Dr. Rebecca Hartman discusses key points from her lecture, Practical Pearls From the Pigmented Lesion Clinic, at the 6th Annual Elevate-Derm Alliance Fall Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Lisa Weiss, Dr. Hartman explains where total body photography earns its place: high-risk patients with many nevi (50-plus, 100-plus), patients with multiple melanomas, and those with genetic syndromes, where photography can reduce unnecessary biopsies and help her track lesions between visits. She points to the NCCN guidelines for guidance on when to consider it, and describes the shift from the old resident-era "flip book" of patient poses to modern systems, including automated options and 3D imaging a medical assistant can capture with an iPad.

On dysplastic nevi, she tries hard not to biopsy them, since the data show mildly to moderately dysplastic nevi have a low rate of malignant transformation and little patient benefit from removal; her goal is to go after melanomas and severely atypical lesions. For flat lesions she favors a shave removal at least a millimeter deep with a 1-2 mm margin to be "one and done." She credits Dr. Ash Marghoob's group for the two-step dermoscopy algorithm and walks through follow-up intervals for melanoma patients.

  • Consider total body photography in high-risk patients with many nevi (50-100+), multiple melanomas, or melanoma-predisposing genetic syndromes; follow the NCCN guidelines on when to use it.
  • Try hard not to biopsy mildly to moderately dysplastic nevi hem the goal is to catch melanomas and severely atypical lesions, since low-grade dysplastic nevi rarely transform.
  • For flat lesions, use a shave removal at least 1 mm deep with a 1-2 mm margin so the biopsy is 'one and done.'
  • Use Marghoob's two-step dermoscopy algorithm: first decide if the lesion is melanocytic (pigment network, globules, streaks/pseudopods, or homogenous blue color), then look for melanoma-specific features.
  • Follow early-stage melanoma patients every 6 months for 5 years, then annually; extend the 6-month interval for higher-risk patients, and see advanced-disease patients on systemic therapy every 3 months for the first year or two.