Abstract

Introduction

Three-dimensional (3D) total body photography (TBP) offers faster and enhanced skin visualization, potentially improving surveillance of high-risk skin cancer patients. This prospective longitudinal observational study (July 2021-December 2023) aimed to report the clinical outcomes of integrating 3D-TBP with digital dermoscopy for follow-up of high-risk melanoma patients.

Materials and methods

Adult patients at high risk for melanoma underwent follow-up with 3D-TBP and digital dermoscopy. Confocal microscopy was used as second-level screening in changing atypical melanocytic lesions.

Results

A total of 1274 high-risk patients (mean [SD] age 52.6 [14.6] years; 672–52.7 %- women) were followed. Most had a personal history of melanoma (785, 61.6 %), followed by atypical mole syndrome alone (437 [34.1 %]); 12 (0.9 %) had Xeroderma Pigmentosum. In total, 452 lesions were excised in 322 patients: 419 (92.7 %) during 3D-TBP and digital dermoscopy follow-up. Diagnoses included 86 (20.5 %) melanomas, 99 (23.6 %) basal cell carcinomas, 16 (3.8 %) squamous cell carcinomas and 163 (38.9 %) nevi, with a number-needed-to-excise (NNE) of 3.26:1. Notably, 40 melanomas (46.5 %) were detected without prior digital dermoscopy. Melanomas with prior digital dermoscopy were more frequently nevus-associated (8 vs. 3, P = 0.2), in situ (35 [76.1 %] vs. 24 [60.0 %], P = 0.11) and showed lower mean Breslow index (0.5 [SD 0.18] mm vs. 0.7 [0.76] mm, P > 0.9).

Discussion

In our experience, the use of 3D-TBP enabled monitoring of a large high-risk cohort, while maintaining low NNE. Enhanced visualization through 3D maps contributed to the detection of numerous melanomas through TBP, reducing reliance on digital dermoscopy and improving clinical workflow.