Mole maps

Principle

Sequential digital dermoscopic imaging ("mole mapping") - systematic photographic documentation and dermoscopic imaging of a patient's naevi, enabling detection of new or changing lesions over time - a surveillance tool for patients at elevated melanoma risk
Melanoma is characterised by change over time (evolving size, shape, colour, or a genuinely new lesion) - sequential imaging directly captures this temporal change, which is otherwise difficult to assess reliably from a single time-point examination, particularly in a patient with many atypical-appearing but stable (benign) naevi

Particularly valuable for patients with numerous naevi and/or a personal or family history of melanoma, where relying on memory/informal comparison to detect a new or changing lesion is unreliable given the large number of naevi to monitor
Dysplastic naevus syndrome, familial melanoma, numerous atypical naevi, melanoma surveillance in high-risk patients

Baseline total-body photography plus dermoscopic close-up imaging of naevi of concern, repeated at intervals (typically 3-12 months depending on risk level) to detect interval change
A stable naevus over serial imaging is reassuring even if it has some atypical dermoscopic features, while a changing lesion warrants biopsy regardless of how benign it might otherwise appear - change over time is itself diagnostically significant, independent of the lesion's static appearance

High-risk patients (numerous atypical naevi, personal/family melanoma history, dysplastic naevus syndrome) benefit most from structured surveillance programs - risk stratification should determine imaging frequency rather than applying a uniform interval to all patients
A biopsy decision should be triggered by documented change, new lesion appearance, or a lesion with sufficiently concerning static features regardless of imaging follow-up plans

Change over serial imaging is a powerful, independent diagnostic signal - a lesion that would otherwise appear only mildly atypical in isolation becomes a stronger biopsy indication if it has measurably changed on sequential imaging, which is precisely the value this surveillance approach adds beyond a single-timepoint examination

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