Total body photography improves dysplastic nevi follow-up

Key Points

New York - Benefits of whole body photography as a follow-up for patients at increased risk of melanoma include its potential to catch problem lesions, avoid needless excisions and enhance patients' self-exams, an expert says.

"By using whole body photography, we have the potential to catch otherwise unsuspected melanomas, because it allows us to find changing lesions in patients with very complex skin exams," says Allan C. Halpern, M.D., chief of New York's Memorial Sloan-Kettering Cancer Center's dermatology service.

Conversely, he tells Dermatology Times, "It allows us to avoid unnecessary excision of stable nevi in these high-risk patients."

In practice, Dr. Halpern explains that total body photography involves a patient undergoing a session where, without any clothing, they are photographed from head to toe.

The session would use anywhere from 18 to 40-plus photos, depending on the technique.

"That serves as a baseline set of images against which the patient is compared at follow-up visits," he says.

When the patient returns, "The physician does a side-by-side comparison of the patient's skin to their baseline pictures, looking for moles that have changed color, shape or size, as well as new moles," Dr. Halpern says.

Similarly, physicians often give patients copies of their photos to use for comparison when performing self-examinations. In some settings, physicians supplement their images with close-ups and/or dermoscopic images of individual changing moles.

"Technical advances have allowed us, essentially, to take these images using high-resolution digital photography, which provides for a very user-friendly graphical interface" that permits tagging close-up and dermoscopic images to the overviews for easy archiving and retrieval, Dr. Halpern says.

"We can literally take a close-up image and put an icon over that mole (in the overview) that, when clicked, will take one right to the close-up image of an individual mole. The hope is that these digital images will lend themselves to automated analysis."

While no prospective studies regarding the efficacy of whole body photography exist, he says, "There have been multiple retrospective reviews of patients undergoing total body photography" that show melanomas found through this approach tend to be diagnosed at an early stage (Arch Dermatol. 2005; 141(8):998-1006).

Photo pros and cons

Furthermore, Dr. Halpern says, "We've done some studies that have demonstrated that providing patients with their photographs increases the likelihood that they will do self-examinations, as well as their comfort and confidence in performing self-examinations."

In one study, the proportion of patients performing self-examinations three or more times during a four-month period grew from 10 percent at baseline to 61 percent (Am J Prev Med. 2004; 26(2):152-155).

By the same token, another study found that patients' sensitivity in finding new and altered moles grew from 60 percent at baseline to 70 percent with the addition of digital photos, while specificity increased from 96 percent to 98 percent (Arch Dermatol. 2004; 140(1):57-62).

Advantages notwithstanding, Dr. Halpern says barriers to use of total body photography include the time it requires, both from the patient and in the form of longer visits and follow-ups on the physician's part.

"In the hands of experienced examiners," he says, "it lengthens the visit only by a matter of several minutes. But it varies based on experience, expertise and technique."

Similarly, he says costs of purchasing equipment or obtaining required photos from outside experts represents another barrier. Currently, obtaining photos typically costs between $150 and $450.