On behalf of the International Society of Digital Imaging of the Skin (ISDIS) for the International Skin Imaging Collaboration (ISIC) D igital photographic documentation is increasingly common in dermatology practice. 1,2 Advances in both photographic and internet technology have improved clinicians' access to high-quality images at relatively low cost. Images are most often archived to monitor skin conditions over time or transmitted between clinicians using store-and-forward methods, enabling wider access to specialist diagnostic and treatment advice. [2][3][4][5][6] Telemedicine services are particularly well suited to dermatology given the skin can be easily viewed and imaged, the majority of cases are nonurgent, and there is high demand for dermatology services in both urban and remote areas 2,7 Digital photography offers additional benefits to traditional methods of assessing and treating a range of skin conditions. The ability to store images enables clinicians to review progress of chronic conditions and responses to treatment, monitor high-risk patients and contribute to ongoing research and education. 1,7 Total body imaging and teledermoscopy methods are increasingly being used for skin cancer monitoring and follow-up, 8,9 but are also useful for long-term monitoring of chronic skin conditions, including psoriasis and cutaneous T-cell lymphoma. 3,10 Image Standardization in DermatologyOptimizing the technological aspects of imaging, such as lighting, focus, and magnification, will ensure photographs accurately represent skin conditions. 6,11 Furthermore, paying adequate attention to aspects of photographic technique, including patient positioning, field of view, and camera resolution enables efficient clinical review and the development of image archives for long-term follow-up of patients when patients see multiple clinicians, or move to another state or country.Without standardized and consistent approaches to imaging, clinicians and researchers risk limiting the usefulness of a large and IMPORTANCE Standardizing dermatological imaging is important to improve monitoring of skin lesions and skin conditions, ensure the availability of high-quality images for teledermatology, and contribute to the development of a robust archive of skin images to be used for research.OBJECTIVE To provide guidelines for the clinical application of the Standards for Dermatological Imaging set forward by the ISIC. EVIDENCE REVIEWThe ISIC recommendations were developed through a hybrid Delphi methodology. The methods for achieving consensus have been described previously. The practical application of these recommendations was evaluated by 2 clinical photographers with expertise in skin imaging. Images corresponding to each recommendation were taken by a clinical photographer and provided as visual examples of how these recommendations can be implemented in clinical practice. RESULTSThe Standards for Dermatological Imaging developed by the ISIC members could be followed in the clinical setting. Images showing appropriate ...

Changes in dermoscopic patterns of naevi may be associated with melanoma; however, there is no consensus on which dermoscopic classification system is optimal. To determine whether different classification systems give comparable results and can be combined for analysis, we applied two systems to a case-control study of melanoma with 1037 participants: 573 classified using a "1/3 major feature" system, 464 classified based on rules of appearance, and 263 classified with both criteria. There was strong correlation for non-specific (Spearman R = 0.96) and reticular (Spearman R = 0.82) naevi, with a slight bias for globular naevi with the rules of appearance system. Inter-observer reliability was high for the rules of appearance system, particularly for reticular naevi (Pearson >0.97). We show that different classification systems for naevi can be combined for data analysis, and describe a method for determining what adjustments may need to be applied to combine data sets.