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Bounce Flash Enhances Readability of Teledermatology Images
1192
759
Bounce Flash Enhances Readability of Teledermatology Images William Leyva, MD, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Teresa LaNasa, PA, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Karen Fareri, NP, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Nadia DiClemente, PA, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States
DermLens: Device for mobile teledermatology Isabella Lai, Stanford University School of Medicine, CA, United States; Justin Ko, MD, MBA, Stanford University Department of Dermatology, Stanford, CA, United States; Akhilesh Pathipati, Stanford University School of Medicine, Stanford, CA, United States
Improvements made in digital photography over the last few decades have allowed teledermatology to become a useful diagnostic tool, increasing access to specialty care for patients at some distance from a dermatologist. However, there are challenges in obtaining good quality digital images, which include lighting issues, such as accurate color balance and adequacy of illumination. Bounce flash can overcome difficult lighting situations in the clinic setting. The bounce flash technique is well known to professional photographers and as the name suggests, light from an electronic flash unit is bounced off the ceiling, or some other suitable reflective surface, to create diffused lighting without the harsh shadows produced by direct flash. Utilizing electronic flash offers the benefits of increasing the level of room light in dimly lit clinic rooms and increasing the accuracy of color balance. Indirect benefits of increased illumination include the ability to use smaller apertures (higher f-stops) when capturing images, which results in improved depth of field (depth of focus) for skin lesions and inflammatory dermatoses. In this presentation, we comparatively demonstrate the advantages of bounce flash in clinical dermatology images. We also demonstrate the practical implementation of this technique for teledermatology. Commercial support: None identified.
Background: Store-and-forward mobile teledermatology is an innovative and robust modality to provide consultations for skin neoplasm screening. While mobile teledermatology has been attempted in many settings, there is currently no solution that facilitates broad-scale capture of professional-quality images of skin lesions (\2 cm) and transfer of such images to specialists. Objective: To address the limitations, we developed a low-cost device—the DermLens—that attaches to any smartphone and allows users to easily capture images of small lesions comparable to that of a dermatoscope. In this study, we aimed to show the utility of the DermLens for mobile teledermatology. Methods: A prospective study was conducted on patients during their clinic visit with Stanford Dermatology. Patients were asked to identify skin lesion(s) of concern, to capture images an iPhone alone and an iPhone with the DermLens attachment, and to complete a survey. Images were subsequently analyzed by a dermatologist to determine diagnostic confidence given the different modalities. Results: Of the 92 patients, 72% preferred using the DermLens attachment over the iPhone alone. Additionally, 98% said they would use the DermLens to send images if given a device. There were 120 skin lesions analyzed from participating patients. A one-way ANOVA was conducted to compare the physician’s diagnostic confidence when presented with skin lesion on iPhone, on iPhone with DermLens attachment, and during an in person visit. There was a significant effect on diagnostic confidence depending on the method utilized at a P \.05 for the three conditions [F (2,357) ¼ 120, P \.0001]. Post hoc comparisons using the Tukey HSD test indicated that the mean score for iPhone alone (M ¼ 4.93, STD ¼ 2.23) was significantly different than the iPhone with DermLens attachment (M ¼ 7.16, STD ¼ 2.36), and both were different from an in clinic visit (M ¼ 9.03, STD ¼ 1.45). Conclusion: Our results suggest that the DermLens attachment can significantly improve diagnostic confidence, and thereby impact further management. However, it should be noted that diagnostic confidence is still significantly higher during inperson clinic visits. Given our results, we believe that the DermLens can play a large role in improving teledermatology by providing a low-cost dermatoscope to capture high quality clinically relevant images. Further studies will focus on design optimization and ways to address other limitations in teledermatology. Commercial support: None identified.
1632 Correlation of in vivo RCM and ex vivo FCM images with the histopathology of BCC most common subtypes Alejandra Villarreal, MD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Antoni Bennassar, MD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Joseph Malvehy, MD, PhD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Susana Puig, MD, PhD, Hospital Clinic, University of Barcelona, Barcelona, Spain Introduction: Basal cell carcinoma (BCC) is the most common skin cancer in humans. Reflectance confocal microscopy (RCM) allows the real time visualization of superficial skin layers with a cell resolution. Fluorescence confocal microscopy (FCM) is a new technology used to perform quick images in excised tissue without the need for conventional histopathologic processing. Objective: To correlate diagnostic criteria between RCM, FCM and histopathology of most common BCC subtypes. Subjects and Methods: Basal cell carcinomas excised by Mohs surgery or simple excision were included. RCM and FCM images of the lesions before and after excision were respectively taken. Later, excised BCC where processed for conventional histopathologic study. Previously described criteria for RCM and FCM were analyzed and correlation thereof was performed. Results: A total of 26 BCCs where included. The histologic subtypes were: 10 (38.4%) nodular, 9 (34.6%) superficial, 4 (14.3%) infiltrative, 2 (7.6%) micronodular y 1 nodular- infiltrative (3.8%). We observed criteria found in RCM that could predict the histologic subtype. This criterion was also observed by FCM and in the histologic tissues. In all a good correlation was observed. However, in nodular and micronodular the correlation was higher. By RCM the presence of peripheral palisading, fibrosis around nests, branch like structures and increased vascular diameter were characteristic in nodular and micronodular subtypes. Conclusions: RCM and FCM are useful techniques for BCC diagnosis. RCM and FCM could allow us to differentiate the histologic subtype of basal cell carcinoma. Commercial support: None identified.
AB88
J AM ACAD DERMATOL
1687 Dermoscopy of eccrine spiradenoma: A case report Mustafa Turhan Sahin, MD, Celal Bayar University Medical Faculty Department of € urkcan, MD, Celal Bayar University Dermatology, Manisa, Turkey; Serap Ozt€ Medical Faculty Department of Dermatology, Manisa, Turkey; Cemal Bilac¸, MD, Celal Bayar University Medical Faculty Department of Dermatology, Manisa, Turkey; Ayc¸a Tan, MD, Celal Bayar University Medical Faculty Department of Pathology, Manisa, Turkey Eccrine spiradenomas are rare, benign, cutaneous tumors that originate in the sweat glands. It is clinically distinct, because most examples are either tender or painful. Eccrine spiradenoma presents as a solitary, intradermal, circumscribed, round or oval, firm lesion. It most commonly arises in people aged 15 to 35 years, and the front of the trunk and proximal limbs are the most common sites. Their color can vary but many have a bluish element. The histogenesis of spiradenomas remains in question, but many lesions demonstrate apocrine differentiation. Here, we report the case of a 37- year-old man who had a solitary eccrine spiradenoma in the subcutaneous tissue of his left infraclavicular region accompanied by agonizing pain which was triggered by pressure. His lesion was a solitary, 0.5 cm, firm, domeshaped papule, bluish in color. Dermoscopic examination revealed light bluecolored background, different vascular structures, and light-brown reticular pigmentation at the periphery. Histopathologic study demonstrated the typical histopathologic findings of eccrine spiradenoma. We present this case to draw attention not only to the dermatoscopic findings of eccrine spiradenoma for the first time, but also its differential diagnosis, as it can be mistaken clinically for a variety of adnexal tumor. Commercial support: None identified.
MAY 2015
759
Bounce Flash Enhances Readability of Teledermatology Images William Leyva, MD, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Teresa LaNasa, PA, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Karen Fareri, NP, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States; Nadia DiClemente, PA, Pittsburgh Veterans Administration, Division of Dermatology, Pittsburgh, PA, United States
DermLens: Device for mobile teledermatology Isabella Lai, Stanford University School of Medicine, CA, United States; Justin Ko, MD, MBA, Stanford University Department of Dermatology, Stanford, CA, United States; Akhilesh Pathipati, Stanford University School of Medicine, Stanford, CA, United States
Improvements made in digital photography over the last few decades have allowed teledermatology to become a useful diagnostic tool, increasing access to specialty care for patients at some distance from a dermatologist. However, there are challenges in obtaining good quality digital images, which include lighting issues, such as accurate color balance and adequacy of illumination. Bounce flash can overcome difficult lighting situations in the clinic setting. The bounce flash technique is well known to professional photographers and as the name suggests, light from an electronic flash unit is bounced off the ceiling, or some other suitable reflective surface, to create diffused lighting without the harsh shadows produced by direct flash. Utilizing electronic flash offers the benefits of increasing the level of room light in dimly lit clinic rooms and increasing the accuracy of color balance. Indirect benefits of increased illumination include the ability to use smaller apertures (higher f-stops) when capturing images, which results in improved depth of field (depth of focus) for skin lesions and inflammatory dermatoses. In this presentation, we comparatively demonstrate the advantages of bounce flash in clinical dermatology images. We also demonstrate the practical implementation of this technique for teledermatology. Commercial support: None identified.
Background: Store-and-forward mobile teledermatology is an innovative and robust modality to provide consultations for skin neoplasm screening. While mobile teledermatology has been attempted in many settings, there is currently no solution that facilitates broad-scale capture of professional-quality images of skin lesions (\2 cm) and transfer of such images to specialists. Objective: To address the limitations, we developed a low-cost device—the DermLens—that attaches to any smartphone and allows users to easily capture images of small lesions comparable to that of a dermatoscope. In this study, we aimed to show the utility of the DermLens for mobile teledermatology. Methods: A prospective study was conducted on patients during their clinic visit with Stanford Dermatology. Patients were asked to identify skin lesion(s) of concern, to capture images an iPhone alone and an iPhone with the DermLens attachment, and to complete a survey. Images were subsequently analyzed by a dermatologist to determine diagnostic confidence given the different modalities. Results: Of the 92 patients, 72% preferred using the DermLens attachment over the iPhone alone. Additionally, 98% said they would use the DermLens to send images if given a device. There were 120 skin lesions analyzed from participating patients. A one-way ANOVA was conducted to compare the physician’s diagnostic confidence when presented with skin lesion on iPhone, on iPhone with DermLens attachment, and during an in person visit. There was a significant effect on diagnostic confidence depending on the method utilized at a P \.05 for the three conditions [F (2,357) ¼ 120, P \.0001]. Post hoc comparisons using the Tukey HSD test indicated that the mean score for iPhone alone (M ¼ 4.93, STD ¼ 2.23) was significantly different than the iPhone with DermLens attachment (M ¼ 7.16, STD ¼ 2.36), and both were different from an in clinic visit (M ¼ 9.03, STD ¼ 1.45). Conclusion: Our results suggest that the DermLens attachment can significantly improve diagnostic confidence, and thereby impact further management. However, it should be noted that diagnostic confidence is still significantly higher during inperson clinic visits. Given our results, we believe that the DermLens can play a large role in improving teledermatology by providing a low-cost dermatoscope to capture high quality clinically relevant images. Further studies will focus on design optimization and ways to address other limitations in teledermatology. Commercial support: None identified.
1632 Correlation of in vivo RCM and ex vivo FCM images with the histopathology of BCC most common subtypes Alejandra Villarreal, MD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Antoni Bennassar, MD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Joseph Malvehy, MD, PhD, Hospital Clinic, University of Barcelona, Barcelona, Spain; Susana Puig, MD, PhD, Hospital Clinic, University of Barcelona, Barcelona, Spain Introduction: Basal cell carcinoma (BCC) is the most common skin cancer in humans. Reflectance confocal microscopy (RCM) allows the real time visualization of superficial skin layers with a cell resolution. Fluorescence confocal microscopy (FCM) is a new technology used to perform quick images in excised tissue without the need for conventional histopathologic processing. Objective: To correlate diagnostic criteria between RCM, FCM and histopathology of most common BCC subtypes. Subjects and Methods: Basal cell carcinomas excised by Mohs surgery or simple excision were included. RCM and FCM images of the lesions before and after excision were respectively taken. Later, excised BCC where processed for conventional histopathologic study. Previously described criteria for RCM and FCM were analyzed and correlation thereof was performed. Results: A total of 26 BCCs where included. The histologic subtypes were: 10 (38.4%) nodular, 9 (34.6%) superficial, 4 (14.3%) infiltrative, 2 (7.6%) micronodular y 1 nodular- infiltrative (3.8%). We observed criteria found in RCM that could predict the histologic subtype. This criterion was also observed by FCM and in the histologic tissues. In all a good correlation was observed. However, in nodular and micronodular the correlation was higher. By RCM the presence of peripheral palisading, fibrosis around nests, branch like structures and increased vascular diameter were characteristic in nodular and micronodular subtypes. Conclusions: RCM and FCM are useful techniques for BCC diagnosis. RCM and FCM could allow us to differentiate the histologic subtype of basal cell carcinoma. Commercial support: None identified.
AB88
J AM ACAD DERMATOL
1687 Dermoscopy of eccrine spiradenoma: A case report Mustafa Turhan Sahin, MD, Celal Bayar University Medical Faculty Department of € urkcan, MD, Celal Bayar University Dermatology, Manisa, Turkey; Serap Ozt€ Medical Faculty Department of Dermatology, Manisa, Turkey; Cemal Bilac¸, MD, Celal Bayar University Medical Faculty Department of Dermatology, Manisa, Turkey; Ayc¸a Tan, MD, Celal Bayar University Medical Faculty Department of Pathology, Manisa, Turkey Eccrine spiradenomas are rare, benign, cutaneous tumors that originate in the sweat glands. It is clinically distinct, because most examples are either tender or painful. Eccrine spiradenoma presents as a solitary, intradermal, circumscribed, round or oval, firm lesion. It most commonly arises in people aged 15 to 35 years, and the front of the trunk and proximal limbs are the most common sites. Their color can vary but many have a bluish element. The histogenesis of spiradenomas remains in question, but many lesions demonstrate apocrine differentiation. Here, we report the case of a 37- year-old man who had a solitary eccrine spiradenoma in the subcutaneous tissue of his left infraclavicular region accompanied by agonizing pain which was triggered by pressure. His lesion was a solitary, 0.5 cm, firm, domeshaped papule, bluish in color. Dermoscopic examination revealed light bluecolored background, different vascular structures, and light-brown reticular pigmentation at the periphery. Histopathologic study demonstrated the typical histopathologic findings of eccrine spiradenoma. We present this case to draw attention not only to the dermatoscopic findings of eccrine spiradenoma for the first time, but also its differential diagnosis, as it can be mistaken clinically for a variety of adnexal tumor. Commercial support: None identified.
MAY 2015