Diagnostic accuracy and safety of short‐term teledermoscopic monitoring of atypical melanocytic lesions

Background Short‐term dermoscopic monitoring ( STDM ) of atypical melanocytic lesions ( AML ) after 3.0–4.5 months can be used to detect featureless melanomas without performing countless unnecessary excisions of nevi. Recently, short‐term teledermoscopic monitoring ( STTM ) was incorporated into the STDM clinical routine at Sahlgrenska University Hospital in Gothenburg, Sweden. Follow‐up images for STTM were taken by an assistant nurse with subsequent teledermoscopic assessment by a dermatologist. Objectives The purpose of this study was to evaluate the diagnostic accuracy and safety of STTM . Methods In this retrospective observational study, data from electronic health records of patients with teledermoscopically monitored AML s were explored. The number of changed and excised AML s and their histopathological diagnoses were recorded. The excised AML s were categorized into three subgroups according to when they changed and were excised: (i) following STTM , (ii) after planned long‐term follow‐up or (iii) after unplanned long‐term follow‐up. Results A total of 686 patients with 883 AML s were monitored with STTM . Sixty‐two AML s (7.0%) were excised following STTM , 14 (1.6%) after planned long‐term follow‐up and 10 (1,1%) after unplanned long‐term follow‐up. Twenty‐one melanomas were detected using STTM , three after planned long‐term follow‐up and three after unplanned long‐term follow‐up. All melanomas were in situ ( n  = 20) or thin and non‐ulcerated ( n  = 7; median Breslow thickness 0.4 mm, range 0.3–0.8 mm). The sensitivity for the diagnosis of melanoma by means of STTM with the option of additional planned follow‐up was 88.9%, and the specificity was 93.9%. The number of AML s needed to monitor in order to detect one melanoma with the STTM routine was 32.7, and the number needed to excise was 3.2. Conclusions STTM of AML s was safe and allowed for high diagnostic accuracy. All detected melanomas were in situ or thin and non‐ulcerated. Furthermore, a considerable number of unnecessary excisions were spared.