The role of dermoscopy and digital dermoscopy follow-up in the clinical diagnosis of melanoma: clinical and dermoscopic features of 99 consecutive primary melanomas

Early recognition is the most effective intervention for improving the prognosis of patients with primary malignant melanoma (MM) [1]. Dermoscopy has shown to increase the sensitivity in the clinical diagnosis of melanoma from 60 to 90% with specificity as high as 95% [2]. However, melanoma may be clinically but also dermoscopically indistinguishable from melanocytic nevi making early recognition a diagnostic challenge [3], especially in incipient lesions. Furthermore, overlap of clinical features may lead to overlooking MMs and excising an excessive number of benign lesions [4]. Dermoscopic documentation of melanocytic lesions for the comparison of current and previous images in search of subtle changes over time, namely digital follow-up (DFU), has shown to be helpful in the diagnosis of early melanomas which might lack of specific criteria for malignancy. This approach has proved to be efficient in detecting early MMs without increasing the number of unnecessary excisions [5–7]. The use of baseline regional photographs, so-called total body photography (TBP), might facilitate the detection of new lesions, and visual changes in pre-existing lesions, by providing a comparative reference for subsequent examinations [8]. The combined use of TBP and digital dermoscopy, called the “two-step method” of digital follow-up [9], has been proposed an approach for the assessment of individuals at high risk, being potentially more accurate than the two strategies separately since it allow not only for the detection of MM with few dermoscopic criteria by comparison of dermoscopy records, but also for the detection of melanoma either presented as new lesions or arising from nevi that were not monitored by dermoscopy [10]. The inclusion of patients who are at high risk for melanoma in follow-up programs allows the detection of melanomas in early stages, with good prognosis, even in the absence of clinical and dermoscopic features of melanoma [11]. The aim of this study was to assess the clinical, dermoscopic and histologic features of melanomas diagnosed with the use of dermoscopy during routine skin examinations and the use of digital dermoscopy monitoring, compared with those melanomas that led to patient’s consultation.