top of page
Total Body Photography

Dermoscopy

Confocal Microscopy

Diffuse Multispectral Imaging

MRI

Optical Coherence Tomography

Total Body Photography

Ultrasound

Overview

Sequential total body photography (TBP) and digital dermatoscopy significantly contribute to early melanoma detection, especially in the context of high-risk individuals.

In studies involving high-risk patients, about 10-20% of melanomas are identified through changes observed in TBP (1-4). This number can vary depending on the study or dataset and is influenced by factors such as the frequency of monitoring, the technology used, and the characteristics of the patient population. Melanomas detected via TBP are more often diagnosed at an earlier stage, with a lower Breslow’s thickness and a higher proportion of in situ melanomas. This is due to the detection of dermoscopic and macroscopic changes as well as new lesions that were not previously registered for follow-up. In addition, TBP is helpful in reducing unnecessary biopsies of benign lesions (5) and reduction in Patient and Physician Anxiety .


A specially trained photographer takes high-resolution clinical photographs of the patient’s entire skin surface from various standardized angles (Figure1), creating a 2D or 3D map of the body. The process takes about 5–15 minutes, depending on the technology used. Total body photography documentation is usually combined with digital dermoscopy images of suspected lesions "two step approach" (4). These clinical and dermoscopic images are then stored in computer systems and used as reference points for future examinations to monitor new or changing lesions. Depending on the individual’s level of risk, TBP may be repeated yearly or obtained only once as a baseline for future reference. Digital dermoscopy images can be reviewed short-term (every 3–4 months) or annually, depending on the risk associated with the lesions and the patient’s history.


In addition to aiding in melanoma diagnosis, total body photography images can be used to monitor treatment response, document the location of biopsied lesions, and track the progression of dermatologic disease.


Examples of commercial systems for total body photography include:

  • Vectra 3D (Canfield)

  • DermEngine (MetaOptima)

  • FotoFinder

  • MoleMax HD (Derma Medical Systems)


Currently, TBP is not covered by Medicare.


Figure1. Standard poses required for 2D TBP. "Canfield" Vectra 2nd generation.


Indications for TBP Follow-Up

Different studies have included various patient populations for follow-up, which is why there is no single guideline. However, all known high-risk groups, such as those with genetic predisposition, a family history of melanoma, a personal history of melanoma, or a high total nevus count, might benefit from total-body photography (5).  The NCCN guidelines suggest that total-body photography and sequential digital dermoscopy may aid in the surveillance of new primary melanoma, especially in patients with a high mole count and/or clinically atypical nevi. The International Dermoscopy Society (IDS) recommends total-body photography for (6):

  • Patients with more than 60 melanocytic nevi.

  • Patients with a CDKN2A mutation or other rarer high-risk melanoma genetic variants.

  • Patients with more than 40 melanocytic nevi and a personal history of melanoma.

  • Patients with more than 40 melanocytic nevi and red hair and/or an MC1R mutation.

  • Patients with more than 40 melanocytic nevi and a history of organ transplantation.


TBP in Dysplastic nevus syndrome

Dysplastic nevus syndrome is defined as having at least 50 moles, with at least 2 being dysplastic. In 40% of cases, the disorder is linked to germline mutations in the CDKN2A gene, which codes for p16 (10). Dysplastic nevi often grow larger than ordinary moles and may have irregular and indistinct borders. Their color can be uneven, ranging from light pink to very dark brown. They usually start as flat but may develop raised areas. Individuals with dysplastic nevi have a lifetime risk of developing melanoma greater than 10%, compared to less than 1% for those without dysplastic nevi (9). Such individuals need to be monitored regularly for any changes in their moles and for any new ones. Detecting melanoma in this high-risk population can be very challenging. To diagnose these lesions and prevent unnecessary procedures, TBP and sequential dermatoscopic documentation can be helpful, as they facilitate both the detection of melanoma and the reduction of unnecessary excisions.


How to monitor a lesion?

Digital monitoring should be reserved for small and flat melanocytic lesions with potential for melanoma. The main principle of mole mapping is that melanoma tends to change and grow over time. Any morphologic changes observed at the three-month follow-up should be evaluated for potential excision. In a study of 1,152 excised lesions during TBP follow-up, the most frequent dermatoscopic features associated with melanoma were focal changes in pigmentation or structure (7). Because nevi are much more common than melanoma, changes in nevi are frequently observed. However, these changes, such as symmetric enlargement, are benign. Suspicious changes include alterations in size, color, and structure:

  • Appearance of a new color or change in a pre-existing color

  • Disappearance of an existing pattern or appearance of a new pattern

  • Changes in the presence or number of basic pattern elements (such as dots or clods)

  • Asymmetric enlargement

  • Regression


Challenges and Limitations

  • Detection of hypopigmented melanomas (2–8%) may be less reliable compared to pigmented lesions.

  • The system's large physical size, high cost, and need for professional operation.

  • The technology does not cover lesions in genital, acral, or scalp areas?.

  • Dermoscopy images require interpretation by experienced dermoscopist.

  • Biopsy efficiency may be reduced in younger patients where benign nevi are still increasing and changing.


Limitations of 2D Imaging

2D imaging remains a widely utilized and popular method for total body photography. However, it has several limitations:

  • Time-Consuming: Composing a body map using 2D imaging requires capturing multiple separate images of the patient from various anatomical positions.

  • Overlap and Gaps: Images can overlap or fail to include some nevi if not captured from the correct angles, potentially missing critical details.


References:

(1).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916771/

(2). https://jamanetwork.com/journals/jamadermatology/fullarticle/2777610

(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916771/pdf/ijerph-18-01726.pdf

(4). https://www.sciencedirect.com/science/article/pii/S0190962211004762

(5). https://pubmed.ncbi.nlm.nih.gov/26947450/#:~:text=Conclusions%3A%20Patients%20at%20risk%20for,higher%20biopsy%20rates%20after%20TBP.

(6). https://pubmed.ncbi.nlm.nih.gov/35570085/

(7). https://pubmed.ncbi.nlm.nih.gov/36534527/

(8). https://www.sciencedirect.com/science/article/pii/S0190962212001211

(9). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616416/

(10). https://www.ncbi.nlm.nih.gov/books/NBK7030/




Relevant Links

Recent Developments

Evolution of Total Body Photography


Total body photography evolved from 2D imaging to the ability to create a 3D representation of the patient, integrated with dermoscopic images of individual lesions marked on the 3D avatar, ensuring accurate documentation of each lesion’s anatomical location and enabling effective monitoring over time.


Since 2017, the Vectra WB360 system (Canfield Scientific Inc, Parsippany, NJ, USA) has been available (Figure2). This system features:

  • 92 Cameras and Enhanced Lighting: Captures images simultaneously, constructing a digital 3D avatar within milliseconds as the patient maintains a single anatomical position. The physical device using an imaging pod equipped with 92 fixed cameras (46 stereo-pairs of cameras) and xenon flashes capable of both crossed-polarized and non-polarized lighting.

  • 360-Degree View: Provides a comprehensive 360-degree view of all body angles, including curved surfaces that are difficult to capture with 2D imaging. Lesions on certain anatomic sites like the volar surfaces, genitalia, or hair-bearing scalp are generally not visible.


Figure 2. The Vectra 3D system (Canfield Scientific, Inc., Parsippany, NJ, USA).

Memorial Sloan Kettering Cancer Center. The patient stands in the device and image capture happens in milliseconds.


The new system provides insights based on AI and includes automatic comparison between images, tracking changes, and marking new or changing lesions on the pictures. At present, the resulting 3D-images are primarily used by dermatologists as a reference comparison to identify new or changing pigmented skin lesions in moly patients. A single-center, retrospective observational study by Marchetti et al (3) showed that automated analysis of whole-body 3D images could effectively discriminate melanoma from other skin lesions, highlighting the potential to improve melanoma detection with larger, more diverse datasets in future studies.


The Vectra DermaGraphix software can automatically identify and characterize the clinical morphology of all visible lesions greater than 2mm on an individual's body (Figure 3). It also allows clinicians to tag (record) and monitor lesions within a secure database, which can be associated with pathology reports. The Lesion Visualizer (LV) research tool for DermaGraphix uses AI algorithms to automatically locate lesions throughout the 3D TBP capture and estimates a set of measures for each lesion, including size, shape, color, "nevus confidence," and asymmetry, among others. Lesions are identified in one of two ways: (1) manual lesion tagging performed by a clinician, often to attribute other clinical and dermoscopy photos to the lesion; and (2) automated lesion detection performed by the LV.


Figure 3: Representative clinical images (3). (a) Example views of a 3D whole body image from a model (images provided by and courtesy of Canfield Scientific Inc.). (b) Illustrative patient diagnosed with melanoma in situ on right chest (red circle, lesion no. 18). Other lesions automatically identified by the software are tagged with white triangles. (c) Screenshot of the same patient's data provided by the software for all 522 automatically-detected skin lesions. The spiral diagram at center shows 522 lesions >2mm sorted by longest diameter (larger lesions in center and smaller lesions at periphery). The melanoma in situ is indicated by the red circle. The left panel shows the relatives scores of the melanoma in situ (white bars) ranked in context of the scores for the patient's other 521 lesions (blue bars) for longest diameter, contrast, border irregularity, color variation, hue, and nevus versus non-nevus confidence. The prediction model's score of the melanoma in situ on the right chest was ranked in the 98th percentile of the patient's lesions (516 out of 522).



References

(1). https://pubmed.ncbi.nlm.nih.gov/37453242/

(2). https://pubmed.ncbi.nlm.nih.gov/29911103/

(3). https://pubmed.ncbi.nlm.nih.gov/36708077/







Upcoming Meetings

No upcoming meetings.

Other topics

Dermoscopy
Confocal Microscopy
Diffuse Multispectral Imaging
MRI
Optical Coherence Tomography
Total Body Photography
Ultrasound

Explore Image Modalities

bottom of page