PracticalDermatology

A New SOLUTION

Barco Demetra combines the best of analog and digital imaging in a wireless handheld device. The device can take incredibly crisp multispectral dermoscopic, close-up, and overview images. The device allows you to easily appreciate changes in lesions using the comparison and lesion mapping features. Also, retaking the same image at a follow-up visit is easily accomplished by lining up the original lesion with the saved ghost image from the original lesion image.

Patient Satisfaction

Other dermoscopy devices are made for providers to interpret and see the images themselves, but the Barco Demetra device captures and displays images on a handheld screen the size of a large iPhone, thereby allowing the images to be easily shown to patients. Images are stored in a HIPAA-compliant cloud portal and can be accessed on the device or through a secure web portal. Patients with benign lesions are reassured when their dermatologist explains the features of the image that indicate a benign diagnosis. What’s more, patients who are hesitant to have biopsies are more willing to proceed with them after being shown how their dermoscopic image shows concerning features.

Lastly, the noncontact cone is particularly useful in capturing images with minimal patient contact. You are also able to capture very clear focused images by hovering over the lesion.

Examination of pigmented lesions

The Barco device excels at capturing high resolution images of pigmented lesions.

Figure 1a is dermoscopic image of biopsy-proven compound melanocytic nevus when taken with Barco Demetra device. Using the device, I was able to appreciate the tan and darker brown colors that were symmetrically distributed with network pattern surrounding a central amorphous area. Image resolution is excellent, especially when compared to standard photography with the iPad (Figure 1b). Many of my patients comment that our practice is “so high tech” and are grateful I am using the newest diagnostic tools to carefully examine them.

Figure 1a (left). Barco Demetra Dermoscopic image of benign compound melanocytic nevus. Figure 1b (right). Photo of benign nevus taken with iPad Camera.

Figure 2a is a dermoscopic image of a biopsy-proven melanoma in-situ. The atypical pigment network with areas of pigment loss and irregularly distributed globules are clearly visualized. In addition to pigmented lesions, the Barco Demetra dermatoscope has been useful for a variety of other clinical applications. Summarized below are various clinical scenarios.

Figure 2a (left). Barco Demetra dermoscopic image of a melanoma in-situ. Figure 2b (right). The same melanoma in-situ photographed with an iPad

Evaluation of nail fold capillaries in autoimmune disease

A 36-year-old white male patient was referred to me from rheumatology for evaluation of an asymptomatic rash on the hands and feet. The patient had been experiencing joint pain and fatigue. Rheumatology workup was largely negative for autoimmune disease, and laboratory studies revealed mildly elevated liver enzymes. On clinical exam, the patient had macular erythema in the distal interphalangeal joints of the bilateral hands (Figure 3).

Figure 3. iPad photograph of patient hands with autoimmune disease.

Dermoscopy imaging (Figure 4) showed some ragged cuticles and mild dilated capillaries and irregularly distributed capillaries. Shave biopsy subsequently revealed an interface dermatitis without increased mucin.

Figure 4. Barco Demetra Dermoscopic image of nailfold and cuticles of patient with autoimmune disease.

The clinical picture was most consistent with dermatomyositis, and the patient was subsequently started on Cellcept per rheumatology. The patient had recently been on prednisone prior to his initial visit and skin biopsies. Exam and pathological findings may have represented partially treated dermatomyositis.

Visualization of Demodex

A 56-year-old male with redness and diffuse dryness of the face for many years was seen. He was using hydrocortisone occasionally and was unable to afford metronidazole gel. On exam, diffuse redness and scaling affecting his cheeks and nasolabial folds were observed. He also had redness and scaling of his eyebrows and forehead (Figures 5-6). He was started on ketoconazole shampoo and metronidazole gel without improvement.

Figure 5. iPad image of patient with erythema of cheeks.

Figure 6. iPad image of redness and scaling of brows and eyebrows.

Dermoscopic imaging (Figure 7) revealed filaments protruding out of follicular openings suspicious for Demodex tails. In addition, erythema and non-specific scales were observed on dermoscopic images—also associated with Demodex. The clinical picture was consistent with Demodex rosacea, and patient was subsequently put on oral ivermectin and weekly permethrin for four weeks and improved. There is not always time during the patient encounter to do a skin scrapping, so having the Barco Demetra device provides an efficient way to search for potential Demodex infections.

Figure 7. Barco Demetra Dermoscopic image of Demodex tail.

Evaluation of Clinical boundaries

I also have found the Barco Demetra device useful for clarifying the clinical boundaries of superficial basal cell carcinomas in patients with significant actinic damage. This can aid in determining treatment recommendations (Figures 8, 9).

Figure 8. Dermoscopic image of a biopsy proven superficial BCC

Figure 9. iPad image of the superficial BCC in Figure 8.

New feature: Skin Parameter Maps

The skin parameter maps are a new feature just launched in July 2021. This functionality provides image analysis using three maps—a pigment contrast map, a blood contrast map, and a scatter contrast map. The pigment contrast map highlights melanin, while the blood contrast map highlights vascularity. The scatter contrast map shows the surface texture.

Figure 10. iPad photo of biopsy proven pigmented seborrheic keratosis.

Figure 11. Barco Demoscopy Image

A pigmented seborrheic keratosis (Figure 10) was photographed using the Barco Dermoscopy device (Figure 11), and the skin parameter maps (Figures 12-14) were generated to provide additional analysis of the lesion.

Figure 12. Pigment contract map highlighting pigmented areas within the seborrheic keratosis.

Figure 13. Scatter contrast map showing the surface texture of the seborrheic keratosis.

Figure 14. Blood contrast map showing minimum vascularity.

The skin parameter map images are generated through the analysis feature of the device and are currently available through the web application. Future releases will allow visualization of the maps on the device.

Barco pricing and workflow

Barco Demetra offers an affordable and convenient subscription-based pricing structure. A one-year subscription is listed as $1,788/year and a two year is $1,428/year (prices and plan options may vary). The subscription fee includes the device, software, support, repairs, future upgrade, and service. The service also includes storage of images in a secure and HIPAA-compliant cloud environment. The web portal provides access to the images and additional features such as reports and expanded image comparison functionality. Barco is currently collaborating with providers to collect data on pathologic diagnosis and treatment completed for dermoscopic images to develop algorithms to measure and track lesion size and provide AI-based risk scores.

I find the device very easy and intuitive. Our medical assistants were trained in a matter of minutes and now routinely photograph lesions prior to any biopsies and as directed for other skin lesions we wish to capture. Barco is currently working on electronic medical record (EMR) integration and is already interfaced with Modernizing Medicine’s (EMA) electronic medical record. Other EMRs, such as Nextech, are currently in the works as well. The Barco Demetra Dermoscopy device has been a great clinical tool for my practice and has enhanced the patient experience.