One of my favorite responsibilities being the Editor in Chief of the Journal of the Dermatology Nurses' Association (JDNA) is being able to recognize and celebrate the individuals who work to make the JDNA such an amazing publication. Just to be clear, I try every day and every week to acknowledge and praise those who make the JDNA a success, but this is a very special acknowledgement. This time of year, I have the privilege of announcing the 2015 JDNA Writing Award winners. If you have been a reader of the Journal for a period, you likely know that, each year, we honor three articles with writing awards. In addition to presenting articles with the Best Clinical Award and Best Research Award, in 2015, we are, for the first time, giving an award for the article chosen to be the People's Choice Award. This award chosen by you, the members of the Dermatology Nurses' Association (DNA), reflects what you, our readers, think was the best article of 2015. These writing awards were officially announced at the annual DNA Convention in Indianapolis earlier this year, but for those of you who were unable to join us at this event, I wanted to share publically the award winners.
The writing award for the 2015 Best Clinical Article was titled "A Case of Pyoderma Gangrenosum Responsive to Systemic Corticosteroids." This was written by Ms. Macpherson, Ms. Kornbleuth, and Dr. Olans. The writing award for the 2015 Best Research Article was "The Effects of Education on Compliance with Skin Cancer Risk Reduction Guidelines," written by Ms. Zundell, Ms. Chen, and Ms. Woyansky. The inaugural writing award for the 2015 People's Choice Article was titled "Tips for ICD-10 Seamless Readiness" and was written by Faith McNicholas. Looking ahead, I encourage each of you to submit an article to the JDNA in 2016 so that you are eligible for award consideration next year, which I look forward to presenting at our next annual DNA convention in Orlando, Florida. Please join me in extending compliments and congratulations to the 2015 JDNA Writing Award winners.
Revisiting another topic that I know we've talked about before, I wanted to share with you dear readers my most recent and brave step since my melanoma diagnosis. One of the recommendations made to me very shortly after my diagnosis was to consider total body photography (TBP; Figure 1). TBP is done by DermaTrak Skin Imaging Centers and is a tool that is often used with patients who have had a skin cancer diagnosis or who have numerous nevi. This procedure, like the name implies, involves taking pictures of most of the skin surfaces. This "mole mapping" is a great way to document baseline nevi appearances. If we are being truthful, I was also personally hoping that having this documentation done would prevent future additional surgeries. So on February 5, 2016, I found myself in a 10-minute photo session.
Have any of you ever had TBP? Let me tell you a little more about this experience. First, yes, I was totally naked for this. In part because of the skilled excellence of the scheduling team for the procedure, and in part because of common sense, I knew this would be the case ahead of time. This knowledge was good and bad; it was good so that I truly knew what I was getting into, and it was bad since I had time to think about being naked for a series of photos. Now, I am not quite as shy as I was 20 years ago, but I still didn't relish the thought of standing completely naked in front of anyone. But I am getting ahead of myself.
Let's get back to the scheduling. This could not have been easier. First, I went to http://www.canfieldsci.com/imaging-centers/. This Web site is extremely helpful and intuitive; it answered many of my questions right away. It has sections about What to Expect, Photo Delivery Options, information about the photographer Bill Witmer, and a section that reviews the locations of where this kind of photography is done in the United States. The Web site includes their telephone number (800-801-4240) and email information. So, I exchanged a few emails and set the date and time. But, dear readers, that was not enough for me. I decided to go the next step and email the photographer Bill Witmer. In my email, I indicated I was interested in talking with him after the photo session and learning more about his background and how he spent a career learning about the role of TBP. He responded graciously and agreed to sit and talk with me after the photo session.
I prepared for my big day of photos like one might expect; I shaved really well (hey, it was winter here in the Northeast!), took off my nail polish, and psyched myself up for the experience. Driving to the appointment that morning took about 2 hours, so my till-then-calm mind had time to start getting slightly anxious. I shouldn't have worried. The entire process was efficient and pleasant. It even helped a little bit that the woman who had her photos done right before me came out smiling. I must have looked scared because she proceeded to tell me it wasn't a bad experience and she even showed in the waiting room how she had posed. Her reassurance was delightful and certainly took the edge off. In fact, I think one of her statements about the photo session was reminiscent of taking glamour shots. I will forever be grateful to her for calming any last minute nervousness that I had.
The photo shoot itself was very clinical and very professional. In a room with great lighting set up (obviously), I stood, yes, naked, on a large blue piece of photo paper with a dot that centered me at all times. The photo shoot itself went quickly. To be honest, I tried to not make eye contact with the photographer or with the assistant in the room. I think that helped, some. During this session, most of my skin was photographed. He did take a photo of the soles of my feet, but not of the interdigital areas, my scalp, or the skin in the genital region. He did take time to look behind both ears though and did ask about lesions between my fingers and toes. I get the sense he would have photographed them as needed. And then it was all done. I probably should note that this not-inexpensive photo session was not covered by my insurance (shame on you BlueCross BlueShield!). I was told, however, that some insurance companies do cover this medical procedure, and I was given great documentation at check-in so that I can self-submit to my insurance if I choose to do so. Whatever the cost, the procedure is worth the price. It is my understanding that, in a few weeks, a glossy book of my skin pictures will arrive, along with a USB drive with the same documents. I can't wait, but honestly, I am not sure if I'll look at them or just wait to let my dermatologist have the first look.
After the session, I had the opportunity to sit down with Bill Witmer and talk about TBP and the progression of the use of this novel tool. Honestly, I probably should have taken more notes while I was talking with him that day, but have you ever been in the presence of a great story teller and all you wanted to do was to listen?
One of the first things he told me, and that may be on the forefront of your mind, is that, after 10 days, all the images are purged from the computer system. Meaning, he processes them in the way that is needed, and my products will be shipped to me as planned, but no photos of me and my skin will ever be kept anywhere. I think we all live in a modern society where this question definitely deserves to be asked; consequently, I settled that concern early on in my questioning. From what I understand, from both my research and from listening to him, Bill Witmer has been at the forefront of photography of the skin for documentation purposes for the past 40ish years. His first job was at Temple University, Philadelphia, PA, with Dr. Wallace Clark of Clark's level fame! His first job documenting experiments in the laboratory evolved into taking clinical photographs for isotretinoin trials and then for earlier melanoma detection. He was instrumental in helping to develop photographic protocols for dermatology use.
When I asked Mr. Witmer what dermatology nurses needed to know about TBP, he simply answered, "listen to the patient" and "educate." I wonder if he is secretly a nurse. He would like us to simply inform our patients that there is this option of TBP available, which allows "the entire skin surface to be documented for baseline comparison" (personal communication, February 5, 2016). He has been working with skin photography since the 1970s and has seen many changes evolve as the science has evolved. He indicated that he would like for all insurance companies to cover this serial prevention and says that "this is what this is, not experimental." This procedure is now popular among many dermatology offices, and having baseline photography of certain patients is considered valuable. During our time together, he indicated that an ideal time for the photography is during late winter, when many of the patients would be least tan; obviously, this would allow for best imaging of the nevi. I think this probably makes intuitive sense to us as dermatology nurses, but it may not hurt to remind patients not to schedule the session immediately after their beach vacation, cruise, ski trip, and so forth. Ideally, for most people, he recommends the first baseline nevi evaluation to be done after puberty and then at least 5 years later. To have additional photos done sooner has no benefit, unless there have been dramatic weight changes or some other indicating factor. In addition, having the baseline photos done during pregnancy is not ideal. However, he did say the youngest person he has photographed was 7 years old and that some patients may need annual TBP if new nevi are developing.
In the effort to have a balanced question-and-answer time with Mr. Witmer, we did discuss some of the "cons" associated with TBP. Aside from cost, which can be prohibitive for some patients, he indicates that there is concern among some dermatologists that the process will "document their mistakes." I know we live in a litigious society, but l would implore you to please explain to your patients, and maybe your providers, that this is not the purpose of the photography, and this really is a superb tool for those with many nevi or those of us who have had melanoma.
Looking ahead, we talked about the future of TBP and where the state of the science is at this point. In the near future, we will likely see 3-D TBP as well as TBP that incorporates dermoscopy as a component of the procedure. Currently, at one location in the United States, there is a system of 42 cameras that takes simultaneous photos in high resolution, which allows a navigable 3-D photo to be made of a person's entire skin. This imaging would be able to be viewed three dimensionally, much like some of our other imaging available today.
I am excited about the future of TBP and think it's a great option for many of our patients. What are you telling your patients about TBP? Is this something your practice recommends? Is this something you think you'd like to know more about? Is this something you'd like to consider for yourself?
Looking forward to hearing from you,
Angela L. Borger
Editor in Chief
E-mail: [email protected]