<b><i>Objective:</i></b> To analyze routine clinical management of atypical melanocytic lesions through monitoring or surgery in Italian hospitals. <b><i>Methods:</i></b> A nationwide survey of clinical practices was conducted. <b><i>Results:</i></b> Digital monitoring is performed in most Italian hospitals and is preferred over excision for single atypical melanocytic lesions in 82% of hospitals. For multiple atypical lesions, 60% of high-volume hospitals prefer digital monitoring to surgical excision (40%). There is a statistically significant difference between high- and low-volume hospitals (60 vs. 39%; p = 0.003). Digital monitoring is performed at mean intervals of 4/5 months for both types of lesions. <b><i>Conclusions:</i></b> We show an asymmetric relation between application of the method and practical impact based on available clinical evidence. Although digital monitoring provides better characterization of the evolution of melanocytic lesions, our results indicate that the advantages and limitations of this method require further investigation.