03 Jul

Every surgery there will be several patients who will attend with a skin problem. It is not surprising as the skin is the biggest organ in the human body. Also, there are frequent visits of someone who is worried about a skin lesion, usually a mole which they fear may be skin cancer. We are fortunate that we can refer to an excellent service in Hammersmith hospital with the longstanding walkin skin clinic every Monday morning.

Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education. The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
The Ealing CCG has purchased a Dermascope which can examine the skin using skin surface microscopy. It is also sometimes called ‘epiluminoscopy’ and ‘epiluminescent microscopy’. Dermoscopy is mainly used to evaluate pigmented lesions in order to distinguish malignant skin lesions, such as melanoma and pigmented basal cell carcinoma, from benign melanocytic naevi and seborrhoeic keratoses. Hence,with specialists trained in dermoscopy, there is considerable improvement in the sensitivity (detection of melanomas) as well as specificity (percentage of non-melanomas correctly diagnosed as benign), compared with naked eye examination. Astudy showed that the accuracy by dermatoscopy was increased up to 20% in the case of sensitivity and up to 10% in the case of specificity, compared with naked eye examination. By using dermatoscopy the specificity is thereby increased, reducing the frequency of unnecessary surgical excisions of benign lesions.


We will now be referring patients to a community nurse-led clinic to perform Dermoscopy and then the photos of the images will be sent by email to be read by a Dermatologists in the same way X-rays are read by Radiologists.

Figure 5. Milky-red globules/areas (circle) in an invasive melanoma (A) and crown vessels (asterisks) in a sebaceous hyperplasia (B) (original magnification ×10).

Figure 5.
Milky-red globules/areas (circle) in an invasive melanoma (A) and crown vessels (asterisks) in a sebaceous hyperplasia (B) (original magnification ×10).

As you can see the details are amazing and can be closely evaluated and a diagnostic language is evolving.
With modern phone technology a Dermoscope has been developed by attaching the magnifier to an iPhone and in the future this will probably be part of a Gp’s equipment alongside the stethoscope and ophthalmoscopeDermatocope


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