Teledermatology for suspected skin cancers

Clinical images

Created 2017.

In brief (any system):

• Practice taking photographs of different body parts and lesions.
• Find or create suitable plain grey, green or blue background to subject.
• Remove extraneous objects.
• Lens should be lined up with the subject.
• Ensure focus + exposure is correct.
• Flash is preferred.
• If too close, back off and zoom.

For each skin lesion:

• Location image or anatomic diagram or both
• Macroscopic (macro) image
• Distance should be 20 cm from the lesion.
• May be useful to have a second image from another angle.
• Repeat image with rule if no anatomic reference structure (eg eye).
• Dermatoscopic (micro) images
• Referrals for pigmented lesions MUST include these.
• Clean and polish lens beforehand, between images and after use . 
• Apply fluid to lesion, eg methylated spirits in spray bottle, sanitiser solution/gel (essential for unpolarised, desirable for polarised).
• Contact views are best and should be used whenever possible.
• Polarised and unpolarised views, if available.
• Patient identification image
• You can photograph the consent form.
• Some people photograph an ID label.
• Some people stick an ID label onto the patient besides the lesion; labels with date and rule are available to purchase.
• Delasco.com sells Photo Measuring Labels, and Dermatoscopy stamps, stickers and chart record forms.
• Poster supplied to DermNet NZ by CanfieldScientific.(PDF file)
  
• Some smartphone apps have NHI barcode recognition software.

When unable to apply lens in contact with lesion (eg inner canthus):

• Use non-contact polarised images

Curved surfaces, small body parts are hard to focus and obtain correct exposure:   

• Use grey or green card with cut-out