Digital Epiluminescence Microscopy Monitoring of High-Risk Patients

Objective: To examine the outcome of digital epiluminescence microscopic (DELM) surveillance of atypical nevi in a high-risk population for 4 years. Design: Atypical, flat melanocytic lesions in 100 patients at high risk of developing melanoma were followed annually with DELM. Pigmentary changes or an increase in DELM diameter of 1 mm or greater was an indication to perform an excisional biopsy. Setting: Cardinal Bernardin Cancer Center Melanoma Program, Loyola University Health System, Maywood. Patients: A consecutive sample of 3482 lesions from 100 patients (aged 18-65 years) with at least 2 images of the same lesion. Main Outcome Measures: The DELM change was confirmed by histopathologic examination. Patient confidence in and comfort with dermatologic surveillance and skin self-examination performance were assessed. Results: During annual surveillance with DELM, 5.5% of the lesions changed. Among the 193 excisional biopsy specimens there were 4 melanomas in situ, 169 dysplastic nevi, and 20 common nevi. Confidence in and comfort with surveillance and skin self-examination improved after DELM. Conclusions: The criteria applied to detect substantial DELM changes were an increase in DELM diameter of 1 mm or greater and pigmentary changes, including radial streaming, focal enlargement, peripheral black dots, and "clumping" within the irregular pigment network. Use of DELM enhanced confidence in and comfort with care, which extended to performing more extensive skin self-examination.