Incidence of New and Changed Nevi and Melanomas Detected Using Baseline Images and Dermoscopy in Patients at High Risk for Melanoma

Cancer Council Victoria, Melbourne, Victoria, Australia
Archives of Dermatology (Impact Factor: 4.79). 09/2005; 141(8):998-1006. DOI: 10.1001/archderm.141.8.998
Source: PubMed


To determine the incidence of new, changed, and regressed nevi and melanomas in a cohort of patients at high risk for melanoma using baseline total body photography and dermatoscopy.
Cohort study of patients at high risk for melanoma who underwent baseline cutaneous photography between January 1, 1992, and December 31, 1997, and had at least 1 follow-up visit by December 31, 1998.
Private practice rooms of 1 dermatologist in conjunction with a public hospital-based, multidisciplinary melanoma clinic in Victoria, Australia.
A total of 309 patients who had at least 1 of the following risk factors for melanoma: personal history, family history, 100 or more nevi, or 4 or more dysplastic nevi.
Number of new, changed, and regressed nevi and melanomas detected and excised during the study interval.
The incidence of new, changed, and regressed nevi decreased with increasing age (P<.001), whereas the incidence of melanomas increased (P = .05). The number of dysplastic nevi at baseline was positively associated with the incidence of changed nevi (P<.001) and melanomas (P = .03). The use of baseline photography and dermatoscopy was associated with low biopsy rates and early detection of melanomas. The development of melanoma in association with a preexisting nevus was not directly correlated with a change in a preexisting lesion monitored by baseline photography.
Nevi are dynamic, and only a small percentage of all new and changed melanocytic lesions are melanomas. Patients younger than 50 years had a lower incidence of melanomas and a higher rate of new, changed, and regressed nevi when compared with patients older than 50 years. A new or changed pigmented lesion is more likely to be a melanoma in patients older than 50 years.

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Available from: John Philip Dowling, Feb 05, 2015
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    • "In a study by Banky using TBP, the benign-to-malignant ratio was also approximately 3:1 (Banky et al., 2005). These ratios compare very favorably with the ratios of 12:1 or 30:1 reported for dermatologists not implementing the use of TBP and general physicians, respectively (Banky et al., 2005). Although benign/malignant ratio of biopsies is a useful indicator of diagnostic accuracy, the patient mix seen by each individual physician can modify the outcome of this parameter. "
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    • "This may occur through a number of processes including apoptosis, immune destruction, or withdrawal of growth ISRN Dermatology factors like MSH [2] [3] [4]. It is interesting to note that while late childhood and young adulthood represents the time period in which the majority of nevus promotion occurs, it is also the time period in which most nevi begin to involute [5]. Thus, it is possible that nevi still present in late adulthood represent nevi that possess cellular mechanisms that make them resistant to involution. "
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    • "Baseline whole body digital photography has also been shown to improve patient self-skin monitoring in patients at high risk for melanoma, increasing self skin examination by over 51% when patients were given books or storage disks with copies of baseline images for comparison [89,90,91]. Whole body imaging has shown that new or changing nevi in patients over the age of 50 are more likely to be melanomas–30% when compared to <1% of new or changing lesions in younger patients [92]. This is consistent with the natural history of benign nevi, which rarely form and often regress after age 50. "
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