CLINICS 2011;66(3):493-499 Silva JH et al. Figure 5 - Digital dermoscopy (20X) of melanocytic lesions that have similar dermatoscopic appearance (A , B; C , D): A) compound melanocytic nevus; B) dysplastic nevus; C) dysplastic junctional nevus with severe atypia, D) thin melanoma. malignant lesions and the minimization of unnecessary biopsies of benign lesions.43,44 Total body mapping and digital dermoscopy allow for storage of macroscopic and dermoscopic images for comparison over time. Follow-up procedures using this technique can be accomplished in short and long term. The long-term follow-up is performed at intervals of 9 to 12 months and is more suitable for risk patients with multiple nevi, including those with AMS.45 In this type of follow-up, changes that indicate lesion excision include the following: growth, change in shape, regression, changes in color and appearance of dermoscopic structures known to be asso- ciated with melanomas.34 In short term follow-up, the revaluation of the lesions must occur within 3 months from the first visit and is indicated for suspicious melanocytic lesions that have no dermoscopic features of melanoma. These include clinically moderate atypical lesions and less atypical ones that present a change history.45 The lesion should be excised when it presents any kind of morpholo- gical change except alterations in the number of milia cysts or global aspect of pigmentation.46 Follow-up recommendations for AMS patients The importance of early identification and treatment of melanoma is well established, as evidenced by the differences between the survival curves of patients at different stages as determined by the American Joint Committee on Cancer (AJCC) that show a 5-year survival rate around 95% for patients in Stage I and 15% for patients in Stage IV.6,47 Therefore, follow-up strategies for high risk populations such as those with AMS are justified by maximizing opportunities for detecting melanoma in its early stages.3 497 As the majority of melanomas arise de novo and only about 20-30% arise in a pre-existing nevus, atypical melanocytic nevi are considered important risk markers.26 Thus, prophylactic excision of all clinically dysplastic nevi in a subject with multiple nevi is unfounded and often not feasible.18 This approach could give the patient a false sense of security since their increased risk of melanoma persists even with the removal of all melanocytic lesions. A periodic dermatological examination is generally recommended for patients with dysplastic nevi or AMS, ranging from an examination every 3-12 months, depending on a patient’s position within the risk spectrum described above.3 Thus, some authors propose that patients of Rigel’s group 0 be examined annually, while those with higher risk (Rigel I, II or III) should be evaluated by a dermatologist every 3 to 6 months.3 According to Tucker et al.32, the risk of melanoma for patients with AMS in families predisposed to melanoma begins to increase at around 10 years of age and so it is recommended that monitoring begin at puberty.3 Physical examination of the entire integument is essential because most melanomas occur on covered areas and previous studies have demonstrated that the detection of melanoma was 6 times more frequent in patients who undressed completely.3,48 As mentioned above, dermoscopy increases the dia- gnostic accuracy of melanocytic neoplasias, and its imple- mentation is recommended during dermatologic consulta- tion.48,49,50,51 However, even with the aid of a dermatoscope, identifi- cation of new lesions and significant changes in nevi in individuals with multiple pigmented lesions and AMS can be challenging, making total body mapping and digital dermoscopy of great benefit to the diagnostic process.43,44 In