Dear OncoLink "Ask The Experts,"
I have had melanoma twice in the past 15 years. I have hundreds of moles and have been diagnosed with dysplastic nevi. I live in a state with poor medical resources for my situation. I have gone without medical monitoring for the past 7 years, and my current Doctor is suggesting an aggressive course of biopsies (approx 3 to 5 per month) for the next 12 months. I have heard of mole mapping, and I am having a difficult time finding information about it. I am wondering if it is an effective tool for diagnosis, and if it would be a viable option to take in lieu of such an aggressive biopsy schedule or possibly prior to such a schedule?
Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:
Mole mapping refers to full body photography to track changes in existing nevi or the development of new nevi. Our pigmented lesion group at University of Pennsylvania (led by Dr. Michael Ming) follows patients with this technique. A photographer is present in the clinic to take numerous photos and close-ups of abnormal moles. These photos are kept in the patient's file for reference at each visit. I use it very selectively in my own clinic, usually for patients that are anxious about their moles or those who have too many to track with notes. Some doctors use computer programs that allow you to zoom in and out of the full body photography to get closer looks than print photography will allow.
Random sampling of 3-5 nevi every month for a year sounds very aggressive. Certainly it is reasonable to biopsy the most atypical nevi on clinical exam. If one of them is read as a melanoma, then additional biopsies may be warranted. If all are read as atypical nevi on histopathology, it would be more reasonable to have regular skin examinations by a dermatologist.
Full-body photography could be very helpful in your case, because you will want to become comfortable examining your own skin for changes in existing nevi. In a patient with innumerable nevi, it's nearly impossible to keep track of changes without photography for reference. If you note any changes, a biopsy is warranted. Your photos will also be helpful for your dermatologist, who will use the photos to help decide whether or not to biopsy.