Dermatology: Practical and Conceptual Observation | Dermatol Pract Concept 2017;7(2):4 23 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Introduction While dermoscopy has become standard procedure in the diagnosis and man- agement of patients with skin lesions, clinical and dermoscopic photographic documentation of lesions scheduled for biopsy are only infrequently performed in everyday practice [1-7]. Herein we present a case of a young woman who developed a re-pigmen- tation within the scar of an excised primary melanoma and highlight the importance of pre-surgical clinical pho- tography in her management. Case Presentation A 23-year-old woman with multiple nevi presented because of a brown, sharply demarcated plaque on her left shoulder (Figure 1A arrow), which she recently The value of pre-surgical photography in the management of melanoma Iris Zalaudek1,Teresa Deinlein1, Nora Woltsche1, Romana Kupsa1, Christina Ambros-Rudolph2 1 Department of Dermatology and Venereology, Medical University of Graz, Austria 2 Private Practice, Graz, Austria Key words: melanoma, preventive medicine, photography, dermoscopy Citation: Zalaudek I, Deinlein T, Woltsche N, Kupsa R, Ambros-Rudolph C. The value of pre-surgical photography in the management of melanoma. Dermatol Pract Concept. 2017;7(2):4. DOI: https://doi.org/10.5826/dpc.0702a04 Received: December 15, 2016; Accepted: January 14, 2017; Published: April 30, 2017 Copyright: ©Zalaudek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. IRB statement: It was waived, because we did no studies in humans. Patient consent: The explicit written informed consent of the patient for publication was given. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Iris Zalaudek, MD, Non-melanoma Skin Cancer Unit, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8 8036 Graz, Austria. Tel. 0043 316 385 80542; Fax. 0043 316 385 16827. Email: iris.zalaudek@medunigraz.at Figure 1. (A) Clinical picture showing a well-defined, roundish, brown macula on the left shoulder. (B) Dermoscopy reveals irregular brown globules varying in size at the periphery and a dark-brown structereless area in the center of the lesion. [Copyright: ©Zalaudek et al.] A B noticed. Upon dermoscopy the lesion exhibited irregularly sized brown glob- ules and a central dark-brown struc- tureless area (Figure 1B). Based on this pattern, a diagnosis of melanoma was suspected and the lesion was excised. mailto:iris.zalaudek@medunigraz.at 24 Observation | Dermatol Pract Concept 2017;7(2):4 only be made because review of the pre- surgical images revealed the presence of a small pigmented nevus at the side, at which the re-excision of the primary melanoma had been performed. In fact, the clinically suspected diagnosis of per- sisting nevus within a scar was further confirmed by digital monitoring reveal- ing no canges over a follow-up period of one year. Hence, we suggest that pre-surgical digital photography become a rou- tine procedure in the management of patients with skin tumors. However, before excision, a clinical overview of her back, a digital dermo- scopic image of the lesion, as well as some of the surrounding nevi was per- formed. Histopathology confirmed the clini- cal suspect and revealed a melanoma (0.5 mm tumor thickness, mitosis < 1/ mm2). Imaging examinations were unre- markable and re-excision with 1 cm safety margins was performed. Histo- pathology of the re-excision showed no further tumoral evidence. At follow-up 6 months later, a linear brown pigmentation extending from the lower border into the scar of the primary tumor was noticed. Dermo- scopically, a structureless brown to gray pigmentation was observed (Figure 2B arrow). Side-by-side review of the clini- cal overview image taken at baseline and at the current visit (Figure 3) revealed a small pigmented nevus in about 1 cm distance at the lower area of the primary melanoma (Figure 3A red arrow). Based on this observation, a diagnosis of an incompletely removed nevus during the surgical procedure of the re-excision of the primary melanoma was made and the lesion was scheduled for digital fol- low-up. At follow-up 6 and 12 months later, the lesions remained completely unchanged. Conclusion Ferrara et al. showed that the addition of clinical information including pre- surgical images improves the diagnostic accuracy and confidence of patholo- gists when dealing with melanocytic skin tumors that are difficult to inter- pret. Moreover, Bauer and coworkers reported that review of dermoscopic images can help in avoiding sampling errors in histopathology [1-7]. Our case adds further support to the value of pre-surgical photographic documentation of the clinical manage- ment of patients with pigmented skin lesion. In our patient, the diagnosis of an incompletely removed nevus could References 1. Ferrara G, Argenyi Z, Argenziano G, et al. The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms. PLoS One. 2009;4:e5375. 2. Bauer J, Metzler G, Rassner G, Garbe C, Blum A. Dermatoscopy turns histopa- thologist’s attention to the suspicious area in melanocytic lesions. Arch Dermatol. 2001;1371338-1340. 3. Ferrara G, Argenziano G, Soyer HP, et al. Dermoscopic an histopathological diag- nosis of equivocal melanocytic lesions. An interdisciplinary study on 107 cases. Cancer. 2002;95:1094-1100. Figure 2. (A) Linear homogenous brown pigmentation extending from the lower border into the scar of the primary tumor. (B) Structureless brown to gray pigmentation dermoscopically. [Copyright: ©Zalaudek et al.] A B Figure 3. Side-by-side review of the follow-up (B) and baseline image (A) revealed a small pigmented nevus at a distance of about 1 cm from the lower area of the primary melanoma (A, red arrow). [Copyright: ©Zalaudek et al.] A B Observation | Dermatol Pract Concept 2017;7(2):4 25 logical diagnosis of cutaneous melanoma and other pigmented skin lesions. J Clin Oncol. 1996;14:1218-1223. 6. Farmer ER, Gonin R, Hanna MP. Discor- dance in the histopathological diagnosis of melanoma and melanocytic nevi be- 4. Ferrara G, Argenziano G, Cerroni L, et al. A pilot study on combined dermoscopic- pathological approach to the telediagnosis of melanocytic skin neoplasms. J Telemed Telecare. 2004;10:34–38. 5. Corona R, Mele A, Amini M, et al. In- terobserver variability on the histopatho- tween expert pathologists. Hum Pathol. 1996;27:528-531. 7. Soyer HP, Kenet RO, Wolf ICH, Kenet BJ, Cerroni L. Clinicopathological correlation of pigmented skin lesions using dermos- copy. Eur J Dermatol. 2000;10(1):22-8