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Melanoma Monitoring — SCE Dermatology MCQ

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ModerateSkin CancerMelanoma MonitoringSCE Dermatology

A 35-year-old woman has a 2 cm melanocytic naevus on her shoulder that shows subtle asymmetry and colour variation on dermoscopy, but without clear-cut melanoma features. Her dermatologist decides to monitor with sequential digital dermoscopy. After 3 months, comparison images show a new area of irregular pigment network and new regression structures. What is the appropriate action?

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Correct answer: D — Excisional biopsy — morphological change on sequential dermoscopy warrants excision

Any morphological change detected on sequential digital dermoscopic monitoring warrants excisional biopsy. The purpose of short-term monitoring (typically 3-month intervals) is specifically to detect melanoma-specific changes (asymmetric growth, new colours, new dermoscopic structures, regression) that would not be expected in stable benign naevi. BAD guidelines state that any lesion showing change on sequential dermoscopy should be excised. New irregular pigment network and regression structures are particularly concerning. The principle is: if monitoring detects change → excise; if no change → the lesion is likely benign and monitoring can continue or be discontinued.

Reference: BAD 2016 Dermoscopy Guidelines; BAD 2017 Melanoma