SAN DIEGO — The way Dr. Charles H. Miller sees it, dermatologists should have a digital camera at the ready to take photos of every lesion they biopsy.
"You should jump in and start doing this as part of your daily practice, because the future of dermatology is going to be significantly impacted by how we use digital images," Dr. Miller, chief of dermatology at Kaiser Permanente, San Diego, said at a melanoma update sponsored by the Scripps Clinic.
He and his associates routinely send along digital images of relevant lesions when they refer their patients to other specialists. "Anytime we send a patient for Mohs surgery, head and neck surgery, general surgery, or plastic surgery, we'll upload photos," he explained. "The surgeons love it because they can get an idea of what to expect before they see the patient. They're well prepared for what's to come, oftentimes saving a preop appointment."
He emphasized the importance of choosing a digital camera that fits you and your style of practice. Some can be had for less than $200, but the most important characteristic of a camera is not price. It's "that it's one you'll use often," Dr. Miller said.
"Some people wear white coats; others don't. Some people see 60-80 patients a day; other people see 20 a day. If you're seeing a lot more than 30 patients a day, make sure you have the camera with you at all times or else you're just not going to take the time to snap a picture."
In general, digital cameras with a resolution of at least 11 megapixels (MP) take pictures that are just as clear as those taken with the old 35-mm Kodachrome film technology. And when viewed on computer monitors, photos of much lower resolutions are acceptable. He divided his favorite cameras currently on the market into one of three groups based on size: "shirt pocket," "pants pocket," and "white-coat pocket" cameras "The actual measurements won't vary much," just an inch or so, "but it's enough" to make a difference, Dr. Miller said. Prices are approximate.
His recommended shirt-pocket cameras, which are "usually no bigger than a deck of cards," include the Canon SD790 (8 MP, $225), the Nikon S210 (8 MP, $150), the Sony T700 (10 MP, $350), and the Panasonic FX37 (10 MP, $270).
His recommended pants-pocket cameras include the Fujifilm 200EXR (12 MP, $360), the Canon A470 (8 MP, $145), the Canon S90 (10 MP, $399), the Canon SD780 IS (12 MP, $250), the Panasonic FX150 (15 MP, $300), and the Sony W300 (14 MP, $300).
Dr. Miller's recommended white coat-pocket cameras include the Panasonic LX3 (10 MP, $425), the Nikon P6000 (14 MP, $450), and the Canon G11 (10 MP, $459).
For even higher resolution, consider digital single lens reflex (DSLR) cameras, which accept macro lenses that are more optically correct and have less distortion than lenses in the smaller cameras listed above. Dr. Miller's suggested cameras in this category include the Nikon D40x (10 MP, $499), the Canon EOS Rebel T1i (15 MP, $720), the Nikon D90 (12 MP, $900), and the Nikon D700 (12 MP, $2,450).
"A lot of these cameras now include video capability as well," he noted. "That's something that dermatologists will start to consider in the future. It may be easier to take a quick video of a patient if it's at high-enough resolution, as opposed to taking single pictures. But that's something that needs to be more thoroughly evaluated."
Dr. Miller also advises dermatologists to think of digital cameras as disposable items that they'll want to replace every 3-5 years. "Once you get into that mind-set, it's not nearly as hard to jump in, because you realize that every few years you're going to grant yourself the benefit of upgrading," he said. He is on his sixth digital camera in 13 years.
Disclosures: Dr. Miller had no relevant conflicts to disclose.