Background Early detection of melanoma results in excision of thinner melanomas, which are associated with better prognosis. Total cutaneous photography provides a temporal comparison o lesions, which allows clinicians and patients to recognize new and subtly changing lesions. Objectives We examined the utility of total cutaneous photography in detecting melanoma identified the reason for biopsy of suspicious lesions and determined who detected new melanomas the physician on follow-up examination or the patient on self-examination. Patients/methods The charts of the 576 patients in the total cutaneous photography database were reviewed. Twelve patients were identified who had melanoma diagnosed with photographic assistance. Baseline and prebiopsy photographs, dermatology clinic notes (115 patient visits) and pathology reports for each biopsied lesion were reviewed. Histological diagnosis, cause for biopsy and whether the lesion was detected by the patient or physician, was recorded for each of the biopsied lesions. Also noted were all the lesions that concerned patients, the cause for concern, and whether these lesions were biopsied. Results A total of 93 lesions were biopsied in these patients. Twenty-seven (35%) of 77 melano- cytic lesions were histologically diagnosed as melanoma. The thickest melanoma found measured 1·1 mm, indicating a favourable prognosis in our patients. Seventy-four per cent of the melanomas were biopsied due to changes from baseline and 19% were biopsied because they were new lesions The changes noted were subtle and the lesions that proved to be melanoma did not satisfy the classical clinical criteria for melanoma. Eight (30%) of the melanomas were identified by patients on skin self-examination. Twenty-six per cent of the lesions that concerned patients were not biopsied after evaluation by a physician. Conclusions We found that photographically assisted follow-up helped detect new and subtly changing melanomas, which did not satisfy the classical clinical features of melanoma. In addition photographically assisted follow-up helped detect nonmelanoma skin cancers. Patient skin selfexamination proved to be valuable, in that it complemented physician follow-up examination in detecting melanomas. Photographic follow-up was also valuable in avoiding unnecessary biopsy in suspicious, but stable lesions. Total cutaneous photography therefore may be an effective way to increase the sensitivity and specificity for detecting melanoma. [ABSTRACT FROM AUTHOR]