IMAGING IN DERMATOLOGY
Dermatology is a uniquely wonderful field due to its visual nature and the accessibility of the cutaneous surface to be sampled. As such, visual identification of disease by the dermatologist’s eye is a harmonious blend of skill, intelligence, training, and today, technology.
Dermatology has been adept at adapting technology to augment the visual inspection of the skin. Advancements in optics and light technology have afforded the dermatologist with new tools to noninvasively image cutaneous structures, both macroscopically and microscopically. Dermoscopy has become the standard of care in most dermatologic practices; and while there is a learning curve associated, many dermatologists have embraced this technology. With its widespread availability, there have been numerous studies validating its use and confirming its advantages.
Similar to dermoscopy, the use of digital imaging, 3D imaging, reflectance confocal microscopy, optical coherence tomography, and ultrasound have allowed dermatologists an enhanced view of the skin. Whether used to monitor nevus progression or noninvasively diagnose, detect, or delineate cancer margins, these devices are changing the practice of dermatology.
This issue of Seminars in Cutaneous Medicine and Surgery highlights the current state of imaging in dermatology. It is important for the practicing dermatologist to understand the technology that is currently available, both the advantages and the pitfalls of such. Likewise, radiographic imaging, while not historically used, has become the standard of care for certain malignancies, whether for diagnosis, workup, or staging, due to newer advancements in treatment.
The field of dermatology is experiencing a technologic boom with the advent of devices that can aid in the inspection and diagnosis of cutaneous disease. This trend will continue to be refined and perfected going forward. With the addition of computer intelligence and digital-pattern recognition, the dermatologist of the future may be armed not with a scalpel but rather wearable optics.
Medical imaging has dramatically transformed the practice of medicine, especially the field of dermatology. Imaging is used to facilitate the transfer of information between providers, document cutaneous disease, assess response to therapy, and plays a crucial role in monitoring and diagnosing skin cancer. Advancements in imaging technology and overall improved quality of imaging have augmented the utility of photography. We provide an overview of current imaging technologies used in dermatology with a focus on their role in skin cancer diagnosis. Future technologies include three-dimensional, total-body photography, mobile smartphone applications, and computerassisted diagnostic devices. With these advancements, we are better equipped to capture and monitor skin conditions longitudinally and achieve improved diagnostic accuracy of skin cancer.
Semin Cutan Med Surg 35:2-8 © 2016 Frontline Medical
Wrong-site surgery in dermatology often results from inaccurate identification of a skin cancer biopsy site. Factors making biopsy-site identification difficult include background actinic damage, delays from biopsy to surgery, and lack of photographic documentation. While other methods exist for biopsy-site identification, photography is the most helpful tool available. Although modern technology has made high-quality photographic equipment ubiquitous and easy to use, photography for biopsy-site identification continues to be underutilized. The authors recommend that photographic documentation of biopsy sites become the standard of care.
Semin Cutan Med Surg 35:9-12 © 2016 Frontline Medical Communications
Self-acquired patient images, also known as selfies, are increasingly utilized in the practice of dermatology; however, research on their utility is somewhat limited. While the implementation of selfies has yet to be universally accepted, their role in triage appears to be especially useful. The potential for reducing office wait times, expediting referrals, and providing dermatologic services to patients with limited access to care is promising. In addition, as technology advances, the number of smartphone applications related to dermatology that are available to the general public has risen exponentially. With appropriate standardization, regulation, and confidentiality measures, these tools can be feasible adjuncts in clinical practice, dermatologic surgery, and teledermatology. Selfies likely will have a large role in dermatologic practice and delivery in the future.
Semin Cutan Med Surg 35:13-17 © 2016 Frontline Medical Communications
Melanoma is the most dangerous type of skin cancer and its incidence has risen sharply in recent decades. Early detection of disease is critical for improving patient outcomes.
Semin Cutan Med Surg 35:18-24 © 2016 Frontline Medical Communications
The computer-assisted diagnosis of melanoma is an exciting area of research where imaging techniques are combined with diagnostic algorithms in an attempt to improve detection and outcomes for patients with skin lesions suspicious for malignancy. Once an image has been acquired, it undergoes a processing pathway which includes preprocessing, enhancement, segmentation, feature extraction, feature selection, change detection, and ultimately classification. Practicality for everyday clinical use remains a vital question. A successful model must obtain results that are on par or outperform experienced dermatologists, keep costs at a minimum, be user-friendly, and be time efficient with high sensitivity and specificity.
Semin Cutan Med Surg 35:25-30 © 2016 Frontline Medical Communications