BACKGROUND Atypical nevi are a common risk factor for melanoma.

OBJECTIVES The objective was to determine the utility of monitoring dermoscopic photographs of atypical nevi in a high-risk population.

METHODS Over a 4.5-year period, digital dermoscopic photographs were taken of clinically atypical nevi at initial and follow-up visits, such that side-by-side comparisons could be made.

RESULTS A total of 5,945 lesions were monitored in 297 patients over 3 to 52 months (median, 22 months), and 324 lesions were biopsied. Photographic (dermoscopic) changes were noted in 96 of 5,945 (1.6%) lesions, which included 64 dysplastic nevi (67%), 25 common nevi (26%), and 1 melanoma (1.0%). Of 6 melanomas biopsied during the follow-up period, only 1 was detected by dermoscopic photographic change at follow-up.

CONCLUSIONS Most clinically atypical melanocytic nevi are stable over time, and lesions exhibiting dermoscopic changes are most likely to be dysplastic nevi. Although dermoscopy is a useful tool for clinical examination, the sensitivity of dermoscopic monitoring is limited by melanomas that may arise in normal skin or in clinically benign nevi that were not initially photographed.