics

Monitoring Patients with Multiple Nevi

https://doi.org/10.1016/j.det.2013.06.004Get rights and content

Section snippets

Key points

  • •

    Early recognition is the most effective intervention to improve melanoma prognosis.

  • •

    Early diagnosis of melanoma in atypical mole patients, with a reduced number of unnecessary biopsies of benign lesions, may be challenging.

  • •

    Stratification of risk in patients with multiple nevi is useful to guide the strategy for early diagnosis of melanoma. Clinical factors, such as age, number of nevi, atypical mole syndrome, history of melanoma, and/or genetic background, are of major importance. Dermoscopic

Identification of risk factors for melanoma in patients with multiple nevi

Stratification of the risk of developing melanoma in cases of multiple nevi is of great value. The identification of some or several such factors is mandatory to establish the best strategies and methods to follow-up patients. The main known risk factors may be classified as atypical mole syndrome and number of nevi, personal/familial history of melanoma, and genetic background. The efficacy of periodic surveillance is appropriate in high-risk subjects and the strategies of follow-up should be

Strategies for early detection of melanoma in patients with multiple nevi

In patients with atypical moles, different strategies have been introduced to allow the early detection of melanoma, minimizing the number of unnecessary excisions. These strategies are SEE, total-body examination, dermoscopy, digital monitoring, TBP + DD, and computer-assisted diagnosis.

Digital follow-up: total-body photography plus digital dermoscopy

Several studies, including a recent meta-analysis, have demonstrated the benefit of DFU in the context of patients with atypical mole syndrome.47 In patients at high risk for melanoma with atypical mole syndrome, DFU is one of the most efficient strategies to detect early melanomas while minimizing unnecessary excisions.61 Several studies have shown that benign melanocytic lesions in patients with atypical mole syndrome tend to remain stable under short-term and long-term monitoring

Computer-assisted diagnosis and other methods

With enhancements in imaging and computer technologies as well as image-processing software for the detection of melanoma in patients with multiple nevi, the method of the future is high-resolution 3-D mapping of the entire body as a periodic screening tool. Ideally, the photographic imaging technique would be coupled with dermoscopy and possibly with another more quantitative diagnostic technique.

Commercial systems for assessment of melanocytic lesions using digital photography already exist;

Summary/discussion

Patients with multiple nevi have an increased risk of developing melanoma. According to clinical information (ie, number of nevi, atypical mole syndrome, and history of melanoma) and genetic background, a stratification of risk grades can be assessed.

In cases of atypical mole syndrome, many lesions have features associated with early melanoma. This characteristic makes accurate detection of malignant lesions with reduced number of excisions difficult; thus, clinical information associated with

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