Digital Monitoring

“Digital monitoring has been shown to allow early detection of clinically "featureless" melanoma; ie. melanoma that cannot be detected by routine clinical examination, while at the same time reducing needless excisions.”

Associate Professor Scott Menzies

Some patients have irregular moles that don’t show clinical features of a melanoma but the Doctor would like to monitor it over a period of time (normally 3 months) to see whether it is undergoing change. The dermatoscope – a skin surface microscope, enables a fine detailed examination of the mole. Below you can see the difference between what the naked eye can see and what one is able to see under the dermoscopic view.

Skin lesion as seen with the naked eye	Skin lesion viewed with dermoscopy The detailed structure of the lesion can be seen which enables the Doctor to diagnose more easily
These figures are courtesy of the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital.

The dermatoscope is attached to the digital camera and a series of images are taken over a 3 month interval  to spot differences in the mole.  An immersion oil is applied over the mole and is photographed. Changes that can appear over a period of time are changes in the moles overall size, shape, pattern and colour. An example of size and colour changes are shown below. This technique allows the early detection of melanomas and also reduces unnecessary biopsies.

Baseline image	3 months later
This lesion has changed during the 3 month period with increase in pigment (colour change) and needs to be removed

Baseline image	3 months later
This lesion shows change in size and pattern, and needs excision

For additional reading material:

Kittler H, Guitera P, Riedl E, Avramidis M, Teban L, Fiebiger M et al. Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging. Arch Dermatol. 2006;142:1113-9.