"Virtual microscopy" and the Internet as telepathology consultation tools - Diagnostic accuracy in evaluating melanocytic skin lesions

The Internet offers a widely available, inexpensive tool for telepathology consultations. It allows the transfer of image and text files through elect ronic mail (e-mail) or file transfer protocols (FTP), using a variety of mi crocomputer platforms. We studied the use of the Internet and "virtual micr oscopy" tools for the diagnosis of 35 skin biopsies, including a variety of benign and malignant melanocytic lesions. Digitized images from these lesi ons were obtained at 40x and 100x optical magnification, using a high resol ution digital camera (Microlumina, Leaf Systems, Southborough, MA), a light microscope with a phototube adapter and a microcomputer with a Pentium 166 MHz microprocessor. Two to four images of each case were arranged on a "ca nvas" to represent the majority or an entire biopsy level, using Phatoshop software (Adobe Systems Inc., San Jose, CA). The images were compressed usi ng Joint Photographers Expert Group (JPEG) format. The images were then vie wed on a computer Video monitor in a manner that closely resembles light mi croscopy, including scrolling by using the "hand tool" of Photoshop and cha nging magnification digitally up to 4 times without visible image degradati on. The image fries, ranging in size from 700 kilobytes to 2.1 megabytes (a verage 1.6 megabytes) were attached to e-mail messages that contained clini cal information, using standard Multipurpose Internet Mail Extension (MIME) protocols and sent through the Internet, for interpretation by a dermatopa thologist. The consultant could open the images from the e-mail message, us ing Microsoft Outlook Express (Microsoft Corp., Redmond, WA) and Photoshop software, scroll them, change magnification and render a diagnosis in a man ner that closely simulates light microscopy, One hundred percent concordanc e was obtained between the telepathology and traditional hematoxylin and eo sin slide diagnoses. The Internet and relatively inexpensive "virtual micro scopy" tools offer a novel technology for dermatopathology consultations. P otential applications of this technology to pathology and technical problem s posed by the use of an open, widely distributed network to share sensitiv e medical information are discussed.