Testimonials

Dermatology

At the Forefront of Dermatology in Spain: The Success of the Casio Dermatology Camera and Dermatology Scope

Dr. Paola Pasquali (Spain)

Spain’s eastern coast faces the Mediterranean and is a world-renowned beach resort area. A dermatologist in this region, Dr. Paola Pasquali, is a devoted user of the Casio DZ-D100 Dermatology Camera (hereafter, Dermatology Camera) and DZ-S50 Dermatology Scope (hereafter, Dermatology Scope). We interviewed her about the state of dermatology in Spain and her impressions about the usefulness and applicability of Casio products.

Efficiency in Dermatological Care Is a Challenge in Spain, a Country with High Life Expectancy

The Mediterranean coast in eastern Spain, known as Costa Daurada (Golden Coast), is a region that has seen significant population growth since the mid-20th century due to the development of beach resorts. The town of Valls, where Dr. Pasquali serves as the head of the dermatology department at Pius Hospital, and the town of Cambrils, where she runs a hospital, are both close to Tarragona, the central port city of Costa Daurada.

—How does the incidence of skin cancer in Spain compare globally?

Dr. Pasquali: “The incidence of skin cancer in the population in Spain is average for Europe, but globally, it’s lower than in the United States and about the same as in Australia. Within Spain, the Mediterranean coastal region where I practice tends to have a higher incidence of skin cancer due to the large number of sailors and farmers. This is because many people here have fair skin and spend long hours in the sun.

While skin cancer rates are increasing, the number of dermatologists is not growing proportionally. Moreover, Spain’s life expectancy is on par with Japan’s, which is among the longest in the world. The longer people live, the more skin cancer cases we see, so dermatologists in Spain are chronically overworked. That’s why it’s crucial to be able to use dermoscopy, a non-invasive diagnostic technique that doesn’t harm the body, to determine whether specialized treatment is necessary.”

Tele-dermatology Suitable for Screening Benefits Both Doctors and Patients

—How many patients do you see in a day? And what’s the ratio of telemedicine to face-to-face consultations?

Dr. Pasquali: “I see about 60 patients a day. Of these, 40% are via telemedicine, and 60% are face-to-face consultations. My specialty is oncology, so dermoscopy is essential, and I observe and check all lesions with the Dermatology Scope.

Tele-dermatology is ideal for screening. In Spain, we have a well-developed primary care network, with family physicians who are responsible for the health of families in the community and handle outpatient care for all specialties. When people or their family members feel unwell or have concerning symptoms, they first visit their family physician. The family physician examines the patient and decides which specialist to refer them to, if the case is beyond their expertise.

At my hospital, all referrals are done remotely. Family physicians provide clinical and dermoscopic images along with a brief medical history. The main advantage of this system is triage. Patients who don’t need urgent care or can be sufficiently examined remotely don’t need to visit the hospital. This applies to about 70–75% of all cases. This is a beneficial policy that saves time and money for both patients and hospitals.

Given this background, the number of patients I see via telemedicine is increasing. Additionally, telemedicine has the benefit of allowing family physicians to learn by reviewing the images after the specialist’s diagnosis.”

—How are the images for tele-dermatology diagnosis sent to you?

Dr. Pasquali: “For accurate remote diagnosis, it’s crucial to have high-quality images with proper white balance, distance to the lesion, and focus. Cameras that can automatically adjust these settings without requiring expertise are invaluable.

We receive referrals from about 40 family physicians. In Spain, responding to referrals within a few hours, or at most, a few days, is important. Therefore, all of these family physicians have dermatology scopes and send images taken with smartphones.

As smartphone cameras have become more advanced, image quality has improved. However, about 5-10% of the images we receive are still not diagnostic quality. That’s why there’s a strong demand in the physicians’ offices for user-friendly cameras suitable for skin photography.”

—While clinical images can be taken with smartphone cameras, do family physicians also use smartphone cameras for dermoscopic images?

Dr. Pasquali: “All the family physicians who refer cases to me have universal smartphone adapters for dermoscopy. These adapters have their own light source and make it easy to adjust the distance to the lesion and focus, so the images they can capture tend to be superior to clinical images.”

—You’ve also contributed to the spread of tele-dermatology in the Tarragona region. How was it introduced?

Dr. Pasquali: “When I first arrived at the hospital in that region, there was a very long waiting list of patients. So, I devised a method to prioritize those who needed consultations, entrust common illnesses to family physicians, and make sure everyone gets seen. This was the beginning of tele-dermatology.

We held dermoscopy training courses, starting with a few family physicians, and eventually distributed the dermatology scopes to all of the family doctors. To date, we have handled over 20,000 tele-dermatology consultations. This is the most successful example in this region.

When we went into lockdown during the COVID-19 pandemic, this tele-dermatology system was already familiar to people in the area.”

The Ability to Capture Both Clinical and Dermoscopic Images with One Device Is a Major Advantage

—How do you utilize the Dermatology Camera and Dermatology Scope in your daily practice?

Dr. Pasquali: “The Dermatology Camera allows us to record how the physician saw the condition at that moment, allowing us to identify changes in the condition through later comparisons. It is also beneficial for patients to see changes in their condition themselves.

Medical images are shared for educational purposes with fellow doctors, healthcare workers, and even non-medical staff. They’re also useful for training residents and other learners. It is no longer conceivable to conduct dermatology education without medical images.

As I mentioned earlier, in tele-dermatology, we use clinical images to virtually examine and diagnose patients who are in remote locations. I believe the Dermatology Camera can play a significant role here as well.”

—Please share your impressions of using the Casio Dermatology Camera and Dermatology Scope.

Dr. Pasquali: “One of the reasons I like and use the Casio Dermatology Camera is the compact size and long-lasting battery. I have an excellent digital SLR camera, but it’s large and heavy and can only take clinical images.

With the Dermatology Camera, I can capture clinical images and both polarized and non-polarized dermoscopic images with a single device. It is very convenient since I can save images to the patient’s chart or show examination results to patients.

While the clinical image quality could be improved compared to the sharp images from a digital SLR camera, I’m satisfied with Casio’s dermoscopic images.

The Casio Dermatology Scope, with its high-brightness LED, is helpful because I want to observe lesions clearly.

Although I own many dermoscopes, I use the Casio Dermatology Scope every day.”

—What do you expect from Casio in the field of dermatology in the future?

Dr. Pasquali: “For me, the ideal future of image diagnosis is an ‘all-in-one device.’ It would be wonderful to have a single camera that can capture clinical, dermoscopic, video, and microscopic images.

It might sound like science fiction, but someday, we might have a single device that can serve as a dermatology camera, dermoscope, ultrasound, and confocal microscope—a true all-in-one camera.”

In Spain, where Dr. Pasquali works, even family physicians who are not dermatology specialists use dermoscopes and smartphones for imaging. In the future, we may see an increase in family physicians owning dermatology cameras that can also capture clinical photos.

While Dr. Pasquali included a critique, saying that the image quality of the Casio Dermatology Camera could be further improved, she expressed satisfaction with its ability to capture clinical images and both polarized and non-polarized dermoscopic images with a single device.