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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.