Smartphone photography in Dermatology

It is estimated that about 80% of Americans have smartphones in the United States. Phone applications are being utilized by patients and providers to monitor patient health care parameters (such as heart rate) and deliver healthcare information. In dermatology, it is often helpful to have a picture of the concerning lesion or biopsy site. This simple systematic method has been studied and published in a medical journal and will help you obtain consistent, high-quality biopsy site photographs with your own smartphone device.

BIOPSY 1-2-3 METHOD for every biopsy:

1) Have one other person take the photograph with your smartphone

2) Ensure there are two anatomical landmarks

3) Have three photos of each site

Having someone else take the photograph allows proper distance with the patient’s device as opposed to a ‘biopsy site selfie’ which is often too close and blurry. Furthermore, this allows the photograph to be taken with the higher quality camera on the back of the device as opposed to the selfie camera on the front. Use a dark pen, highlighter, or marker to circle the lesion of concern. This can be done prior to the biopsy or up to about one week after the biopsy by the clinic staff or a family member.  Ensure there are two body parts (i.e. ear and nose) or two joints (i.e. elbow and wrist) in at least two of the pictures. Lastly, have at least three pictures of every biopsy site. Be sure to delete any blurry out of focus photographs.

Smartphones are powerful tools that can play an important role in health care.  Using the BIOPSY 1-2-3 method to photograph your biopsy site will allow you to utilize your own smartphone camera reliably.   In addition, you will have the ability to have the pictures with you at all your appointments as well as document the size and location of skin lesions.  This technique may also be used for intermittent issues or to show how a skin rash is affecting you.  As integration between smartphones and medical records improve, biopsy site photographs may seamlessly enter your medical record in the future. Until that time, Biopsy 1-2-3 is a simple method that will help you document your skin lesions and concerns today. 

REFERENCES:

1. Lichtman MK, Countryman NB. Cell phone assisted identification of surgery site. Dermatologic Surgery. 2013;39(3 Pt 1):491-2.
2. Foltynski P, et al. A new smartphone-based method for wound area measurement. Artif Organs. 2014;38(4):346-52.
3. Ke M, et al. Where is it? The utility of biopsy-site photography. Dermatol Surg. 2010;36(2):198-202.
4. See comment in PubMed Commons belowThe Joint Commission Universal Protocol. Available at: http://www.jointcommission.org/assets/1/18/up_poster1.pdf. Accessed Mar 2016
5. Perlis CS, et al. Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons. Dermatol Surg. 2006;32(1):79-83.
6. Zhang J, et al. Factors associated with biopsy site identification, postponement of surgery, and patient confidence in a dermatologic surgery practice. J Am Acad Dermatol. 2016. Epub.
7. Nijhawan RI, et al. Biopsy Site Selfies—A Quality Improvement Pilot Study to Assist With Correct Surgical Site Identification. Dermatol Surg. 2015 Apr;41(4):499–504.
8. Highsmith J^1,2, Weinstein, D³, Highsmith MJ^4,5, Etzkorn J⁶.BIOPSY 1-2-3: Improving Smartphone Photography. Technology and Innovation. Vol. 18, pp. 203-206, 2016. 1. James A. Haley VA Hospital, Tampa, FL; 2. Dermatology Surgery Institute, Lutz, FL; 3. University of Central Florida Department of Internal Medicine. Orlando, FL; 4. U.S. Dept of Veterans Affairs. Extremity Trauma & Amputation Center of Excellence; 5. University of South Florida. School of Physical Therapy & Rehabilitation Sciences. Tampa, FL; 6. University of Pennsylvania, Department of Dermatology. Philadelphia, PA.