Adapting Dermoscopy for the Oculoplastic Surgery Clinic

Lesions on the eyelid or other tissue around the eye may develop in patients of all ages for a number of reasons. The vast majority of these lesions are benign, and do not require surgical removal. Examination by a specialist in eye plastics and orbital surgery can be key in assessing a lesion correctly. Unfortunately, most patients do not have ready access to these specialists.

Christine Nelson, M.D., FACS, is working on a way to remotely evaluate lesions around the eye using dermoscopy, one of dermatology’s go-to-diagnostic tools.

A dermoscope is a handheld device that provides a magnified view of skin lesions. Dermoscopy helps detect conditions like melanoma with sensitivity and specificity not achievable with the naked eye. Until now, its use has been largely limited to examining flat surfaces of the skin. “Most clinicians assume dermoscopy can’t be used to examine curved areas, like the areas under the brow or over the globe of the eye,” Dr. Nelson explains. “Our work challenges that assumption.”

Dr. Nelson, Section Leader of Eye Plastic, Orbital and Facial Cosmetic Surgery, with a dual appointment in Ophthalmology and Surgery, put together a cross disciplinary team of faculty and medical students to explore whether dermoscopy could be adapted to evaluate periorbital, eyelid and conjunctival lesions.

Practicing first on each other, the team began by developing techniques to capture images both near the eye and touching the eye, using a 10x dermoscope mounted to a standard cell phone camera. High-quality images of 91 lesions were then captured from 78 of 97 patients enrolled in the study. The images were assessed for diagnostic utility by an oculoplastic surgeon and two dermatologists. Based on their evaluations, 63 of the lesions were flagged for biopsy; one third of those were malignant.

The results of their IRB-approved proof-of-concept study were presented at the 2022 meeting of the American Academy of Ophthalmology.

“It’s a steep learning curve to become proficient at the techniques,” reports Dr. Nelson. “But we’ve demonstrated that it’s possible to create diagnostic-quality dermoscopic images safely and reliably on and around the eye.”

While still in its infancy, the virtual health approach has the potential to help put patients’ minds at ease without requiring them to travel long distances.

“Eventually, providers in remote areas could transmit digital images of suspicious lesions to us,” she says, “and know right away whether to refer a patient for specialty care or treat the condition locally.”