©Creative1 Comparison of Photographic Methods for ... · lesions, vitiligo, melasma, or...
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Comparison of Photographic Methods for Evaluation of Skin Lesions Kristin Kucera Marcum, M.D., Neal Goldman, M.D. Department of Otolaryngology Head and Neck Surgery, Wake Forest Baptist Medical Center Methods Methods Skin characteristics are examined for example various types of lesions such as basal cell lesions, vitiligo, melasma, or photoaging, under various methods of photography including black and white flash photography, standard color photography, parallel polarized light photography, cross polarized light photography, and ultraviolet passing photography. A Nikon N70 camera with a UV passing filter with black and white Tmax400 film was used for the black and white, ‘control’ as well as UV passing, ‘experimental’ photographs. Two white lightening flash with the UV protectant film removed were used to obtain adequate amount of light. A Nikon digital camera with setting of F11, was used behind a parallel polarizing filter for the parallel polarized light and a second filter rotated 90 degrees for a cross-polarized light photograph. Conclusion Conclusion By implementing various types of advanced photographic techniques such as parallel and cross polarized light as well as ultraviolet passing photography, skin characteristics are more readily demonstrated and documented. Cross polarized photography is effective at revealing underlying vascular and subsurface features as well as skin pigment changes but poor at documenting surface features and texture. Parallel polarizing light is useful to examine and document skin surface features and texture but poor at documenting skin pigment and vasculature. UV passing light photography can reveal underlying sun damaged skin and worrisome premalignancy lesions but is poor at documenting vascular lesions. Appropriate choice of advanced photographic techniques will more effectively document and diagnose and monitor cutaneous disease and dermatologic characteristics and thus improve our ability to provide patient care. References References 1. Rizova, E (2001). "New photographic techniques for clinical evaluation of acne". Journal of the European Academy of Dermatology and Venereology (0926-9959), 15 Suppl 3 (3), p. 13. 2. Muccini, J A (11/1995). "Polarized light photography in the evaluation of photoaging". Journal of the American Academy of Dermatology (0190-9622), 33 (5), p. 765. 3. Ericson MB, Sandberg C, Gudmundson F, et al. Fluorescence contrast and threshold limit: implications for photodynamic diagnosis of basal cell carcinoma. J Photochem Photobiol B: Biol 2003;69:121-7. 4. Crawford, W. (1979). The keepers of light: A history and working guide to early photographic processes. Dobbs Ferry, NY: Morgan & Morgan. 5. Galdino, G., Vogel, J., & Vander Kolk, C. A. (2001). Standardizing digital photography: It's not all in the eye of the beholder. Plastic and Reconstructive Surgery, 108(5), 1334–1344. 6. Parker, W. L., Czerwinski, M., Sinno, H., Loizides, P., & Lee, C. (2007). Objective interpretation of surgical outcomes: Is there a need for standardizing digital images in the plastic surgery literature. Plastic and Reconstructive Surgery, 120(5), 1419–1423. Sunlight and almost every other form of natural and artificial illumination produces light waves whose electric field vectors vibrate in all planes that are perpendicular with respect to the direction of propagation. If the electric field vectors are restricted to a single plane by filtration of the beam with specialized materials, then the light is referred to as plane or linearly polarized with respect to the direction of propagation, and all waves vibrating in a single plane are termed plane parallel or plane-polarized. Polarized light photography relies on the fact that light reflected from the skin has two components, namely, regular reflectance (glare) and light ‘‘back-scattered’’ from within the tissue. The regular reflectance contains the visual information relating to the skin surface texture including structure and contours of the stratum corneum, whereas the backscattered light contains the information relating to intracutaneous While the back-scattered light is depolarized, the reflected light preserves the plane of polarization of the incident light. This characteristic can be exploited to separate surface and intracutaneous detail by using polarizing filters that are parallel or perpendicular in orientation to each other. If the second filter covering the camera lens is parallel to that of the filter covering the flash, only the reflected polarized light passes through the lens filter and consequently surface details of the skin (texture, elevation, scaling) are enhanced and pigmentation, vascularity, and color are diminished. UV Passing Filter UV Passing Filter Parallel Polarizing Light Parallel Polarizing Light Cross Polarizing Light Cross Polarizing Light Conversely, if the lens filter is perpendicular to the flash filter, the regular reflectance is blocked and only the back- scattered light from the tissues reaches the lens. In this way, all surface detail is lost, but telangiectasia, tattoos, and inflammatory lesions are enhanced and pigmented lesions are more easily seen. A number of applications, most notably polarized optical microscopy, rely on crossed polarizers to examine birefringent or doubly refracting specimens. When two polarizers are crossed, their transmission axes are oriented perpendicular to each other and light passing through the first polarizer is completely extinguished. Abstract Objectives: To observe and document the different skin characteristics that can be better evaluated by examining skin under various types of photographic methods including parallel polarizing, cross polarizing and UV passing photography. Introduction: Since the beginning of time there has been interest in capturing one’s own image. Therefore when the first photograph, a method to permanently capture an image, was created, there was almost a state of hysteria in the masses interested in this unimaginable phenomenon. Modern photography has advanced to include not only standard and digital photography, but there has been increasing research into the different skin characterizations that can be determined using photography. The standard initial consultation for facial plastics involves accurate flash photography for photo documentation. Newer techniques however exploring the use of polarized light, cross and ultraviolet photography can give detailed information on subtle skin lesions including skin pigmentation and skin surface characteristics. These multiple photography methods will provide a basis for objective, non-invasive data collection, which is much superior to the standard subjective evaluation of skin. Setting: Tertiary Academic Medical Center Methods: A prospective analysis of advanced photographic techniques used to evaluate skin texture, pigment, and/ or vascularity, on patients that present themselves to the Department of Otolaryngology clinics. Subjects meeting the inclusion criteria and who have given written informed consent to participate have their photo taken under standard photography, polarized light photography, cross-polarized light photography and ultraviolet passing light. The photos are then evaluated by two photographers (otolaryngology resident and facial plastic surgeon) and a blinded observer (non physician) to characterize the differences visualized in each type of photography. Results: Each method of photography shows a significant difference in its ability to evaluate and document elements such as skin texture, vascularity, and pigmentation when used by the study team photographers. This is verified by the blinded observer. Conclusions: Cross polarized photography is effective at revealing underlying vascular and subsurface features as well as skin pigment changes but poor at documenting surface features and texture. Parallel polarizing light is useful to examine and document skin surface features and texture but poor at documenting skin pigment and vasculature. UV passing light photography can reveal underlying sun damaged skin and worrisome premalignancy lesions but is poor at documenting vascular lesions. Polarizng filters UV passing filter Photography Setup Polarizing filter Polarizing and Passing Filters Ultraviolet (UV)-emitting lamps emit light at wavelengths of 300 to 400 nm. As UV light penetrates the epidermis, it is absorbed by the epidermal melanin. As UV light is absorbed by melanin, skin areas with high epidermal concentrations of this pigment, such as solar lentigines, show up as darker areas compared with normal skin. Conversely, depigmented areas such as vitiligo lesions do not absorb UV light and appear as lighter areas. Standard Parallel Standard Parallel Increased forehead texture Standard Standard Standard Cross Polarized Cross Polarized Standard Cross Polarized Note increased sensitivity to surface features Note increased sensitivity to dermal pigment ©Creative1
Transcript of ©Creative1 Comparison of Photographic Methods for ... · lesions, vitiligo, melasma, or...
Comparison of Photographic Methods for Evaluation of Skin Lesions
Kristin Kucera Marcum, M.D., Neal Goldman, M.D.Department of Otolaryngology Head and Neck Surgery, Wake Forest Baptist Medical Center
MethodsMethodsSkin characteristics are examined for example various types of lesions such as basal cell lesions, vitiligo, melasma, or photoaging, under various methods of photography including black and white flash photography, standard color photography, parallel polarized light photography, cross polarized light photography, and ultraviolet passing photography.
A Nikon N70 camera with a UV passing filter with black and white Tmax400 film was used for the black and white, ‘control’ as well as UV passing, ‘experimental’ photographs. Two white lightening flash with the UV protectant film removed were used to obtain adequate amount of light. A Nikon digital camera with setting of F11, was used behind a parallel polarizing filter for the parallel polarized light and a second filter rotated 90 degrees for a cross-polarized light photograph.
ConclusionConclusionBy implementing various types of advanced photographic techniques such as parallel and cross polarized light as well as ultraviolet passing photography, skin characteristics are more readily demonstrated and documented.
Cross polarized photography is effective at revealing underlying vascular and subsurface features as well as skin pigment changes but poor at documenting surface features and texture. Parallel polarizing light is useful to examine and document skin surface features and texture but poor at documenting skin pigment and vasculature. UV passing light photography can reveal underlying sun damaged skin and worrisome premalignancy lesions but is poor at documenting vascular lesions.
Appropriate choice of advanced photographic techniques will more effectively document and diagnose and monitor cutaneous disease and dermatologic characteristics and thus improve our ability to provide patient care.
ReferencesReferences1. Rizova, E (2001). "New photographic techniques for clinical evaluation of acne". Journal of the European Academy of Dermatology and Venereology (0926-9959), 15 Suppl 3 (3), p. 13.2. Muccini, J A (11/1995). "Polarized light photography in the evaluation of photoaging". Journal of the American Academy of Dermatology (0190-9622), 33 (5), p. 765.3. Ericson MB, Sandberg C, Gudmundson F, et al. Fluorescence contrast and threshold limit: implications for photodynamic diagnosis of basal cell carcinoma. J Photochem Photobiol B: Biol 2003;69:121-7.4. Crawford, W. (1979). The keepers of light: A history and working guide to early photographic processes. Dobbs Ferry, NY: Morgan & Morgan.5. Galdino, G., Vogel, J., & Vander Kolk, C. A. (2001). Standardizing digital photography: It's not all in the eye of the beholder. Plastic and Reconstructive Surgery, 108(5), 1334–1344.6. Parker, W. L., Czerwinski, M., Sinno, H., Loizides, P., & Lee, C. (2007). Objective interpretation of surgical outcomes: Is there a need for standardizing digital images in the plastic surgery literature. Plastic and Reconstructive Surgery, 120(5), 1419–1423.
Sunlight and almost every other form of natural and artificial illumination produces light waves whose electric field vectors vibrate in all planes that are perpendicular with respect to thedirection of propagation. If the electric field vectors are restricted to a single plane by filtration of the beam with specialized materials, then the light is referred to as plane orlinearly polarized with respect to the direction of propagation,and all waves vibrating in a single plane are termed plane parallel or plane-polarized. Polarized light photography relies on the fact that light reflected from the skin has two components, namely, regular reflectance (glare) and light ‘‘back-scattered’’from within the tissue. The regular reflectance contains the visual information relating to the skin surface texture including structure and contours of the stratum corneum, whereas the backscattered light contains the information relating to intracutaneous While the back-scattered light is depolarized, the reflected light preserves the plane of polarization of the incident light. This characteristic can be exploited to separatesurface and intracutaneous detail by using polarizing filters that are parallel or perpendicular in orientation to each other. If the second filter covering the camera lens is parallel to that of the filter covering the flash, only the reflected polarized light passes through the lens filter and consequently surface details of the skin (texture, elevation, scaling) are enhanced and pigmentation, vascularity, and color are diminished.
UV Passing FilterUV Passing FilterParallel Polarizing LightParallel Polarizing Light Cross Polarizing LightCross Polarizing LightConversely, if the lens filter is perpendicular to the flash filter, the regular reflectance is blocked and only the back-scattered light from the tissues reaches the lens. In this way, all surface detail is lost, but telangiectasia, tattoos, and inflammatory lesions are enhanced and pigmented lesions are more easily seen.
A number of applications, most notably polarized optical microscopy, rely on crossed polarizers to examine birefringent or doubly refracting specimens. When two polarizers are crossed, their transmission axes are oriented perpendicular to each other and light passing through the first polarizer is completely extinguished.
AbstractObjectives: To observe and document the different skin characteristics that can be better evaluated by examining skin under various types of photographic methods including parallel polarizing, cross polarizing and UV passing photography.
Introduction: Since the beginning of time there has been interest in capturing one’s own image. Therefore when the first photograph, a method to permanently capture an image, was created, there was almost a state of hysteria in the masses interested in this unimaginable phenomenon. Modern photography has advanced to include not only standard and digital photography, but there has been increasing research into the different skin characterizations that can be determined using photography. The standard initial consultation for facial plastics involves accurate flash photography for photo documentation. Newer techniques however exploring the use of polarized light, cross and ultraviolet photography can give detailed information on subtle skin lesions including skin pigmentation and skin surface characteristics. These multiple photography methods will provide a basis for objective, non-invasive data collection, which is much superior to the standard subjective evaluation of skin.
Setting: Tertiary Academic Medical Center
Methods: A prospective analysis of advanced photographic techniques used to evaluate skin texture, pigment, and/ or vascularity, on patients that present themselves to the Department of Otolaryngology clinics. Subjects meeting the inclusion criteria and who have given written informed consent to participate have their photo taken under standard photography, polarized light photography, cross-polarized light photography and ultraviolet passing light. The photos are then evaluated by two photographers (otolaryngology resident and facial plastic surgeon) and a blinded observer (non physician) to characterize the differences visualized in each type of photography.
Results: Each method of photography shows a significant difference in its ability to evaluate and document elements such as skin texture, vascularity, and pigmentation when used by the study team photographers. This is verified by the blinded observer.
Conclusions: Cross polarized photography is effective at revealing underlying vascular and subsurface features as well as skin pigment changes but poor at documenting surface features and texture. Parallel polarizing light is useful to examine and document skin surface features and texture but poor at documenting skin pigment and vasculature. UV passing light photography can reveal underlying sun damaged skin and worrisome premalignancy lesions but is poor at documenting vascular lesions.
Polarizng filters
UV passing filter
Photography Setup
Polarizing filter
Polarizing and Passing Filters
Ultraviolet (UV)-emitting lamps emit light at wavelengths of 300 to 400 nm. As UV light penetrates the epidermis, it is absorbed by the epidermal melanin. As UV light is absorbed by melanin, skin areas with high epidermal concentrations of this pigment, such as solar lentigines, show up as darker areas compared with normal skin. Conversely, depigmented areas such as vitiligo lesions do not absorb UV light and appear as lighter areas.
Standard
Parallel
Standard
ParallelIncreased forehead texture
Standard
Standard
Standard Cross Polarized
Cross Polarized
Standard Cross Polarized
Note increased sensitivity to surface features
Note increased sensitivity to dermal pigment
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