TECHNOLOGY IN DERMATOLOGY AND DERMATOLOGIC SURGERY
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.
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
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.
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.
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, www.telederm.org).
Semin Cutan Med Surg 27:101-105 © 2008 Elsevier Inc. All rights reserved.