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Comprehensive Guidelines and Indications for Digital Monitoring of Patients at High-Risk for Melanoma: A Position Paper by the Israeli Association for Dermatology

Ofer Reiter, Mor Miodovnik, Emily Avitan-Hersh, Nadav Astman, Nir Nathanson, Ayelet Rishpon, Aviv Barzilai and Alon Scope

Introduction: Early detection may lead to reduced morbidity and mortality from melanoma. This study aims to establish guidelines for selecting patients suitable for digital monitoring of skin lesions.

Methods: A literature review was conducted, followed by consensus among experts appointed by the Israeli Dermatology Association.

Results: Two effective methods for early melanoma diagnosis were identified: Total-body photography (TBP) and digital dermoscopy. TBP involves capturing clinical images of the entire skin area for long-term monitoring (6-12 months). Digital dermoscopy focuses on close-up images of distinct lesions for short-term monitoring (3-4 months). Various risk factors for melanoma were identified, including genetic and familial factors, as well as demographic and phenotypic characteristics. Based on these risk factors and feasibility of clinical follow-up, a comprehensive list of indications for TBP was developed, categorized into three groups based on the expected level of benefit. Digital dermoscopy surveillance is recommended for patients with flat or slightly raised skin lesions showing dermoscopic features that do not definitively indicate melanoma.

Discussion and Summary: TBP significantly improves early melanoma detection, enhancing sensitivity and specificity while reducing unnecessary biopsies. However, due to its high cost and limited coverage by the Israeli public health care system, prioritizing patients who would benefit most from TBP is crucial. The compiled list of indications aligns with international recommendations and provides further details within the article.

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