RISK-ADAPTED MONITORING OF MELANOCYTIC LESIONS WITH PERIPHERAL GLOBULES: A LONGITUDINAL COHORT STUDY ON MELANOMA RISK STRATIFICATION.

BACKGROUND: Peripheral globules are often considered a marker of benign horizontal growth in melanocytic nevi, but their significance during follow-up remains unclear. OBJECTIVE: To determine whether longitudinal evolution of peripheral globules and related lesion dynamics predict adverse histopathologic outcomes. METHODS: In this single-center ambispective cohort study, 1923 melanocytic lesions with peripheral globules from 215 patients underwent sequential digital dermoscopy. Longitudinal changes in globules, growth rate, and pigmentation were analyzed using a Bayesian generalized linear mixed model with patient-level random intercepts. RESULTS: During follow-up, 46.9% of lesions showed complete globule resolution. Compared with resolution, persistent globules were associated with increased risk, including stable globules (adjusted OR, 3.91; 95% CrI, 1.32-12.21) and increasing globules (adjusted OR, 4.18; 95% CrI, 1.33-13.93). Increasing pigmentation (adjusted OR, 6.33; 95% CrI, 2.39-18.21), faster growth (adjusted OR, 1.15 per 0.1 mm2/month; 95% CrI, 1.04-1.26), and personal history of melanoma (adjusted OR, 7.65; 95% CrI, 2.99-22.02) were independently associated with a clinically significant histopathologic endpoint, whereas age was not. LIMITATIONS: Single-center design, possible referral bias, and lack of histopathologic confirmation for non-excised lesions. CONCLUSION: Peripheral globules are dynamic rather than static findings, and longitudinal lesion behavior may improve risk stratification beyond baseline morphology alone.