A new papule and “age spots”

While dermatoscopes are the true “skin stethoscopes,” most primary care physicians do not have them. Many, however, do have a digital camera. A digital camera with a macro-focus feature can be viewed as another stethoscope for the skin. Pictures allow great magnification on the computer screen, presenting color and detail that may be missed on routine clinical inspection. They allow an unhurried “self–second opinion”; you can evaluate lesions with no motion, breathing, or other distractions, following the office visit.

Digital images may also be important for:

• the patient, who may not be able to see the lesion, because it’s on his back, buttocks, or behind his ears. Consider, too, the older patient who may not be able to see the seborrhea in his eyebrow with his bifocals, but he can see it on the camera’s monitor.
• the medical record (printed or electronically stored).
• the pathologist—when forwarded with the pathology specimen. The images can be helpful in developing a clinical correlation to include in the pathology report.
• the insurance carrier, as indisputable documentation for the clinical rationale for biopsying 4 lesions on 1 visit in the event of a “Dear Bad Doctor” Medicare letter. In fact, if not for the indisputable photographic record, one author (GNF) would have been extremely hesitant to perform 4 biopsies on a Medicare patient in 1 session.
• light and magnification where the 2 may be in short supply, such as a poorly mobile patient in a hospital bed. A camera with flash, auto-focus, and macro mode may allow access to otherwise inaccessible lesions.