AnBrasDermatol.2020;95(3):379---382
Anais
Brasileiros
de
Dermatologia
www.anaisdedermatologia.org.br
IMAGES
IN
DERMATOLOGY
Wide
area
digital
dermoscopy
applied
to
basal
cell
carcinoma
夽,夽夽
Gerson
Dellatorre
∗,
Guilherme
Augusto
Gadens
DepartmentofDermatology,HospitalSantaCasadeMisericórdiadeCuritiba,Curitiba,PR,Brazil
Received6May2019;accepted26August2019
Availableonline20March2020
KEYWORDS Carcinoma,basal cell; Dermoscopy; Imageprocessing, computer-assisted
Abstract Insituationsinwhenadermoscopicrecordofalargelesionisdesirable,theresulting
imagesareusuallyrestrictedtoasmallfieldofviewduetothelimiteddiameterof
dermato-scope lenses. Thislimitationoftenproduces severalphotographsseparately,thus losingthe
possibilityofasingle-imageglobalevaluation.Inthesecasereports,weshowexamplesofa
recentlypublishedimagemontagetechniquecalledWideAreaDigitalDermoscopy,inthiscase,
appliedtobasalcellcarcinomas.
©2020SociedadeBrasileira deDermatologia.PublishedbyElsevierEspa˜na,S.L.U.Thisisan
openaccessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).
Wide
area
digital
dermoscopy
methodology
TocreateaWADDimage,astandarddermoscope(10× mag-nification, polarized) attached to a digital camera and a computer withAdobe Photoshop CCsoftware (Adobe Sys-temsIncorporated,SanJose,CA,USA,v19.1.6)wereused.
Thefollowingstepswereperformed:
夽 Howtocitethisarticle:DellatorreG,GadensGA.Widearea
dig-italdermoscopyappliedtobasalcellcarcinoma.AnBrasDermatol.
2020;95:376---9.
夽夽StudyconductedattheHospitalSantaCasadeMisericórdiade
Curitiba,Curitiba,PR,Brazil.
∗Correspondingauthor.
E-mail:[email protected](G.Dellatorre).
1) Image acquisition: During this step,all the lesion was covered,performingaperipheraloverlapineachphoto (20---30%ofthepreviousimageareaineachnewpicture). 2) Mergingimages:InPhotoshopsoftware,FileMenu, Auto-mateandPhotomergeoptionswereselected.InLayout options, Reposition wasselected and acquired dermo-scopicimageswereadded.
3) Imageviewing:Aconventionalbuilt-inWindowsorMac imagevisualizationsoftwarewasusedforimage visual-ization.
Case
1
56-year-old patient presented with a poorly delimited (Fig. 1), mixed type (superficial, nodular and infiltrative) basalcell carcinoma (BCC).After theacquisition of nine-teendermoscopic imageswithan overlapof 30%(Fig.2), we merged them with Adobe Photoshop software (Adobe https://doi.org/10.1016/j.abd.2019.08.030
0365-0596/©2020SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC
380 DellatorreG,GadensGA
Figure 1 BCC. A poorly delimited lesion measuring
30×30mm compromising the left cheek, lateral nasal
wallandnasalala.
Systems Incorporated, San Jose, CA, USA, v19.1.6) by usingitsautomatized‘‘Photomerge’’function,aspreviously detailed.1 ThefinalWADDimageobtainedrepresentedthe full dermoscopic view from the lesional and perilesional areas (Fig. 3). The patient underwent Mohs Micrographic Surgery(MMS)fortumorexcision,andmarginswerecleared aftertwostagesduetoadeeppositivemarginin thefirst stage.
Case
2
A 55-year-old patient presented with a poorly delimited superficial and nodular BCC on his left preauricular area (Fig.4).Hehadahistoryoftopical5-fluorouraciltreatment on hisface one year ago. We acquired sixteen separated dermoscopic images and merged them in the same way as previously mentioned. A dermoscopic-histologic corre-lation wasmade during MMS by analyzing frozen sections of tumoral debulking (Fig. 5). In this case, margins were clearedafteronesurgicalstage.
Discussion
DermatologistscanuseWADDasanewregistertechniquein digitaldermoscopy.This toolcanbeusefulin situationsin whichthelimitedfieldofviewofthedermatoscopelenses difficult this register.1 For example, the use of WADD in the cases presented can serve asa didactic subsidiary in the teaching of tumoral margins demarcation and also in dermoscopic-histopathologicalcorrelations.Theapplication ofthemethodcanstillbebeneficialinthedermatoscopic follow-up of more extensive melanocytic lesions,such as congenitalmelanocyticnevi,allowinganoverallassessment ofthelesionsintheirfollow-up.Also,intrichology, exten-siveandunifiedregistrationofanaffectedhairyareawould beusefulforitsdetailedglobalfollow-up.
Figure2 Nineteenoverlappeddermoscopicimagesofthelesion(HeineDelta20T---HEINEOptotechnikGmbH&Co,Herrsching,
Wideareadigitaldermoscopyappliedtobasalcellcarcinoma 381
Figure3 WADDimage ofBCC. Dermoscopicfindings onthe
margins consisting of ulceration and crusts (), cicatricial
whitishareas(♦)andarboriformtelangiectasias(†),incontrast
totelangiectasiasoftheperipheralphotodamagedskin(*).
The acquisition phase of the separate dermatoscopic imagesisacriticalpointintheprocessofcreatingaWADD image.Theneedforphotographstobeobtainedwitha30% overlap(acrucialtechnicalfactorforthesoftwareto rec-ognizethemeltingpointsofimages)canbechallengingat the beginning of the practice,especially in large lesions.
Figure4 Basal cellcarcinoma.A poorlydelimitedand
non-contiguouslesionmeasuring20×28mmontheleftpreauricular
area.
Another limiting factor of its use is the need for profes-sionalsoftware(Photoshop)forthecompositionoftheWADD image.Inthefuture, thedevelopmentof softwarewitha user-friendly interface built-in on the imaging equipment itselfmayreplacethisphaseofthecompositingprocess.
Financial
support
Nonedeclared.
Authors’
contributions
Gerson Dellatorre: Approval of the final version of the manuscript;conception and planning of thestudy; elabo-rationand writing of the manuscript;obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the
Figure5 A,WADDimage ofBCC.B,Nodular andsuperficialBCC correspondingto erythematousstructureless areas () and
arboriformtelangiectasias(†)ondermoscopy.C,Dermalfibrosiscorrespondingtoacicatricial-whitisharea(♦),probablyrelated
tohisprevious topicaltreatment.D, SuperficialBCC anddermal fibrosiscorresponding toamilky-red area (*)andarboriform
382 DellatorreG,GadensGA propaedeutic and/or therapeutic conduct of the studied
cases; criticalreview of the literature; critical review of themanuscript.
GuilhermeAugustoGadens:Approvalofthefinalversion of themanuscript; conception and planningof the study; intellectualparticipationinthepropaedeuticand/or ther-apeuticconductofthestudiedcases;criticalreviewofthe literature;criticalreviewofthemanuscript.
Conflicts
of
interest
Nonedeclared.
Reference
1.DellatorreG,GadensGA.Wideareadigitaldermoscopy.JAm AcadDermatol.2019;80:e153.