Total Body Photography and Sequential Digital Dermoscopy in Pregnant Women

Gabriela M Martins-Costa, Renato Bakos, Gabriela M Martins-Costa, Renato Bakos

Abstract

Background: Melanocytic nevi can vary in size and number in pregnant women, and the differential diagnosis with melanoma may be challenging.

Objectives: To describe changes in total body photography of pregnant women and dermoscopy aspects of their nevi.

Methods: A prospective cohort study with 703 melanocytic nevi from 18 women was performed, comparing them in the first and third trimester of pregnancy. Images were analyzed between the 2 periods for changes in dermoscopic aspects.

Results: Total body photography images indicated that 44% of patients had new lesions. Regarding the observed changes, there were symmetric or regular changes of the network (23% of cases), occurrence of new globules/dots (12.4%), new vascular structures (3.2%), new streaks (1.7%), and new structureless area (1.0%). Moreover, 55.0% of the nevi increased in size. Enlarging of the nevi was observed mostly on the abdomen (87.1%; P < 0.001) and showed more network changes (27.1%; P = 0.014) and formation of new globules and dots (16.0%; P < 0.001). Patients with a risk of developing melanoma presented more frequently enlarged nevi (45%; P = 0.019). The association between streak formation and skin type was significant (P = 0.012) and was more frequent in skin type II (2.7%), when compared with skin types III (1.3%) and IV (0%).

Conclusions: Development of new melanocytic nevi may occur in pregnant women. The majority of the preexisting melanocytic nevi showed enlarging, and most of them presented with benign dermoscopic changes. The appearance of new streaks is more frequent in fair skin types. Patients with a personal or family history of melanoma in first-degree relatives presented more nevi with changes in size.

Keywords: dermoscopy; digital monitoring; melanocytic nevi; pregnancy; total body photography.

Conflict of interest statement

Competing interests: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) Baseline image of the anterior portion of the trunk and arms of a patient during the first trimester. (B) The development of a new lesion in the right arm in the third trimester (red square) is highlighted in the left upper corner. Blue arrows are not relevant for this evaluation. They are markers in the system that we used which are necessary to number nevi that will be evaluated by dermoscopy. [Copyright: ©2019 Martins-Costa and Bakos]
Figure 2
Figure 2
(A) Dermoscopic image (20 × original magnification) of a melanocytic lesion in the first trimester on the lateral trunk. (B) Image from the same nevus in the third trimester showing enlargement with a symmetric and homogeneous network distribution. [Copyright: ©2019 Martins-Costa and Bakos]
Figure 3
Figure 3
(A) Dermoscopic image (20 × original magnification) of a melanocytic lesion in the first trimester on the middle of the torso. (B) Image from the same nevus in the third trimester showing a rim of symmetric and homogeneous distributed dots in the periphery of the lesion. [Copyright: ©2019 Martins-Costa and Bakos]
Figure 4
Figure 4
Dermoscopic image showing a new irregular pigmented lesion in the third trimester on the left buttock (20 × original magnification). Histopathological examination revealed an atypical nevus. [Copyright: ©2019 Martins-Costa and Bakos]

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