Total body photography and mole mapping
TBP; digital mole mapping; whole-body photography; sequential digital dermoscopy
Total body photography (TBP), often combined with sequential digital dermoscopy imaging, is the established UK surveillance pathway for patients at high lifetime risk of melanoma — atypical mole / dysplastic naevus syndrome, familial melanoma (CDKN2A, BAP1, POT1), multiple primary melanoma, and selected high-risk groups. Two-step short-term monitoring (3-month interval) discriminates evolving melanocytic lesions from stable benign naevi. Long-term surveillance over years detects evolving change against a photographic baseline that no clinician can hold in memory. The technology cannot replace clinical judgement but reliably reduces unnecessary excisions while improving early melanoma detection in trained hands.
Indications
- Multiple atypical / dysplastic naevi — particularly with personal or family history of melanoma.
- Familial melanoma kindreds — CDKN2A, BAP1, POT1.
- Multiple primary melanoma — high lifetime new-melanoma risk.
- Lynch / Muir-Torre, Werner, XP, MEN2b — selected.
- Children and adolescents with very large congenital melanocytic naevi.
- Consistent with specialist high-risk melanoma surveillance practice; NICE NG14 supports access to dermoscopy / medical photography and personalised follow-up, but does not mandate total-body photography. Access varies by Cancer Alliance.
Technique
- Whole-body photography — standardised set of overview images covering all skin in pre-defined poses (anterior, posterior, lateral, head, feet).
- Sequential digital dermoscopy imaging (SDDI) — dermoscopic photographs of individual lesions of concern.
- Imaging is repeated at intervals — short-term 3-month follow-up for newly identified atypical lesions; long-term 12-monthly for the whole-body baseline.
- Two-step monitoring — overview images identify new or changed lesions; close-up dermoscopy identifies change in known lesions.
- Software-assisted change detection (commercial systems — Vectra, FotoFinder, Atlas) flags structural / colour change for clinician review.
Evidence base
- Meta-analyses (Salerni 2013; Adler 2017) — sequential digital dermoscopy substantially improves the diagnostic accuracy for melanoma in high-risk patients and reduces unnecessary excisions.
- Average naevi excised per melanoma detected falls from ~30:1 in unaided clinic to ~4–8:1 with TBP/SDDI.
- Earlier-stage melanoma detection — TBP-detected melanomas have thinner Breslow than incidentally-presenting tumours in matched cohorts.
UK access
- Available in dedicated melanoma surveillance clinics in most cancer-network centres; private dermoscopy services widely provide it.
- Reimbursement variable — most commonly bundled into the melanoma surveillance follow-up tariff.
- Patient counselling — TBP supplements but does not replace photoprotection and self-examination.
References
- Salerni G et al. Benefits of total body photography and digital dermatoscopy in melanoma surveillance. J Am Acad Dermatol; 2012.
- Adler NR et al. Sequential digital dermoscopy imaging — meta-analysis. Br J Dermatol; 2017.
- NICE NG14. Melanoma: assessment and management. London: NICE; 2015 (last updated 27 July 2022), follow-up recommendations on dermoscopy / medical photography and personalised follow-up.
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