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CORRESPONDENCE Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Digital Dermoscopy Monitoring : Is it Time to Define a Quality Standard ?
Calogero PAGLIARELLO 1 , Ignazio STANGANELLI 2 , Giuseppe FABRIZI 3 , Claudio FELICIANI 1 and Sergio DI NUZZO 1
1
Department of Clinical and Experimental Medicine , University of Parma , Via Gramsci 14 , IT-43100 Parma , 2 Skin Cancer Unit IRCCS IRST , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori , Meldola ( FC ), and 3 Istituto Dermopatico dell ’ Immacolata , IDI IRCCS , Rome , Italy . E-mail : calogero . pagliarello @ libero . it
Dermoscopy monitoring is useful in detecting melanoma in patients with multiple atypical naevi ( 1 ). Thus , sequential dermoscopy imaging ( SDI ) has shifted from an academic , investigational practice to a commonly provided service . In the past , SDI was provided only through costly dedicated digital epiluminescence systems available from only a few manufacturers ; however , improvements in digital camera and smartphone technology have recently enabled a notable increase in routine SDI . Diagnosis using the SDI process essentially relies on comparing pictures acquired by various means . We discuss here some of the difficulties dermatologists may face in performing SDI .
At present , a dermatologist can perform SDI of suspicious naevi through :
• a polarized or non-polarized handheld dermatoscope or stereomicroscope coupled with specific compact digital cameras , single-lens reflex camera , smartphone , or tablet ;
• a dedicated point-and-shoot dermoscopy camera ( DermLite Cam , 3Gen Inc ., San Juan Capistrano , CA , USA );
• USB digital microscopes ( Dino-Lite DermaScope , Dino-Lite , Naarden , Holland );
• a dedicated lens coupled to a digital single-lens reflex camera ( DermLite Foto II Pro and DermLite Foto II Pro Plus , 3Gen Inc .; VEOS SLR Canfield Scientific , Parsippany , NJ , USA ).
Image storage and retrieval requires a custom software database . Also , handheld dermatoscope manufacturers provide smartphone applications , such as the DermLite app , Handyscope and Handyscope 2 ( FotoFinder Systems GmbH , Bad Birnbach , Germany ), and the VEOS app ( Canfield Scientific ), allowing the capture of dermoscopy images and localizing lesions on a mannequin directly from within the applications . Since these solutions are readily available to every dermatologist , requiring no more than a smartphone and a handheld dermatoscope , the choice of using a smartphone over a digital camera is greatly encouraged . It should be noted that as the performance of smartphones and digital cameras improves significantly each year , it is expected that , over time , a given patient will receive SDI via different devices , thus increasing picture heterogeneity , even within a single dermatological facility .
A major drawback of such solutions is that it is somewhat demanding to comply with full mole mapping and subsequent follow-up , and this will require a significant amount of time for patients with many moles .
Instead of smartphones and handheld dermatoscopes , large facilities or tertiary referral centres use costly ( usually not less than € 15,000 ) digital epiluminescence systems or videodermatoscopes ( e . g . Vidix Skin Imaging Group , Las Vegas , NV , USA ; FotoFinder Systems ; Molemax Derma Medical Systems , Vienna , Austria ; VideoCap DS Medica , Milan , Italy ). This choice is largely based on the need to rapidly map many moles per patient ( which is possible with these systems ) rather than on the quality of the pictures produced .
When using such methods , dermatologists must deal with the following consequences :
• there are currently many dermatologists compiling a huge number of patient databases with potentially ill-conceived images in terms of colour accuracy and consistency ;
• poor-quality pictures could result in misdiagnosis ;
• transferring patient ’ s SDI results between different facilities is currently difficult , thus preventing the establishment of a reliable dermato-oncology network ;
• at present , digital dermoscopy monitoring is a highly operator-dependent technique , although there are recommendations to minimize this issue ( 2 ).
An outdated proposal for standardizing reports of dermoscopic evaluations of skin tumours recommends including information related to the imaging equipment ( brand name , manufacturer , type of illumination , and spectral band ) and magnifications ( 3 ). However , the guidelines offered are only professional recommendations and are not binding as “ standards .” A more recent teledermatology standards guideline from Primary Care Commissioning in the UK has posed more complete recommendations , but it refers to standard photography ( 4 ).
Such carelessness regarding SDI is of concern . The adequacy of these images for clinical use is not a subjective aesthetic judgement . In cases of a life-threatening disease , such as melanoma , we feel that sometimes even a hard-to-detect hue difference could make a great difference in diagnosis . This is especially important , as this group of patients is generally at greater risk . To avoid misdiagnosis , it seems advisable for dermatologists to doi : 10.2340 / 00015555-2663 Acta Derm Venereol 2017 ; 97 : 864 – 865
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica .