Dermoscopy of Patients With Multiple Nevi

This article highlights how one should not look at a mole in isolation but in the context of the patient’s other moles. I certainly know that I am less inclined to excise an atypical looking mole if all the other moles look the same.

What do you think.




Dermoscopy of Patients With Multiple Nevi

Improved Management Recommendations Using a Comparative Diagnostic Approach

Giuseppe Argenziano, MD; Caterina Catricalà, MD; Marco Ardigo, MD; Pierluigi Buccini, MD; Paola De Simone, MD; Laura Eibenschutz, MD; Angela Ferrari, MD;Giustino Mariani, MD; Vitaliano Silipo, MD; Iris Zalaudek, MD

Arch Dermatol. 2011;147(1):46-49. doi:10.1001/archdermatol.2010.389

Objective To assess the outcome on management recommendations of a comparative approach vs a morphologic approach in evaluating dermoscopic images of lesions from a series of patients with multiple nevi.

Design In a 2-step study, 6 experienced dermoscopists were asked to provide management recommendations (excision or follow-up) for a series of lesions from patients with multiple nevi based on dermoscopic images of the lesions. In the first step, participating dermoscopists evaluated individual images of lesions based only on morphologic structure (morphologic approach). In the second step, the same lesions were grouped by patient, allowing the participants to evaluate the lesions in the context of other nevi from the same patient (comparative approach).

Setting Academic referral center.

Patients Seventeen patients with 190 lesions (184 monitored nevi, 4 excised nevi, and 2 excised melanomas).

Main Outcome Measure Using pooled data from each step, excision recommendation rates for the comparative approach and the morphologic approach were calculated.

Results Using the morphologic approach, 55.1% of overall recommendations favored excision; using the comparative approach, the rate decreased to 14.1%. The 2 melanomas included in the study were correctly judged to merit excision by all participants in step 1 and in step 2.

Conclusion Among patients with multiple nevi, evaluation of equivocal lesions in the context of a patient’s other nevi results in a lower rate of excision recommendations compared with evaluation of individual lesions based on morphologic structure alone.


  1. #1 by hein vandenbergh on January 18, 2011 - 2:55 am

    17 pts with 190 naevi. That’s an ave of 11 naevi/pt. In my book, that hardly rates as ‘multiple naevi’. Run of the mill, really.

    25% of all MVA fatalities are caused by alcohol affected drivers. Better watch out for the 75% of drivers who are sober!!

    Stats can ‘prove’ just about anything. I’m not sure why Mr Zuladek and Mrs Argenziano publish so much marginal stuff; remember, she published the leading article that one can do a proper skin examination in 90 seconds and not miss anyhting significant.

    Wth atypical naevi, it’s really a matter of time-longitudinality, I find, i.e. being familiar with the patient, unless a naevus really stands-out like dogs-balls.

    This study to me is a boring re-hash of the ‘ugly duckling’ or ‘lone trader’ theory so well-known for so long. Too much dough floating around those Euro universities……. Not that iris and Geppi spend much time ‘on board’, always giving the same old tlaks at any skin ca conf one may care to mention. Self-fulfilling prophesy: well-known actors both, now, names then give cachet’ to a woolley study, which in turn promotes their self-saleability………

    Sorry, Ian, not terribly impressed – it reveals little not already known.


  2. #3 by Stewart Precians on February 13, 2011 - 11:05 am

    Yes very entertaining Hein, and I do continue to wonder about us bringing over people from a Mediterranean olive skinned country to tell Australians about melanoma.

  3. #4 by hein vandenbergh on February 13, 2011 - 9:30 pm

    It’s called cultural cringe, Stewart. Also, of course, the definition of ‘expert’ plays a role. An expert gets better the further (s)he has travelled to the conference, first class air-fare, of course. Why do you think most conference registration fees are so exorbitant?

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