Techniques of full-scale colour total body photography: A useful tool in the management of patients with the dysplastic naevus syndrome

Spatial normalization of human back images for dermatological studies

A large number of pigmented skin lesions (PSLs) are a strong predictor of malignant melanoma. Many dermatologists advocate total body photography for high-risk patients because detecting new-appearing, disappearing, and changing PSL is important for early detection of the disease. However, manual inspection and matching of PSL is a subjective, tedious, and error-prone task. A computer program for tracking the corresponding PSL will greatly improve the matching process. In this paper, we describe the construction of the first human back template (atlas), which is used to facilitate spatial normalization of the PSL during the matching process. Four pairs of anatomically meaningful landmarks (neck, shoulder, armpit, and hip points) are used as reference points on the back image. Using the landmarks, a grid with longitudes and latitudes is constructed and overlaid on each subject-specific back image. To perform spatial normalization, the grid is registered into the back template, a unit-square rectilinear grid. To demonstrate the benefits of using the back template, we apply several state-of-the-art point-matching algorithms on 56 pairs of real dermatological images and show that utilizing spatially normalized coordinates improves the PSL matching accuracies.

Standardized positioning of patients (poses) for whole body cutaneous photography

Whole body photography (WBP) has been used for decades by some specialized pigmented lesion clinics as an aid to early melanoma detection in high-risk persons. The recent advent of digital imaging systems for acquiring and archiving whole body skin images has resulted in greater dissemination of this technique. This in turn has led to the recent establishment of a Category III Current Procedural Terminology code for WBP. Here we present a proposed set of standardized body poses for WBP on the basis of the extant literature and the experience of a panel of experts in the field. The proposed poses were developed with consideration of patient comfort and technical efficiency. The poses were optimized to comply with a predetermined set of desirable technical parameters as assessed in a series of 20 consecutive patients. The resulting set of poses is presented as a first step toward the increased standardization of dermatologic WBP.

The development of an improved method of photography for mole-monitoring at the University Hospital of North Durham

The past decade has witnessed a dramatic increase in the number of patients presenting with pigmented lesions to general practitioners. This increase is reflected in the number of patients referred for whole body mole-monitoring photographs to the Medical Photography and Illustration Department of the University Hospital of North Durham. Through a process of qualitative and quantitative research, an improved method of whole body photographic mole-monitoring was devised and implemented within this department. All aspects of the mole-monitoring service were evaluated, from the original photographic request to the photographic session and patient interaction. This process also offered the opportunity to explore the possible use of new technologies.

Use of and beliefs about baseline photography in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States

Medical photography is often used in dermatology to aid in the clinical surveillance of patients with pigmented lesions. This study aimed to assess the utilization, logistics, rationale and beliefs about the usefulness of baseline photography in patients with pigmented lesions by physicians in dermatology residency programmes, and to compare current utilization to that reported in the last decade. Questionnaires were mailed to directors of all accredited dermatology residency programmes in the United States (n = 105). Eighty-three physicians responded to the questionnaire (79%). Utilization of total body and individual lesion photography was reported by 63% and 75% of the respondents, respectively; 16% of the respondents did not use any method of photography. Reasons for using photography included the following beliefs: that it helps detect early melanoma, it results in fewer biopsies, and it reduces patient anxiety. Financial and logistical constraints were reasons why some programmes were not utilizing photography. Thus baseline photography is currently used in a majority of academic dermatology programmes as an aid in the early detection of melanoma.

Photographic utilization in dermatology clinics in the United States: a survey of university-based dermatology residency programs

BACKGROUND

Photography has recently been introduced as an adjunct to the clinical management of patients with the dysplastic nevus syndrome (DNS).

OBJECTIVE

Our purpose was to evaluate the methods used and the extent of clinical photography in dermatology residency programs in the United States.

METHODS

Nonmilitary accredited dermatology residency programs in the United States were surveyed (73% response rate) regarding utilization and technical aspects of clinical photography.

RESULTS

Forty-one percent of respondents used photography for the clinical management of 90% or more of patients with DNS. Twenty-four percent of respondents used photography for the clinical management of all patients with DNS. Eighty-one percent of respondents used slides, and 62% utilized total body photographs. The median number of photographs taken for a patient with DNS was 20.

CONCLUSION

Dermatologic photography has been widely adopted for the clinical management of patients with DNS. Failure of the health insurance industry to recognize the value of this procedure may result in its underutilization.