Vol. 27. No. 1


During the past decade, we have witnessed tremendous advances in the technologies used in the fields of dermatology and dermatologic surgery. These innovations have influenced and will continue to influence the care that we provide to our patients as well as the way we practice. Keeping pace with these changes can be a daunting but rewarding task. Although it is impossible to review all of the significant advances in our field in a single journal issue, this special issue of Seminars in Cutaneous Medicine and Surgery, titled “Technology in Dermatology and Dermatologic Surgery,” provides a sampling of articles covering some of the most pertinent advances in our field. The primary aim of this special edition of Seminars is to provide an update on the current state of selected technologies impacting dermatology and dermatologic surgery. The articles within this special edition provide insight to the current diagnostic and therapeutic technologies available in our field. Technologies often build on previous technologies. By increasing the awareness of the current technological advancements in our field, we hope to not only help practitioners take advantage of current technologies, but also provide the stepping stones to future collaborations leading to innovations that can ultimately impact the way we view, diagnose and treat skin diseases. This special edition is separated into 3 sections. The first section contains articles that relate to diagnostic technologies. The second section deals with therapeutic technologies, whereas the final section reviews pertinent practice-enhancement technologies. All of these articles address either existing technologies or future technologies which will affect the way we diagnose, treat, and practice. We sincerely hope that this special issue helps build awareness among our colleagues as to the numerous technologies available today, and provides useful information to build on for the brilliant minds that will shape and create tomorrow’s technologies.

Practical Digital Photography in the Dermatology Office

Ashish C. Bhatia, MD | Suneel Chilukuri, MD

Imaging has always had an important role in the practice
and evolution of medicine. Even in the earliest medical
documents, illustrations were used to depict tumors, lesions,
and procedures. The development of small film cameras revolutionized
medical imaging in the twentieth century. The
office-based practitioner could readily process film into
prints or slides for personal records and for teaching purposes.
1 Today’s digital cameras have further improved medical
imaging by decreasing the time and expense needed to
view and share photos.
Photography is particularly important in the visuallybased
specialty of dermatology. Medical dermatologists use
photographs to display the pattern of a cutaneous eruption,
the characteristics of skin surface changes, and location, size,
shape, and color of a visible lesion.2,3 Surgical dermatologists
record preoperative, intraoperative, and postoperative images
to evaluate tumor growth, location, defect size, and
wound healing.4 Cosmetic dermatologists use photography
to evaluate a patient’s appearance pre- and postcosmetic intervention.
Digital photography has revolutionized the dermatology
office by providing cost-effective imaging, storage, and retrieval.
Initial equipment costs and recurring costs are nominal,
storage space needed for medical images is minimal, and
properly labeled digital photographs can be rapidly retrieved
and viewed with no degradation of picture quality over time.


Paperless or Less Paper: Realistic Goals in Dermatology Practice

Stanford I. Lamberg

Who benefits and who pays for the electronic health records? Patients may obtain better
health care, while payers benefit from lower costs. Providers pay greater costs to implement
health information technology, however, and may experience lower revenues after
implementation. Although large multispecialty practices or medical centers may benefit
from electronic health record systems, dermatologists—particularly those in dermatology
specialty groups or in solo practice—may be adequately served by document-management
systems that are less complex and less expensive. This article offers a perspective on
medical record documentation alternatives.
Semin Cutan Med Surg 27:86-88 © 2008 Elsevier Inc. All rights reserved.


The Use of High Definition Video Modules for Delivery of Informed Consent and Wound Care Education in the Mohs Surgery Unit

Arianne Chavez-Frazier, MD | Michael Migden, MD | Tri Nguyen, MD

The use of video in the informed consent process has been well documented in the
literature to improve patient satisfaction, understanding, comprehension, and to decrease
anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual
(AV) modules to assist with the delivery of informed consent and to educate patients on the
subject of postoperative wound care. The purpose of this work was to develop HD-AV
media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they
are asked to sign the consent form and to educate patients on basic wound care after Mohs
Surgery. The use of a HD virtual surgeon and nurse in the videos educates the patient,
allowing the surgeon and nursing staff to attend to other patients within the Mohs Surgery
Unit. Using HD digital recording equipment, we captured real-time HD-AV media to explain
the risks, alternatives, and benefits of Mohs surgery (surgeon explanation) and to give
detailed instructions for postoperative wound care (nurse explanation). Once captured, HD
modules were created and stored on a central University of Texas–MD Anderson Cancer
Center server in the Texas Medical Center approximately 1 mile from the Mohs Surgery
Unit. The full-screen HD modules are accessed on demand at the point of need with the use
of standard institutional computers within any of the Mohs’s center’s examination/surgical
suites. An early evaluation of this quality improvement initiative was performed to measure
patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse
discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV
modules used for the delivery of informed consent and postoperative wound care in the MD
Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this
medium was preferred by patients in the video group over physician/nurse discussion
alone. The HD modules allowed increased efficiency and patient comprehension, which
improved patient education in the Mohs Surgery Unit.
Semin Cutan Med Surg 27:89-93 © 2008 Elsevier Inc. All rights reserved.


Selected Applications of Technology in the Pediatric Dermatology Office

Erin E. Ducharme, MD | Nanette B Silverberg, MD

The pediatric dermatologist is equipped with several diagnostic and therapeutic tools that
can be used in the office. The Wood’s lamp, introduced nearly a century ago, continues to
be a safe, noninvasive diagnostic tool used today for diagnosing cutaneous infections,
pigmentary disorders, and porphyrias. The pulsed dye laser is the treatment of choice for
vascular lesions and has an expanding list of other applications, such as warts, which are
extremely common in the pediatric population. Dermoscopy has emerged as an effective
adjunctive tool in the in vivo examination of pigmented skin lesions and early diagnosis of
cutaneous malignant melanoma. Other uses are also being explored including diagnosis of
scabies. Future directions of technology in the pediatric dermatology office include implementation
of electronic medical record systems and treatment of conditions such as
molluscum, warts, and acne vulgaris with photodynamic therapy.
Semin Cutan Med Surg 27:94-100 © 2008 Elsevier Inc. All rights reserved.


Teledermatology: An Update

Cesare Massone, MD | Elisabeth M.T. Wurm, MD | H. Peter Soyer | Rainer Hofmann-Wellenhof, MD

Dermatology is perhaps the most visual specialty in medicine, making it ideally suited for
modern telemedicine techniques, as has been shown in a number of recent studies
investigating feasibility and reliability of teledermatology. It has generally demonstrated
high levels of concordance in diagnosis and management plans compared with face-to-face
consultations. Teledermatology also has been used for various purposes, including triage,
diagnostic and management services, and second-opinion services for primary care practitioners.
It has been set up in a number of ways: (1) direct referral for primary care using
images and clinical history sent to secondary care dermatology services for second opinion
and for triage referrals and (2) facilitating community-based clinics led by nurses or general
practitioners. Moreover, in the last years new fields in teledermatology have grown up.
Teledermoscopy is a promising area for melanoma screening as well as for the diagnosis
and management of equivocal pigmented skin lesions. The feasibility of mobile teledermatology
and mobile teledermoscopy recently has been proven, and these new facilities have
the potential to become an easy applicable tool for everyone and may open the door for a
new flexible triage system for detection of skin cancer in general and melanoma in
particular. The implementation of virtual slide systems for teledermatopathology has allowed
avoiding the limitations imposed by conventional microphotography. Finally, web
consultations in dermatology are a rather new tool that became available in the last years
and teledermatologic services through the Internet offer many possibilities, including
continuing medical education, on-line atlases and databases, and specific web application
suited for teledermatology (ie,
Semin Cutan Med Surg 27:101-105 © 2008 Elsevier Inc. All rights reserved.