of instruction of Mohs surgical excision and forevaluation and feedback for trainees before theyattempt surgery on patients. Depending on the size ofexcised specimens, trainees may be able to exciseseveral ‘‘Mohs layers’’ per specimen, building up theirmotor memory and skills on their way to achievingproficiency.

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1. Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The

effect of bench model fidelity on endo-urological skills: a

randomized controlled study. J Urol 2002;167:1243-7.

2. Anastakis DJ, Regehr G, Reznick RK, Cusimano M, Mumaghan J,

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J AM ACAD DERMATOL

AUGUST 2006

314 Pearls

Clinical Pearl: The use of the handheld digital camerato capture dermoscopic and microscopic images

Mary Elizabeth Rushing, MD, Erik Hurst, MD, and Daniel Sheehan, MD

Augusta, Georgia

The practice of dermatology requires detailedvisualization and recollection of physicalexamination abnormalities and proficiency

with diagnostic tests. Each of these skills can beenhanced with the modern ability to obtain qualityphotographic images. Digital photography has be-come increasingly popular in dermatology, rapidlyreplacing the 35-mm camera. In the past, photogra-phy in the clinic was limited to gross skin lesions.With the advent of the lightweight digital camera,high-resolution photographs of skin lesions andmicroscopic findings can now be achieved with ease.

Dermoscopy is a noninvasive tool that aids thehuman eye in diagnosing dermatologic diseases.Often dermoscopy is utilized to improve visualiza-tion of details and nuances of lesions. After physicalexamination, clinical tests can augment diagnosis.The microscopic findings on potassium hydroxide,oil, and hair preparations are valuable in evaluationof patients. Therefore digital images of dermoscopicand microscopic images are irreplaceable in diagno-sis, academic discussion, and remembrance of alesion. In a dermatologic examination, the combina-tion of these devices proves effective in documenta-tion and diagnosis of the skin disease.

From the Section of Dermatology, Department of Medicine,

Medical College of Georgia.

Funding sources: None.

Conflicts of interest: None identified.

Reprint requests: Daniel Sheehan, MD, 1004 Chafee Ave, Augusta,

GA 30904. E-mail: djs8582@yahoo.com.

J Am Acad Dermatol 2006;55:314-5.

0190-9622/$32.00

ª 2006 by the American Academy of Dermatology, Inc.

doi:10.1016/j.jaad.2005.09.045

TECHNIQUEA dermoscope is held above and focused on

the area of concern (Fig 1). We use a 5-megapixelcamera with a 3X optical zoom and 1.8-inch high-resolution LCD screen. The digital camera is placedabove the dermoscope. The digital camera’s lens ispositioned directly against the posterior aspect of thedermoscope lens (Fig 2). The digital camera’s flash is

Fig 1. Dermoscope is focused on skin lesion.

Fig 2. Digital camera captures dermoscope image.

J AM ACAD DERMATOL

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Pearls 315

disabled, and light is provided by the dermoscope’shalogen illumination. The camera’s automatic focusis activated and applied to the image projected bythe dermoscope. Once the focused image is obtainedon the LCD screen, the physician takes the picture.The resultant image is immediately reviewed to en-sure accurate recording of the desired lesion (Figs 3and 4).

As an additional diagnostic tool, the lens of thecamera is placed over the microscope’s ocular lens,and the slide is visualized using the LCD screen(Fig 5). The camera’s zoom is adjusted to minimizethe dark areas remaining in the periphery of theLCD screen. The digital photograph is then taken.Fig 6 (scabies preparation in mineral oil) andFig 7 (potassium hydroxide preparation of a

Fig 3. Clinical digital photograph of melanoma.

Fig 4. High-resolution digital photograph of dermoscopicimage of melanoma shown in Fig 3.

dermatophyte) demonstrate examples of this tech-nique taken with a 5-megapixel image. Images withless resolution may still be acceptable for clinical use,but are suboptimal for publication.

The resulting high-quality digital photographscan be printed for documentation, scanned onto apatient’s computer medical record, or used forpublication purposes.

Fig 5. The handheld digital camera aperture is placedover the microscope’s eyepiece.

Fig 6. Digital photograph of scabies mite in oil prepara-tion (magnification 320).

Fig 7. Digital photograph of dermatophyte on potassiumhydroxide preparation (magnification 340).