Clinical image tele-evaluation might be the method of choice for mobile tumour screening.

Mobile telemedicine integrates wireless communications for different telemedical applications, such as mobile phones and personal digital assistants, and with the implementation of modern wireless telecommunication, wireless local area network and satellite communication is a reality. New generation cellular phones or personal digital assistants have overcome limitations of image quality seen in older devices and, with dermatology being a visual profession, mobile teledermatology is perhaps the most recent development in this field. Mobile teledermatology may provide a triage service aimed toward management of patients with emergent skin disease or for follow-up with patients requiring systemic treatment. Teledermoscopy enables rapid transmission of dermoscopic images via e-mail or specific web-application and studies have demonstrated a high, 91%, concordance between face-to-face diagnosis and remote diagnosis of such images. Further to this, telediagnosis of melanocytic skin neoplasms achieved a diagnostic accuracy of 83% versus the conventional histopathologic diagnosis. Mobile teledermoscopy is the combination of such approaches enabling transfer of images captured with cellular phones coupled with a pocket dermatoscope and preliminary studies have demonstrated the feasibility and potential of its use in triage of pigmented lesions. Such applications are of benefit to physicians in enabling easy storage of data for follow-up or referral of images for expert second opinion and may facilitate a "person-centered health system" for patients with numerous moles and pigmented skin lesions who could forward images for evaluation. The incidence of skin cancers has reached epidemic proportions among whites and the trend is still going upward. Mobile teledermatology and teledermoscopy may be implemented as a triage or screening tool for malignant tumors to facilitate early detection and diagnosis, which is crucial for improved patient outcomes. While the legal aspects concerning teleconsultations need to be evaluated, the communications technologies provide a unique opportunity for physicians and patients alike and we foresee a place for these tools in dermatology soon.

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This study points out a discrepancy between the observed and the expected cases of leprosy in Italy. Specifically, the number of NCD was less than expected for each studied year. Of course our data do not represent a validation, but only an indication of the leprosy diagnosis in Italy. Difficulty in accessing the health systems, fear of segregation, ignorance and illegal immigrant status with consequent fear of police arrest are possible explaining factors. The critical issue anyhow is the medical expertise. The role of the dermatologist is fundamental. For these reasons, there is still a need for wide spread leprosy teaching programmes. Although with few limitations, this study represents a first approach to validate the accuracy in leprosy diagnosis in Italy.

Teledermatopathology may involve real-time transmission of images from distant locations to consulting pathologists by the remote manipulation of a robotic microscope. Alternatively, the static store-and-forward option involves the single-file transmission of subjectively preselected and captured areas of microscopic images by a referring physician. The recent introduction of virtual slide systems (VSS) involves the digitization of whole slides at high resolution thus enabling the user to view any part of the specimen at any magnification. Such technology has surmounted previous restrictions caused by the size of preselected areas and specimen sampling for telepathology. In terms of client access, these VSS may be stored on a virtual slide server, made available on the Web for remote consultation by pathologists via an integrated virtual slide client network. Despite store-and-forward teledermatopathology being the most frequently used and less expensive approach to teledermatopathology, VSS represents the future in this discipline. The recent pilot studies suggest that the use of remote expert consultants in diagnostic dermatopathology can be integrated into daily routine, teleconsultation, and teleteaching. The new technology enables rapid and reproducible diagnoses, but despite its usability, VSS is not completely feasible for teledermatopathology of inflammatory skin diseases as the performance seems to be influenced by the availability of complete clinical data. Improvements in the diagnostic facility will no doubt follow from further development of the VSS, the slide processor, and of course training in the use of virtual microscope. Undoubtedly, as technology becomes even more sophisticated in the future, VSS will overcome the present drawbacks and find its place in all facets of teledermatopathology.

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A 37-year-old woman first presented in 2003 with an irregularly bordered, slightly elevated, brown-black plaque on her left lower leg and a history of the mole changing over a period of 6 months. Upon excision, the diagnosis of melanoma in the setting of pre-existing naevus, Clark level III, Breslow thickness 0.9 mm, was made. Standard staging work-up disclosed no significant abnormalities. The patient was subsequently managed via 3-monthly clinical surveillance and at the second follow-up visit in April 2004, a new 2-mm light-brown, bluish macule was detected on the left thigh (Fig. 1a). Dermoscopic examination revealed asymmetry of colour and structure, uneven distribution of brownish and bluish irregular streaks and some bluishblack dots with elements of an atypical pigment network (Fig. 1b). The excisional biopsy of this lesion revealed the histopathological features of a melanoma in situ, namely nests of melanocytes with varied size and shape, confluent junctional nest of melanocytes (Fig. 2a) as well as increased numbers of atypical melanocytes at the dermo-epidermal junction and in the upper layers of the epidermis (Fig. 2b).Despite the ABCD rule, a significant proportion of melanomas do not fit the D criterion of 6 mm. 1 In fact small melanomas have a reported frequency of 11.4-38.2% of all diagnosed melanomas. 1-4 In view of a complete skin examination with dermoscopy requiring less than 3 min, 5 we propose all lesions be routinely evaluated under dermoscopy, regardless of the size.Our present observation emphasizes the need for clinicians to be alert to the development of new lesions on individuals with a prior history of melanoma, particularly in the first 6-12 months post excision of the first melanoma. A recent study based in Queensland, Australia, found the risk of a second primary invasive melanoma to be 12.7/1000 person-years in the first 12 months, a figure much higher than that of the general population. 6 Accordingly, we consider our case of an early diagnosis of a second primary melanoma in situ following an invasive melanoma, a product of vigilant surveillance. Provided that the recommendation of close surveillance is adhered to, it is anticipated that any second primary lesion will be smaller and at Correspondence: Professor H Peter Soyer, Figure 1 (a) Clinical photograph of small pigmented macule measuring 2 mm in diameter. (b) Dermoscopy: Asymmetry of colour and structure, with a hint of an atypical pigment network. There is an uneven distribution of brownish and bluish irregular streaks and some bluish-black dots.