Early recognition is the most effective intervention to improve melanoma mortality. Early diagnosis of melanoma in atypical mole syndrome patients, however, may be challenging. Skin self-examination and periodic physician-based total-body skin examinations are recommended in atypical mole patients but dermoscopy, total-body photography, and digital dermatoscopy have been proved to improve accuracy in early detection of melanoma in these high-risk patients. Digital follow-up in atypical mole syndrome patients allows detection of new lesions and changes in preexisting lesions.
Key points
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Early recognition is the most effective intervention to improve melanoma prognosis.
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Early diagnosis of melanoma in atypical mole patients, with a reduced number of unnecessary biopsies of benign lesions, may be challenging.
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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 information of the lesions (features of melanoma, complex pattern, and comparative analyses) should also be used in the evaluation of patients with multiple nevi.
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Patient-based skin self-examination (SSE) with the support of pictures (print books or digital images) and periodic physician-based total-body skin examination are recommended in patients with multiple nevi.
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Dermoscopy, total-body photography (TBD), and digital dermatoscopy (DD) have been proved to improve accuracy in the early detection of melanoma in high-risk patients with atypical mole syndrome.
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Digital follow-up (DFU) in atypical mole syndrome patients allows the detection of new lesions and changes in preexisting lesions.
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Some changes in dermoscopy have been associated with malignancy in the context of atypical mole syndrome patients.
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Risk factors to take into account when detecting malignant melanoma during follow-up are patient age and clinical background (previous melanoma, familial melanoma, and number of atypical lesions).
In patients with multiple nevi, management goals are early diagnosis of melanoma and avoidance of unnecessary biopsies of benign lesions.
Stratification of the risk of developing melanoma in cases of multiple nevi is of great importance to establish the best strategies and follow-up methods.
Atypical nevi count is confirmed to increase the risk factor for melanoma 10-fold in different studies. If a patient has a history of melanoma (personal or family) or genetic mutations in high penetrance genes, the risk increases significantly.
Strategies for early detection of melanoma in patients with multiple nevi include body self-examination, total-body examination, dermoscopy, digital monitoring with TBP and DD, and computer-assisted diagnosis.
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