AI-assisted Total Body Dermoscopic Evaluation of Changes in Melanocytic Nevi during Pregnancy: A Prospective, Comparative Study of 2,799 Nevi

Jelissa K. Peter; Fabrice Helfenstein; Sara E. Cerminara; Julia-Tatjana Maul; Mara L. Zehnder; Dagmar Jamiolkowski; Elisabeth Roider; Beda Mühleisen; Irene Hösli; Alexander A. Navarini; Lara V. Maul

doi:10.2340/actadv.v105.41025

Authors

Jelissa K. Peter Department of Dermatology, University Hospital of Basel, Basel, Switzerland
Fabrice Helfenstein Clinical Trials Unit, University of Bern, Bern, Switzerland
Sara E. Cerminara Department of Dermatology, University Hospital of Basel, Basel, Switzerland
Julia-Tatjana Maul Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
Mara L. Zehnder Department of Dermatology, University Hospital of Basel, Basel, Switzerland
Dagmar Jamiolkowski Department of Dermatology, University Hospital of Basel, Basel, Switzerland; Department of Pediatric Dermatology and Allergology, Children’s Hospital Auf der Bult, Hannover, Germany
Elisabeth Roider Department of Dermatology, University Hospital of Basel, Basel, Switzerland; Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
Beda Mühleisen Department of Dermatology, University Hospital of Basel, Basel, Switzerland
Irene Hösli Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerlan
Alexander A. Navarini Department of Dermatology, University Hospital of Basel, Basel, Switzerland
Lara V. Maul Department of Dermatology, University Hospital of Basel, Basel, Switzerland; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland

DOI:

https://doi.org/10.2340/actadv.v105.41025

Keywords:

Artificial intelligence, Digital Imaging, Melanocytic nevi, Melanoma, Pregnancy

Abstract

Pregnancy-associated changes in melanocytic nevi (MN), apart from size increase on the trunk, remain a topic of debate. We conducted the first prospective study to investigate dermoscopic changes in MN comparing pregnant with non-pregnant women on all body parts using a market-approved convolutional neural network (CNN). We included 25 pregnant and 25 non-pregnant women from Basel, Switzerland, who underwent standard skin cancer screenings and whose MN > 2 mm were digitally recorded and analysed by a CNN. Pregnant women were examined three times: in the first and third trimester and 8–12 weeks postpartum; non-pregnant women twice in an interval of 17–21 weeks. We analysed 2,799 MN. In pregnant women, diameter[p < 0.001], area[p < 0.001], number of colours [p = 0.009], shape asymmetry[p = 0.005] and border sharpness[p = 0.006] (inversely proportional value) increased while ellipseness [p < 0.001] decreased from first trimester to postpartum. Changes occurred mainly during the third trimester to postpartum. Compared to non-pregnant women (only first to third trimester) MN on the upper extremities of pregnant women increased in area[p = 0.011] and diameter[p = 0.025] and decreased in ellipseness[p = 0.037]. MN on the lower extremities increased in area[p = 0.044] and MN on the back increased in colour asymmetry[p = 0.022].

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References

Di Brizzi EV, Pampena R, Licata G, Calabrese G, Longo C, Argenziano G. Are we born and do we die without nevi? A cross‐sectional study. Int J Dermatol 2021; 60: 1405-1410.

https://doi.org/10.1111/ijd.15668 DOI: https://doi.org/10.1111/ijd.15668

Mackie RM, English J, Aitchison TC, Fitzsimons CP, Wilson P. The number and distribution of benign pigmented moles (melanocytic naevi) in a healthy British population. Br J Dermatol 1985; 113: 167-174.

https://doi.org/10.1111/j.1365-2133.1985.tb02060.x DOI: https://doi.org/10.1111/j.1365-2133.1985.tb02060.x

De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, et al. Sun-protection behavior, pubertal development and menarche: factors influencing the melanocytic nevi development - the results of an observational study of 1,512 children. J Invest Dermatol 2018; 138: 2144-2151.

https://doi.org/10.1016/j.jid.2018.02.046 DOI: https://doi.org/10.1016/j.jid.2018.02.046

Lanna C, Tartaglia C, Caposiena Caro RD, Mazzilli S, Ventura A, Bianchi L, et al. Melanocytic lesion in children and adolescents: an Italian observational study. Sci Rep 2020; 10: 8594.

https://doi.org/10.1038/s41598-020-65690-x DOI: https://doi.org/10.1038/s41598-020-65690-x

Woitowich NC, Beery A, Woodruff T. A 10-year follow-up study of sex inclusion in the biological sciences. eLife 2020; 9: e56344.

https://doi.org/10.7554/eLife.56344 DOI: https://doi.org/10.7554/eLife.56344

Kong BY, Haugh IM, Schlosser BJ, Getsios S, Paller AS. Mind the gap: sex bias in basic skin research. J Invest Dermatol 2016; 136: 12-14.

https://doi.org/10.1038/JID.2015.298 DOI: https://doi.org/10.1038/JID.2015.298

Dalmartello M, Negri E, La Vecchia C, Scarfone G, Buonomo B, Peccatori FA, et al. Frequency of pregnancy-associated cancer: a systematic review of population-based studies. Cancers 2020; 12: 1356.

https://doi.org/10.3390/cancers12061356 DOI: https://doi.org/10.3390/cancers12061356

Lundberg FE, Stensheim H, Ullenhag GJ, Sahlgren HM, Lindemann K, Fredriksson I, et al. Risk factors for the increasing incidence of pregnancy‐associated cancer in Sweden - a population‐based study. Acta Obstet Gynecol Scand 2024; 103: 669-683.

https://doi.org/10.1111/aogs.14677 DOI: https://doi.org/10.1111/aogs.14677

Davidson TM, Hieken TJ, Glasgow AE, Habermann EB, Yan Y. Pregnancy-associated melanoma: characteristics and outcomes from 2002 to 2020. Melanoma Res 2024; 34: 175-181.

https://doi.org/10.1097/CMR.0000000000000953 DOI: https://doi.org/10.1097/CMR.0000000000000953

Barnawi AM, Barnawi GM, Alamri AM. Women's health: most common physiologic and pathologic cutaneous manifestations during pregnancy. Cureus 2021; 13: e16539.

https://doi.org/10.7759/cureus.16539 DOI: https://doi.org/10.7759/cureus.16539

Bieber AK, Martires KJ, Stein JA, Grant-Kels JM, Driscoll MS, Pomeranz MK. Pigmentation and pregnancy: knowing what is normal. Obstet Gynecol 2017; 129: 168-173.

https://doi.org/10.1097/AOG.0000000000001806 DOI: https://doi.org/10.1097/AOG.0000000000001806

Koh SS, Roehmholdt BF, Cassarino DS. Immunohistochemistry of p16 in nevi of pregnancy and nevoid melanomas. J Cutan Pathol 2018; 45: 891–896.

https://doi.org/10.1111/cup.13350 DOI: https://doi.org/10.1111/cup.13350

Cosgarea I, Trevisan-Herraz M, Ungureanu L, Zalaudek I. Dermatoscopic features of naevi during pregnancy - a mini review. Front Med 2021; 8: 727319.

https://doi.org/10.3389/fmed.2021.727319 DOI: https://doi.org/10.3389/fmed.2021.727319

Bieber AK, Martires KJ, Driscoll MS, Grant-Kels JM, Pomeranz MK, Stein JA. Nevi and pregnancy. J Am Acad Dermatol 2016; 75: 661-666.

https://doi.org/10.1016/j.jaad.2016.01.060 DOI: https://doi.org/10.1016/j.jaad.2016.01.060

Winkler JK, Sies K, Fink C, Toberer F, Enk A, Deinlein T, et al. Melanoma recognition by a deep learning convolutional neural network-Performance in different melanoma subtypes and localisations. Eur J Cancer 2020; 127: 21-29.

https://doi.org/10.1016/j.ejca.2019.11.020 DOI: https://doi.org/10.1016/j.ejca.2019.11.020

Fink C, Blum A, Buhl T, Mitteldorf C, Hofmann‐Wellenhof R, Deinlein T, et al. Diagnostic performance of a deep learning convolutional neural network in the differentiation of combined naevi and melanomas. J Eur Acad Dermatol Venereol 2020; 34: 1355-1361.

https://doi.org/10.1111/jdv.16165 DOI: https://doi.org/10.1111/jdv.16165

Haenssle HA, Fink C, Toberer F, Winkler J, Stolz W, Deinlein T, et al. Man against machine reloaded: performance of a market-approved convolutional neural network in classifying a broad spectrum of skin lesions in comparison with 96 dermatologists working under less artificial conditions. Ann Oncol 2020; 31: 137-143.

https://doi.org/10.1016/j.annonc.2019.10.013 DOI: https://doi.org/10.1016/j.annonc.2019.10.013

Goessinger EV, Cerminara SE, Mueller AM, Gottfrois P, Huber S, Amaral M, et al. Consistency of convolutional neural networks in dermoscopic melanoma recognition: A prospective real‐world study about the pitfalls of augmented intelligence. J Eur Acad Dermatol Venereol 2024; 38: 945-953.

https://doi.org/10.1111/jdv.19777 DOI: https://doi.org/10.1111/jdv.19777

Cerminara SE, Cheng P, Kostner L, Huber S, Kunz M, Maul JT, et al. Diagnostic performance of augmented intelligence with 2D and 3D total body photography and convolutional neural networks in a high-risk population for melanoma under real-world conditions: A new era of skin cancer screening? Eur J Cancer 2023; 190: 112954.

https://doi.org/10.1016/j.ejca.2023.112954 DOI: https://doi.org/10.1016/j.ejca.2023.112954

Rubegni P, Sbano P, Burroni M, Cevenini G, Bocchi C, Severi FM, et al. Melanocytic skin lesions and pregnancy: digital dermoscopy analysis. Skin Res Technol 2007; 13: 143-147.

https://doi.org/10.1111/j.1600-0846.2007.00180.x DOI: https://doi.org/10.1111/j.1600-0846.2007.00180.x

Zampino MR, Corazza M, Costantino D, Mollica G, Virgili A. Are melanocytic nevi influenced by pregnancy? A dermoscopic evaluation. Dermatol Surg 2006; 32: 1497-1504.

https://doi.org/10.1111/j.1524-4725.2006.32362.x DOI: https://doi.org/10.1111/j.1524-4725.2006.32362.x

Martins-Costa GM, Bakos R. Total body photography and sequential digital dermoscopy in pregnant women. Dermatol Pract Concept 2019; 9: 126-131.

https://doi.org/10.5826/dpc.0902a08 DOI: https://doi.org/10.5826/dpc.0902a08

Cosci I, Grande G, Di Nisio A, Rocca MS, Del Fiore P, Benna C, et al. Cutaneous melanoma and hormones: focus on sex differences and the testis. Int J Mol Sci 2022; 24: 599.

https://doi.org/10.3390/ijms24010599 DOI: https://doi.org/10.3390/ijms24010599

Schmidt AN, Nanney LB, Boyd AS, King LE, Ellis DL. Oestrogen receptor‐β expression in melanocytic lesions. Exp Dermatol 2006; 15: 971-980.

https://doi.org/10.1111/j.1600-0625.2006.00502.x DOI: https://doi.org/10.1111/j.1600-0625.2006.00502.x

Spałkowska M, Dyduch G, Broniatowska E, Damiani G, Wojas-Pelc A. Molecular proof of a clinical concept: expression of estrogen alpha-, beta-receptors and g protein-coupled estrogen receptor 1 (GPER) in histologically assessed common nevi, dysplastic nevi and melanomas. Medicina (Mex) 2021; 57: 1228.

https://doi.org/10.3390/medicina57111228 DOI: https://doi.org/10.3390/medicina57111228

De Giorgi V, Mavilia C, Massi D, Gozzini A, Aragona P, Tanini A, et al. Estrogen receptor expression in cutaneous melanoma: a real-time reverse transcriptase-polymerase chain reaction and immunohistochemical study. Arch Dermatol 2009; 145: 30-36

https://doi.org/10.1001/archdermatol.2008.537 DOI: https://doi.org/10.1001/archdermatol.2008.537

Aktürk A, Bilen N, Bayrämgürler D, Demirsoy E, Erdogan S, Kiran R. Dermoscopy is a suitable method for the observation of the pregnancy‐related changes in melanocytic nevi. J Eur Acad Dermatol Venereol 2007; 21: 1086-1090.

https://doi.org/10.1111/j.1468-3083.2007.02204.x DOI: https://doi.org/10.1111/j.1468-3083.2007.02204.x

Gunduz K, Koltan S, Sahin MT, E Filiz E. Analysis of melanocytic naevi by dermoscopy during pregnancy. J Eur Acad Dermatol Venereol 2003; 17: 349-351.

https://doi.org/10.1046/j.1468-3083.2003.00792_2.x DOI: https://doi.org/10.1046/j.1468-3083.2003.00792_2.x

Wong RC, Ellis CN. Physiologic skin changes in pregnancy. J Am Acad Dermatol 1984; 10: 929-940.

https://doi.org/10.1016/S0190-9622(84)80305-9 DOI: https://doi.org/10.1016/S0190-9622(84)80305-9

Parmley T, O??Brien TJ. Skin changes during pregnancy. Clin Obstet Gynecol 1990; 33: 713-717.

https://doi.org/10.1097/00003081-199012000-00004 DOI: https://doi.org/10.1097/00003081-199012000-00004

Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol 1982; 6: 977-998.

https://doi.org/10.1016/S0190-9622(82)70083-0 DOI: https://doi.org/10.1016/S0190-9622(82)70083-0

Strumia R. Digital Epiluminescence microscopy in nevi during pregnancy. Dermatology 2002; 205: 186-187.

https://doi.org/10.1159/000063901 DOI: https://doi.org/10.1159/000063901

Wyon Y, Synnerstad I, Fredrikson M, Rosdahl I. Spectrophotometric analysis of melanocytic naevi during pregnancy. Acta Derm Venereol 2007; 87: 231-237.

https://doi.org/10.2340/00015555-0227 DOI: https://doi.org/10.2340/00015555-0227

Bajaj S, Dusza SW, Marchetti MA, Wu X, Fonseca M, Kose K, et al. Growth-curve modeling of nevi with a peripheral globular pattern. JAMA Dermatol 2015; 151: 1338.

https://doi.org/10.1001/jamadermatol.2015.2231 DOI: https://doi.org/10.1001/jamadermatol.2015.2231

Cengiz FP, Yılmaz Y, Emiroglu N, Onsun N. Dermoscopic evolution of pediatric nevi. Ann Dermatol 2019; 31: 518.

https://doi.org/10.5021/ad.2019.31.5.518 DOI: https://doi.org/10.5021/ad.2019.31.5.518

Chan MP, Chan MM, Tahan SR. Melanocytic nevi in pregnancy: histologic features and Ki‐67 proliferation index. J Cutan Pathol 2010; 37: 843-851.

https://doi.org/10.1111/j.1600-0560.2009.01491.x DOI: https://doi.org/10.1111/j.1600-0560.2009.01491.x