Health Matters

Technology provides new view of skin

Conway McLean, DPM, Journal columnist

Humans have five senses: the eyes for vision, the tongue to taste, the nose to smell, the ears so we can hear, and the skin to touch. The sense of sight is our most important. When asked, most will say this is the sense they would least like to lose (although we often don’t appreciate our senses until one stops working). Our sight allow us to connect with our surroundings and helps to keep us safe.

Humans are unique in our reliance on sight as the dominant sense. We receive up to 80% of all the information absorbed by means of our sight. Information from our environment gets to us through our eyes, the physical portal to the brain, to be processed and assembled. The brain is required to convert the light received by the eyes into usable information.

Vision is essential to the practice of medicine, more so in some specialties than others. Dermatologic conditions, including those afflicting the foot, ankle and lower leg, require a close visual inspection. How a spot or some kind of skin lesion looks provides vital information about what is causing the skin change and also the prognosis. Is there a high potential for serious complications, like infection, amputation or death.

When someone has a bone problem, we take an x-ray. An ultrasound exam allows us to look at various soft tissue structures. MRI’s are wonderfully informative but are just too costly. Like a C.T. scan, a contrast medium is often used in the scan but these not infrequently cause kidney damage. Besides, many of these types of studies require advance scheduling and insurance approval. This can take an inordinate amount of time on occasion, be an incredibly frustrating affair, and is generally a difficult, laborious process.

What about skin diseases? How can technology help us evaluate these problems more accurately, with more detail. It’s called a dermatoscope and gives us the power of microscopic vision. The concept goes as far back as the 1600’s, although the first were notably crude, as would be expected. It wasn’t until the 1920’s that a light source was added.

Dermoscopy is a noninvasive diagnostic technique that magnifies the skin, allowing visualization of the superficial structures, and even some deeper ones. With modern technologies, many layers of cutaneous structures can be identified, including tiny blood vessels below the superficial layers of skin. With practice, dermoscopy allows the physician to more accurately diagnosis a variety of pathologies.

The “classic” dermatoscope (also known as a dermascope) the one used by thousands of clinicians, has been around for decades and has worked admirably. The design changed considerably with the development of LED lights and better batteries. When I made the switch to the LED design, having used the old style for years, I thought this was IT! The imaging and illumination was head-and-shoulders above the classic, older version. The degree of enlargement was significantly better, while the clarity was phenomenal.

Regardless of the technology, the concept holds true: getting a better view of any kind of cutaneous lesion is a great idea. Much can be learned by zooming in on some skin mass or spot. An examination of a pigmented lesion of the skin is a vital use for dermoscopy, allowing us to find and diagnose these lesions earlier and more accurately. Melanomas usually fall into this category. Most of these are darker colored due to a concentration of skin pigmentation. When lit and enlarged, it is an easier identification. The earlier the diagnosis, the better the prognosis. Consequently, dermoscopy can be said to be a life-saver!

Naturally, there are other uses. Think of how many things on the human body would provide information about some problem, potential or otherwise. I can vouch for the benefits in evaluating nail problems (although biopsy remains the gold standard for diagnosing a fungal infection!). Even such diffuse problems as inflammatory diseases, the typical rash, can be better examined with dermoscopy. With polarization of the light source, we can see deeper, even visualizing more subtle structures, including tiny vascular formations.

The digital age is upon us. Of this there is no doubt. Computerized body parts, computerized cars. As you would expect, there is now digital dermoscopy. Could this be my new “toy”? An exciting and useful piece of new technology? I had to have it……..and it is amazing. To be able to capture and save images is of such value. Storing them directly into the patient’s chart takes seconds. Sending these images to a consulting physician is a simple matter (while still HIPAA compliant). And, even better, it means better documentation about the patient, their condition, their progress.

The next great age is that of artificial intelligence. AI, the subject of numerous science fiction books and movies. Because dermatoscope technology is fairly standardized, and there are a limited number of diagnoses possible, these images may soon be subjected to AI processing. Large public image collections have been amassed and will allow the application of neural networks, another way to say AI. Experiments have shown this technology already can match that of human beings. The days of the robotic physician may not be that far away.

Another example of effective and beneficial uses of new technologies. Are all new devices and techniques better? Certainly not, but discerning between the good and the bad can be difficult. Many are re-hashed older techniques, some simply too expensive, and others ineffective. But this one is absolutely worth the investment. The ability to visualize such minute structures, clearly and precisely, is of tremendous clinical benefit. And to be able to do so for a not outrageous cost? Well worth it, in my book.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.


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