Images in Dermatology
Wide area digital dermoscopy applied to basal cell carcinoma
Gerson Dellatorre
, Guilherme Augusto Gadens
Corresponding author
Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
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Achados dermatoscópicos nas margens que consistem de ulceração e crostas (Δ), áreas branco‐cicatriciais (◊) e telangectasias arboriformes (†), em contrate com as telangectasias da pele fotodanificada periférica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gerson Dellatorre, Guilherme Augusto Gadens" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gerson" "apellidos" => "Dellatorre" ] 1 => array:2 [ "nombre" => "Guilherme Augusto" "apellidos" => "Gadens" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059620300830" "doi" => "10.1016/j.abd.2019.08.030" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300830?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301533?idApp=UINPBA00008Z" "url" => "/26662752/0000009500000003/v1_202006250813/S2666275220301533/v1_202006250813/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059620300842" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.09.027" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "173" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Leproma's dermoscopy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "385" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 602 "Ancho" => 905 "Tamanyo" => 87781 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the leproma: presence of light brown halo in the lesion, with a yellowish appearance, with a scarring nacreous center and telangiectasias of a centrifugal character. 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A poorly delimited lesion measuring 30<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm compromising the left cheek, lateral nasal wall and nasal ala.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Wide area digital dermoscopy methodology</span><p id="par0005" class="elsevierStylePara elsevierViewall">To create a WADD image, a standard dermoscope (10× magnification, polarized) attached to a digital camera and a computer with Adobe Photoshop CC software (Adobe Systems Incorporated, San Jose, CA, USA, v19.1.6) were used.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The following steps were performed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Image acquisition: During this step, all the lesion was covered, performing a peripheral overlap in each photo (20–30% of the previous image area in each new picture).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Merging images: In Photoshop software, File Menu, Automate and Photomerge options were selected. In Layout options, Reposition was selected and acquired dermoscopic images were added.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Image viewing: A conventional built-in Windows or Mac image visualization software was used for image visualization.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case 1</span><p id="par0030" class="elsevierStylePara elsevierViewall">56-year-old patient presented with a poorly delimited (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), mixed type (superficial, nodular and infiltrative) basal cell carcinoma (BCC). After the acquisition of nineteen dermoscopic images with an overlap of 30% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), we merged them with Adobe Photoshop software (Adobe Systems Incorporated, San Jose, CA, USA, v19.1.6) by using its automatized “Photomerge” function, as previously detailed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> The final WADD image obtained represented the full dermoscopic view from the lesional and perilesional areas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient underwent Mohs Micrographic Surgery (MMS) for tumor excision, and margins were cleared after two stages due to a deep positive margin in the first stage.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case 2</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 55-year-old patient presented with a poorly delimited superficial and nodular BCC on his left preauricular area (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). He had a history of topical 5-fluorouracil treatment on his face one year ago. We acquired sixteen separated dermoscopic images and merged them in the same way as previously mentioned. A dermoscopic-histologic correlation was made during MMS by analyzing frozen sections of tumoral debulking (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). In this case, margins were cleared after one surgical stage.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dermatologists can use WADD as a new register technique in digital dermoscopy. This tool can be useful in situations in which the limited field of view of the dermatoscope lenses difficult this register.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> For example, the use of WADD in the cases presented can serve as a didactic subsidiary in the teaching of tumoral margins demarcation and also in dermoscopic-histopathological correlations. The application of the method can still be beneficial in the dermatoscopic follow-up of more extensive melanocytic lesions, such as congenital melanocytic nevi, allowing an overall assessment of the lesions in their follow-up. Also, in trichology, extensive and unified registration of an affected hairy area would be useful for its detailed global follow-up.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The acquisition phase of the separate dermatoscopic images is a critical point in the process of creating a WADD image. The need for photographs to be obtained with a 30% overlap (a crucial technical factor for the software to recognize the melting points of images) can be challenging at the beginning of the practice, especially in large lesions. Another limiting factor of its use is the need for professional software (Photoshop) for the composition of the WADD image. In the future, the development of software with a user-friendly interface built-in on the imaging equipment itself may replace this phase of the compositing process.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Gerson Dellatorre: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Guilherme Augusto Gadens: Approval of the final version of the manuscript; conception and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1365106" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1254939" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Wide area digital dermoscopy methodology" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Financial support" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-06" "fechaAceptado" => "2019-08-26" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1254939" "palabras" => array:3 [ 0 => "Carcinoma, basal cell" 1 => "Dermoscopy" 2 => "Image processing, computer-assisted" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In situations in when a dermoscopic record of a large lesion is desirable, the resulting images are usually restricted to a small field of view due to the limited diameter of dermatoscope lenses. This limitation often produces several photographs separately, thus losing the possibility of a single-image global evaluation. In these case reports, we show examples of a recently published image montage technique called Wide Area Digital Dermoscopy, in this case, applied to basal cell carcinomas.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Dellatorre G, Gadens GA. Wide area digital dermoscopy applied to basal cell carcinoma. An Bras Dermatol. 2020;95:376–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 603 "Ancho" => 905 "Tamanyo" => 79626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BCC. A poorly delimited lesion measuring 30<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm compromising the left cheek, lateral nasal wall and nasal ala.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1274 "Ancho" => 1505 "Tamanyo" => 291542 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nineteen overlapped dermoscopic images of the lesion (Heine Delta 20T – HEINE Optotechnik GmbH & Co, Herrsching, Germany) attached to a DSLR camera (polarized, ×10).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1144 "Ancho" => 905 "Tamanyo" => 167163 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">WADD image of BCC. Dermoscopic findings on the margins consisting of ulceration and crusts (Δ), cicatricial whitish areas (◊) and arboriform telangiectasias (†), in contrast to telangiectasias of the peripheral photodamaged skin (*).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 627 "Ancho" => 905 "Tamanyo" => 127277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Basal cell carcinoma. A poorly delimited and noncontiguous lesion measuring 20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>28<span class="elsevierStyleHsp" style=""></span>mm on the left preauricular area.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1373 "Ancho" => 2500 "Tamanyo" => 612457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A, WADD image of BCC. B, Nodular and superficial BCC corresponding to erythematous structureless areas (Δ) and arboriform telangiectasias (†) on dermoscopy. C, Dermal fibrosis corresponding to a cicatricial-whitish area (◊), probably related to his previous topical treatment. D, Superficial BCC and dermal fibrosis corresponding to a milky-red area (*) and arboriform telangiectasias (†): (Hematoxylin & eosin x40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wide area digital dermoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Dellatorre" 1 => "G.A. Gadens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2018.12.019" "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2019" "volumen" => "80" "paginaInicial" => "e153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30576760" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300830/v4_202007210853/en/main.assets" "Apartado" => array:4 [ "identificador" => "80631" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000003/v4_202007210853/S0365059620300830/v4_202007210853/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300830?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 8 | 24 |
| 2024 October | 103 | 62 | 165 |
| 2024 September | 123 | 79 | 202 |
| 2024 August | 129 | 107 | 236 |
| 2024 July | 133 | 121 | 254 |
| 2024 June | 121 | 75 | 196 |
| 2024 May | 88 | 62 | 150 |
| 2024 April | 157 | 85 | 242 |
| 2024 March | 111 | 79 | 190 |
| 2024 February | 132 | 82 | 214 |
| 2024 January | 95 | 52 | 147 |
| 2023 December | 50 | 55 | 105 |
| 2023 November | 74 | 68 | 142 |
| 2023 October | 70 | 86 | 156 |
| 2023 September | 73 | 86 | 159 |
| 2023 August | 68 | 34 | 102 |
| 2023 July | 47 | 35 | 82 |
| 2023 June | 63 | 48 | 111 |
| 2023 May | 53 | 24 | 77 |
| 2023 April | 42 | 21 | 63 |
| 2023 March | 67 | 47 | 114 |
| 2023 February | 45 | 37 | 82 |
| 2023 January | 45 | 43 | 88 |
| 2022 December | 55 | 23 | 78 |
| 2022 November | 59 | 48 | 107 |
| 2022 October | 177 | 52 | 229 |
| 2022 September | 44 | 53 | 97 |
| 2022 August | 50 | 51 | 101 |
| 2022 July | 39 | 46 | 85 |
| 2022 June | 54 | 74 | 128 |
| 2022 May | 44 | 53 | 97 |
| 2022 April | 44 | 49 | 93 |
| 2022 March | 54 | 61 | 115 |
| 2022 February | 49 | 36 | 85 |
| 2022 January | 81 | 74 | 155 |
| 2021 December | 51 | 57 | 108 |
| 2021 November | 50 | 60 | 110 |
| 2021 October | 48 | 73 | 121 |
| 2021 September | 45 | 52 | 97 |
| 2021 August | 47 | 58 | 105 |
| 2021 July | 38 | 42 | 80 |
| 2021 June | 30 | 56 | 86 |
| 2021 May | 45 | 96 | 141 |
| 2021 April | 109 | 226 | 335 |
| 2021 March | 54 | 64 | 118 |
| 2021 February | 15 | 15 | 30 |
| 2021 January | 28 | 16 | 44 |
| 2020 December | 27 | 18 | 45 |
| 2020 November | 22 | 7 | 29 |
| 2020 October | 8 | 8 | 16 |
| 2020 September | 16 | 9 | 25 |
| 2020 August | 6 | 8 | 14 |
| 2020 July | 14 | 19 | 33 |
| 2020 June | 14 | 21 | 35 |
| 2020 May | 16 | 10 | 26 |
| 2020 April | 0 | 15 | 15 |
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