Sequential Digital Dermoscopy Report

Dermatology — Side-by-Side Pattern-Change Comparison

Report ID: MAA-DSQ-3A8E64
Generated: June 1, 2026
Analysis: AI-Powered Image Interpretation

Patient Profile

Sex / Age:
Male, 38 years
Skin type (Fitzpatrick):
Type II
Patient context:
High nevus count (~80 nevi); under digital dermoscopy surveillance for 3 years
Risk factors:
Outdoor occupation (forestry), prior blistering sunburns, no personal melanoma history; one second-degree relative with melanoma
Lesions monitored:
4 atypical-appearing nevi tracked across baseline and current visit (12-month interval)
Image set:
Polarized contact dermoscopy, paired baseline / current images per lesion, registered for side-by-side comparison

Summary Overview

Side-by-side dermoscopy comparison of 4 monitored lesions across a 12-month interval. 3 lesions stable with no significant pattern change. 1 lesion (#3, left back) shows asymmetric enlargement, new dark globules, and disruption of the prior reticular pattern — an architectural change that warrants excisional biopsy.

3
Stable Lesions
1
Changed Lesion
12 mo
Interval

Surveillance Approach

Method:
Sequential digital dermoscopy imaging (SDDI) — short-term and long-term comparison
Rationale:
Detects melanoma at earlier stages in patients with multiple atypical nevi by identifying pattern change rather than relying on single-time-point morphology [Kittler H, Lancet Oncol 2002]
Decision rule:
Asymmetric or architectural change in one or more lesions warrants biopsy regardless of single-image dermoscopic features [Salerni G, J Am Acad Dermatol 2012]

Lesion-Level Analysis

Lesion #1 — Right Shoulder, 5 mmStable
Symmetric reticular pattern unchanged. No new dots, globules, or structureless areas. Diameter unchanged. Continue surveillance.
Lesion #2 — Mid-Chest, 6 mmStable
Globular pattern with regular distribution; unchanged. Network thickness preserved. No regression structures. Continue surveillance.
Lesion #3 — Left Back, 7 mm → 9 mmChanged
Asymmetric peripheral enlargement (2 mm) at the inferior aspect, with new clusters of irregular dark brown globules and disruption of the previously uniform reticular pattern. Focal blue-gray structureless area appearing on current image. These are textbook concerning changes on sequential dermoscopy [Argenziano G, J Am Acad Dermatol 2003; Salerni G 2012]. Excisional biopsy recommended.
Lesion #4 — Lower Back, 4 mmStable
Faint reticular pattern unchanged. No new structures. Continue surveillance.

Differential — Lesion #3

  • Early melanoma (in situ or thin invasive)Moderate
    Asymmetric enlargement and new architectural disruption are key changes that flag potential malignancy on sequential imaging.
  • Activating dysplastic / atypical nevusModerate
    Some atypical nevi enlarge symmetrically with maintained pattern; this lesion's asymmetric change makes it suspicious enough to biopsy regardless.
  • Trauma / inflammation-related changeLow
    No reported trauma; pattern of change is not consistent with acute irritation.

Analytical Summary & Recommendations

Imaging impression

Sequential dermoscopy across 12 months reveals stability of 3 monitored lesions and a concerning architectural change in lesion #3. Single-time-point dermoscopy alone might not have flagged lesion #3 — the value of sequential surveillance is clear in this case.

Recommended next steps

  • Excisional biopsy of lesion #3 with narrow margins for histopathology [NCCN Melanoma 2025]
  • Continue routine sequential surveillance for the other 3 lesions
  • Total body skin examination at the same visit — high-nevus-count patients often have additional atypical lesions that benefit from inclusion in the surveillance protocol
  • Set next surveillance interval at 6–12 months depending on findings and final pathology of lesion #3
  • Reinforce monthly self-skin examination and rigorous sun protection
  • Consider genetic counseling if family history of melanoma proves to be more extensive on detailed inquiry

Key Questions for Your Dermatologist

  • Is the change in lesion #3 enough to require excision, or could short-term re-imaging at 3 months be appropriate instead?
  • Should additional lesions be added to my surveillance set?
  • How should I balance my outdoor work with sun-protection requirements?
  • Given my family history, is genetic testing for melanoma susceptibility appropriate?
  • What is the next surveillance interval after the biopsy result?

What This Means for You

Compared to your photos from a year ago, three of your four monitored moles look the same — that's reassuring. The fourth one (on your left back) has changed in a way that we cannot ignore: it has grown asymmetrically, and a new pattern of small dark spots has appeared. On dermoscopy, this is a meaningful change.

This does not mean you have melanoma. Some of these changes are caused by atypical (dysplastic) moles "activating" — and they are still benign on biopsy. But the only way to be sure is to remove the lesion and examine it under a microscope. The recommended next step is a small excision (excisional biopsy) of that mole.

This is exactly the value of sequential surveillance: a single still photograph might not have flagged this lesion, but seeing the change between time points lets us catch anything early — when treatment is most effective.

In the meantime: continue your monthly self-skin checks, use broad-spectrum SPF 30+ daily (especially given your outdoor work), and keep your scheduled follow-ups.

Analysis Confidence 86%

High confidence in the change-detection assessment given paired image registration. Single-image dermoscopy and AI assistance complement, but do not replace, dermatologist examination and histopathology.

References

  1. Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol 2002;3(3):159–65.
  2. Salerni G, Carrera C, Lovatto L, et al. Benefits of total body photography and digital dermatoscopy ("two-step method of digital follow-up") in the early diagnosis of melanoma in patients at high risk for melanoma. J Am Acad Dermatol 2012;67(1):e17–27.
  3. Argenziano G, Soyer HP, Chimenti S, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol 2003;48(5):679–93.
  4. Marghoob AA, Usatine RP, Jaimes N. Dermoscopy for the Family Physician. American Family Physician 2013;88(7):441–50.
  5. NCCN Clinical Practice Guidelines in Oncology — Melanoma: Cutaneous. National Comprehensive Cancer Network 2025.