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Summary   Background and objectives  The incidence of melanoma is rising and prevention plays an important role. Multiple nevi as well as a medical history of melanoma are important risk factors. In affected patients, a two‐step algorithm consisting of total‐body photography (TBP) and sequential digital dermatoscopy (SDD) is a helpful diagnostic tool.    Patients and methods  This was a retrospective observational study that lasted six years in order to evaluate the significance of the two‐step algorithm. Cases were evaluated based on distinct dermoscopic patterns and statistical analyses were performed with the latest version of SPSS.    Results  6020 dermoscopic images of 214 patients were included. TBP was performed at a mean interval of 16.9 months (SD ± 1.43 months), while SDD was performed every 9.9 months (SD ± 1.68 months). The number needed to excise was 4.6 and the number needed to monitor was 548. Excisions were mostly performed because dynamic changes were observed. A total of eleven melanomas were detected and had a mean tumor thickness of 0.44 mm (SD ± 0.15 mm; range 0.2–0.6 mm).    Conclusions  Invasive melanomas had a tumor thickness of less than 0.6 mm, thus providing evidence of an effective strategy for early melanoma detection. Excisions of benign nevi were minimized as indicated by a low number needed to excise.

The importance of total‐body photography and sequential digital dermatoscopy for monitoring patients at increased melanoma risk