We demonstrate noninvasive structural and microvascular contrast imaging of different human
skin diseases in vivo using an intensity difference analysis of OCT tomograms.
The high-speed swept source OCT system operates at 1310 nm with 220 kHz A-scan rate. It
provides an extended focus by employing a Bessel beam. The studied lesions were two cases of
dermatitis and two cases of basal cell carcinoma. The lesions show characteristic vascular
patterns that are significantly different from healthy skin. In case of inflammation, vessels
are dilated and perfusion is increased. In case of basal cell carcinoma, the angiogram shows a
denser network of unorganized vessels with large vessels close to the skin surface. Those
results indicate that assessing vascular changes yields complementary information with
important insight into the metabolic demand.
Vascular abnormalities serve as a key indicator for many skin diseases. Currently available methods in dermatology such as histopathology and dermatoscopy analyze underlying vasculature in human skin but are either invasive, time-consuming, and laborious or incapable of providing 3D images. In this work, we applied for the first time dualmodality photoacoustic and optical coherence tomography that provides complementary information about tissue morphology and vasculature of patients with different types of dermatitis. Its noninvasiveness and relatively short imaging time and the wide range of diseases that it can detect prove the merits of the dual-modality imaging system and show the great potential of its clinical use in the future.
We evaluated the accuracy of diagnoses made from pictures taken with the built-in cameras of mobile phones in a 'real-life' clinical setting. A total of 263 patients took part, who photographed their own lesions where possible, and provided clinical information via a questionnaire. After the teledermatology procedure, each patient was examined face-to-face and a gold standard diagnosis was made. The telemedicine data and pictures were diagnosed by 15 dermatologists. The 299 cases contained 1-22 clinical images each (median 3). Nine dermatologists finished all the cases and the remaining six completed some of them, thus providing 2893 decisions. Overall, 61% of all cases were rated as possible to diagnose and of those, 80% were correct in comparison with the face-to-face diagnosis. Image quality was evaluated and the median was 5 on a 10-point scale. There was a significant correlation between the correct diagnosis and the quality of the photographs taken (P < 0.001). In nearly two-thirds of all cases, a teledermatology diagnosis was possible; however, there was insufficient information to make a telemedicine diagnosis in about one-third of the cases. If applied carefully, mobile phones could be a powerful tool for people to optimize their health care status.
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