Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(3):5366 1 Dermoscopic Image Digital Post-Processing Perception and Use Among Members of the International Dermoscopy Society: Results of a Web-based Survey Marian Voloshynovych1,24, Paweł Pietkiewicz2,3,4, Cristián Navarette-Dechent5, Aimilios Lallas6, John Paoli7,8, Harald Kittler9, Ashfaq A. Marghoob10, Mohamad Goldust11, Jacek C. Szepietowski12, Iris Zalaudek13, Thomas M. Beachkofsky14, Caterina Longo15,16, Cliff Rosendahl17, Norbert Kiss18, Giuseppe Argenziano19, Mohammad Jafferany20, Agnieszka Leszczyńska-Pietkiewicz³,²¹, Natalia Salwowska³,²², Nataliia Matkovska²³ 1 Department of Dermatology and Venereology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine 2 Zwierzyniecka Medical Center, Poznań, Poland 3 Polish Dermatoscopy Group, Poznań, Poland 4 Unitelematica Leonardo da Vinci, Zug, Switzerland 5 Department of Dermatology, Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 6 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece 7 Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden 9 Department of Dermatology, Medical University of Vienna, Vienna, Austria 10 Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States 11 Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, United States 12 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland 13 Department of Dermatology, University of Trieste, Trieste, Italy 14 Departments of Dermatology and Medicine, Uniformed Services University, Bethesda, Maryland, United States 15 University of Modena and Reggio Emilia, Modena, Italy 16 Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy 17 Mayne Academy of General Practice, Medical School, The University of Queensland, Australia 18 Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary 19 Dermatology Unit, University of Campania, Naples, Italy 20 Central Michigan University, Saginaw, Michigan, United States 21 Independent researcher, Poznań, Poland 22 Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland 23 Department of Family and Emergency Medicine of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano- Frankivsk, Ukraine 24 Lux Skin, Ivano-Frankivsk, Ukraine Key words: Dermatoscopy, Image enhancement, Image processing, Image interpretation, Diagnostic imaging Citation: Voloshynovych M, Pietkiewicz P, Navarette-Dechent C, et al. Dermoscopic Image Digital Post-Processing Perception and Use Among Members of the International Dermoscopy Society: Results of a Web-based Survey. Dermatol Pract Concept. 2025;15(3):5366. DOI: https://doi.org/10.5826/dpc.1503a5366 Accepted: March 13, 2025; Published: July 2025 2 Original Article | Dermatol Pract Concept. 2025;15(3):5366 Introduction Digital cameras have revolutionized diagnostics and medical recording in the past decade, recently facilitating the imple- mentation of deep-learning models in dermatology. Most dermoscopists use dermatoscopic cameras or dermatoscopes coupled to smartphones to capture clinical and dermoscopic images in everyday practice. All these devices use their own software to process the analog images of skin lesions into digital files. It has been speculated that the use of manual or automated digital image post-processing (DIPP) may highlight certain diagnostic clues for both human raters and machine learning models, increasing the diagnostic accuracy [1–4], but the extent of such an application in a real-world setting, the perceived reliability of the obtained data, and the limitations of this process have not yet been studied. The patterns of use and specific scenarios in which dermoscopists utilize DIPP remain largely unexplored. Objectives The study aimed to investigate the advantages and limita- tions of DIPP as well as its perceived reliability and safety. Methods To fill this knowledge gap, we designed a web-based sur- vey with 17 questions divided into eight sections focusing on: (i) demographics (sex, age, nationality, specialty, profes- sional experience in dermoscopy), (ii) application of digital dermoscopy, (iii) imaging devices, (iv) DIPP software usage, (v) area of DIPP application (e.g., neoplastic dermatoses or inflammoscopy), preference over manual or automatized DIPP, (vi) personally adjusted parameters, (vii) perceived reliability and safety of DIPP (Likert scale), and (viii) an open comment section (Original survey form available as a Supplementary material). Prior to distribution, a pilot study Introduction: Speculatively, digital image post-processing (DIPP) enhances diagnostic accuracy in dermoscopy. Objective: We aimed to investigate the advantages and limitations of DIPP, as well as its perceived reliability and safety. Methods: In this study we investigated the perception and use of DIPP among members of the Inter- national Dermoscopy Society through a web-based survey with 17 questions focusing on: (i) demo- graphics (sex, age, nationality, specialty, professional experience in dermoscopy), (ii) application of digital dermoscopy, (iii) imaging devices, (iv) DIPP software usage, (v) area of DIPP application (e.g., neoplastic dermatoses or inflammoscopy), preference over manual or automatized DIPP, (vi) person- ally adjusted parameters, (vii) perceived reliability and safety of DIPP, and (viii) an open comment section. Results: A total of 360 respondents (64 countries) completed the survey. While 91.7% of respondents reported capturing dermoscopic images during examination, only 22.4% of them declared using DIPP. We have demonstrated that DIPP was used more commonly with smartphones rather than video der- matoscopes or digital cameras and for dermoscopy of neoplastic dermatoses rather than inflammos- copy. Respondents tended to adjust image parameters manually. The perceptions of its usefulness and safety were good, even though slight variability across geographic regions was observed. Conclusion: Given that no regulations for DIPP exist, healthcare professionals involved with dermo- scopic image acquisition and archiving may require special training to responsibly implement DIPP in their practices. ABSTRACT Copyright: ©2025 Voloshynovych et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: Marian Voloshynovych and Paweł Pietkiewicz should be considered joint first authors. All authors have contributed significantly to this publication. Corresponding Author: Marian Voloshynovych, Department of Dermatology and Venereology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine 76000. Orcid ID: 0000-0001-7619-2289. Email: mvoloshynovych@gmail.com Original Article | Dermatol Pract Concept. 2025;15(3):5366 3 involving a group of 10 volunteers was performed before the revision to validate the survey. The final version of the survey was sent to 4,195 active email addresses of the International Dermoscopy Society (IDS) members. A fixed 3-month period (15 December 2023 – 15 February 2024) was used to col- lect all survey responses. Parameters of perceived usefulness and safety were compared across age groups, experience lev- els, and geographic regions (Africa, Australia and Oceania, Asia, Europe, North America, and South America) with ANOVA, whereas the differences in geographic distribution of survey respondents and IDS members were assessed with paired t-tests using Python v3.11.4 (SciPy v1.11.4, Seaborn v0.13.2). P-values of <0.05 were considered statistically sig- nificant for all tests. Results A total of 360 surveys (8.6% response rate) from 64 countries were collected. The dataset can be accessed through Harvard Dataverse at the following link: https://doi.org/10.7910/ DVN/ZKPUPZ. Demographic data of the respondents are presented in Table 1. There were no significant differences in the geographic distribution of survey respondents and IDS members (accessed on 22 July 2024) (paired t-test; P=1.0). The rationale for using DIPP, the key diagnostic devices used for capturing images, and the areas of application given by the respondents are shown in Table 2. Results concerning respondents’ assessment of the usefulness and safety of DIPP are presented in Table 2 and Table 3. The majority of par- ticipants considered the usefulness and safety of DIPP to be “good”. No significant difference was noted between the mean usability and safety scores by either age group or years of experience in dermoscopy. No significant difference be- tween the continents was observed between the total study group and the ones using DIPP (paired t-test; P=1.0). The mean usefulness in Europe was assessed as “good” and safety assessed as “fair”. Usefulness was perceived as highest by South Americans (“good”) and lowest by North Ameri- cans (“fair”). Nonetheless, even though skepticism towards DIPP’s usefulness and safety was observed for North America and that it was a more trusted approach in Asia (2.46±0.53 [95% CI: 1.93–2.99] vs. 3.30±0.66 [95% CI: 2.64–3.96], and 2.38±0.52 [95% CI: 1.86–2.90] vs. 3.40±0.73 [95% CI: 2.68–4.13]), analysis of variance did not prove any statis- tically significant difference in either mean across the geo- graphic areas (P=0.07 and P=0.28, respectively). Discussion Electronic medical records are an indispensable part of mod- ern healthcare systems, facilitating easy access to a patient’s Table 1. Demographic Data of Survey Participants (n=360). Sex n (%) Male 141 (39.2) Female 219 (60.8) Specialty n, (%) Dermatologist 291 (80.8) General Practitioner 52 (14.4) Surgeon 3 (0.8 ) Oncologist 2 (0.6) Internal medicine specialist 1 (0.3) Other medical professional (nurse, assistant, clinical photographer) 11 (3.1) Age group (years) n (%) 21-30 25 (6.9) 41-50 96 (26.7) 31-40 91 (25.3) 51-60 74 (20.6) >60 74 (20.6) Years of experience in dermoscopy n (%) <5 77 (21.4) 5-10 107 (29.7) 11-20 100 (27.8) >20 76 (21.1) Geographic distribution of respondents n (%) Europe 179 (49.7) Asia 53 (14.7) South America 53 (14.7) Australia and Oceania 33 (9.1) North America 24 (6.7) Africa 18 (5.0) medical history. In general, skin diseases are easily accessi- ble for visual inspection, and the majority of dermatological conditions can be diagnosed, or at least differentiated, based on the basic lesion morphology and distribution. Thus, digi- tal photography may play an important role in documenting the history of the evolution of skin symptoms. Dermoscopy is an auxiliary examination complementing the clinician’s diagnostic armamentarium. Knowledge about the correla- tions between the dermoscopic clues (colors, structures, and their spatial relation) and pathology ensures a better under- standing of the nature of the lesion and narrows the range of differential diagnoses[5,6]. The rise of digital medical pho- tography, especially using easily accessible smartphones, was accelerated by the COVID-19 pandemic[7–9]. Although the perception of teleconsultation or teledermoscopy has been investigated among physicians[10], little is known about 4 Original Article | Dermatol Pract Concept. 2025;15(3):5366 Capturing images during dermoscopy (n=360) n (%) Yes 330 (91.7) No 30 (8.3) Primary device used for capturing dermoscopic images (n=330) n (%) Smartphone 187 (56.7) Digital camera 79 (23.9) Video dermatoscope 64 (19.4) Application of photo enhancing software (n=330) n (%) Yes 74 (22.4) No 256 (77.6) Reasons given for abstaining from image post-processing (n=256) n (%) Never heard of it 124 (48.4) Seems unnecessary 51 (19.9) Too time-consuming/ complicated 42 (16.4) Doubts regarding reliability 39 (15.2) Reasons given for image post- processing (n=74) n (%) Extraction of features that are normally obscured 42 (56.8) Superior image quality 37 (50.0) Enhanced diagnostic confidence 31 (41.9) Applications for image post- processing (n=74) n (%) Neoplastic dermatoses 68 (91.9) Non-neoplastic dermatoses 44 (59.5) Image adjustment (n=74) n (%) Manual 30 (40.5) Automatic followed by manual 22 (29.7) Automatic (HDR or auto-adjustment) 22 (29.7) Parameters adjusted manually (n=52) n (%) Brightness 34 (65.4) Contrast 32 (61.5) Hue 29 (55.8) Sharpness 29 (55.8) Exposure 17 (32.7) Saturation 11 (21.2) Perceived reliability of dermoscopic clues after photo enhancement (n=113) n (%) Vascular clues 71 (62.8) Pigment clues 55 (48.7) Polarizing-specific white clues 55 (48.7) Non-polarizing dependent white clues 42 (37.2) Clues of color 32 (28.3) Scale 26 (23.0) None are reliable 14 (12.4) Perceived usefulness of photo enhancement in dermoscopy (n=113) n (%) Perfect 9 (8.0) Very good 28 (24.8) Good 42 (37.2) Fair 23 (20.4) Poor 11 (9.7) Perceived safety of photo enhancement in terms of potentially incorrect decisions in dermoscopy (n=113) n (%) Perfect 6 (5.3) Very good 24 (21.2) Good 41 (36.3) Fair 30 (26.6) Poor 12 (10.6) Table 2. Respondents’ Attitudes towards Digital Image Post-Processing in Dermoscopy. physicians’ perspectives on the usefulness and reliability of DIPP in dermoscopy. Our study demonstrates that the vast majority of re- spondents use some form of dermoscopic image acquisition, particularly smartphones. There may be several reasons for this trend. In 2024, it was estimated that 17.72 billion smart- phones were used worldwide[11], which makes the devices readily and easily accessible to connect dermatoscopes to and to use as portable video dermatoscopes. From a user’s per- spective, it is easier to manipulate image parameters directly within the smartphone’s image browser software, whereas images captured with digital cameras and professional video dermatoscopes need to be downloaded/exported prior to processing. The respondents found DIPP more useful for neoplastic dermatoses than for inflammatory ones, possibly because the pigment clues (which can be enhanced by ad- justing brightness and contrast) play a more important role in dermoscopy of neoplastic dermatoses. Likely due to vari- ability in individual perception of color, manual adjustment tailored to individual needs dominated over automatic ad- justment. Over 50% of respondents relied on the DIPP- enhanced vascular clues, whereas over 25% trusted pigment clues, both polarizing-dependent and -independent white clues, and color clues. Original Article | Dermatol Pract Concept. 2025;15(3):5366 5 T ab le 3 . A ss es sm en t of U se fu ln es s an d Sa fe ty o f D ig it al I m ag e Po st -P ro ce ss in g in D er m os co py ( n= 11 3) . n (% ) U se fu ln es s (m ea n L ik er t sc or e± SD , 95 % C I) Sa fe ty (m ea n L ik er t sc or e± SD , 9 5% C I) A N O V A U se fu ln es s A N O V A Sa fe ty A ge g ro up ( ye ar s) 21 -3 0 5 (4 .4 ) 2. 80 ±0 .4 5 [2 .2 4 – 3. 36 ] 2. 80 ±1 .6 4 [0 .7 6 – 4. 84 ] F= 0. 24 , P =0 .9 1 F= 0. 76 , P =0 .5 5 31 -4 0 39 ( 34 .5 ) 2. 92 ±1 .1 8 [2 .5 4 – 3. 31 ] 2. 79 ±0 .9 2 [2 .5 0 – 3. 09 ] 41 -5 0 23 ( 20 .4 ) 3. 17 ±1 .1 9 [2 .6 6– 3. 69 ] 2. 57 ±0 .9 5 [2 .1 6 – 2. 97 ] 51 -6 0 21 ( 18 .6 ) 3. 05 ±1 .1 2 [2 .5 4– 3. 56 ] 3. 00 ±1 .2 6 [2 .4 2 – 3. 58 ] >6 0 25 ( 22 .1 ) 3. 00 ±0 .9 1 [2 .6 2– 3. 38 ] 3. 04 ±1 .0 2 [2 .6 2 – 3. 46 ] Y ea rs o f ex pe ri en ce in d er m os co py <5 17 ( 15 .0 ) 2. 76 ±0 .9 7[ 2. 27 – 3 .2 6] 2. 59 ±1 .1 8 [1 .9 8 – 3. 19 ] F= 1. 13 , P =0 .3 4 F= 1. 00 , P =0 .4 0 5- 10 36 ( 31 .9 ) 3. 17 ±1 .2 3 [2 .7 5 – 3. 58 ] 2. 78 ±0 .9 6 [2 .4 5 – 3. 10 ] 11 -2 0 30 ( 26 .6 ) 2. 80 ±1 .0 3 [2 .4 2 – 3. 18 ] 2. 80 ±1 .0 0 [2 .4 3 – 3. 17 ] >2 0 30 ( 26 .6 ) 3. 17 ±0 .9 9 [2 .8 0 – 3. 53 3. 10 ±1 .1 2 [2 .6 8 – 3. 52 ] C on ti ne nt E ur op e 60 ( 53 .1 ) 3. 13 ±0 .2 7 [2 .8 6 – 3. 40 ] 2. 92 ±0 .2 6 [2 .6 6 – 3. 18 ] F= 2. 08 , P =0 .0 7 F= 1. 28 , P =0 .2 8 N or th A m er ic a 13 ( 11 .5 ) 2. 46 ±0 .5 3 [1 .9 3 – 2. 99 ] 2. 38 ±0 .5 2 [1 .8 6 – 2. 90 ] A us tr al ia an d O ce an ia 12 ( 10 .6 ) 2. 67 ±0 .6 1 [2 .0 7 – 3. 28 ] 2. 75 ±0 .6 9 [2 .0 6 – 3. 44 ] So ut h A m er ic a 11 ( 9. 7) 3. 45 +± 0. 55 [ 2. 90 – 4 .0 0] 2. 73 ±0 .4 7 [2 .2 6 – 3. 20 ] A si a 10 ( 8. 9) 3. 30 ±0 .6 6 [2 .6 4 – 3. 96 ] 3. 40 ±0 .7 3 [2 .6 8 – 4. 13 ] A fr ic a 7 (6 .2 ) 3. 30 ±0 .8 4 [2 .4 6 – 4. 14 ] 2. 57 ± 0. 84 [ 1. 73 – 3 .4 1] A bb re vi at io ns : A N O V A , a na ly si s of v ar ia nc e; S D , s ta nd ar d de vi at io n; C I, co nf id en ce in te rv al ; P , s ig ni fi ca nc e. 6 Original Article | Dermatol Pract Concept. 2025;15(3):5366 thank Prof. Amanda Oakley (Department of Dermatology, Te Whatu Ora Waikato, Hamilton, New Zealand) for her guidance. References 1. Braun RP, Marghoob A. High-Dynamic-Range Dermoscopy Imaging and Diagnosis of Hypopigmented Skin Cancers. JAMA Dermatol. 2015;151(4):456-457. DOI:10.1001/jamadermatol .2014.4714 PMID: 25535875. 2. Cherepkova O, Hardeberg JY. Enhancing dermoscopy images to improve melanoma detection. In: 2018 Colour and Visual Computing Symposium (CVCS);2018:1-6. DOI:10.1109/CVCS .2018.8496604 3. Mello-Román JC, Vázquez Noguera JL, Legal-Ayala H, et al. Dermoscopy Images Enhancement via Multi-Scale Morpho- logical Operations. Appl Sci 2021;11:9302. DOI:10.3390 /app11199302 4. Voloshynovych M, Girnyk G, Chmut V, et al. Application of Machine Learning Technologies to Improve the Diagnostic Value of Dermatoscopy, Combined with Digital Photo-fixation of Skin Neoplasms. Dermatol Pract Concept 2022;12:e2022181. DOI:10.5826/dpc.1204a181 PMID: 36534544 5. Kittler H. Dermatoscopic-pathological correlation of melano- cytic skin lesions. Hautarzt 2018;69:528-535. DOI:10.1007 /s00105-018-4204-8 PMID: 29876611 6. Errichetti E, Zalaudek I, Kittler H, et al. Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermos- copy Society. Br J Dermatol 2020;182:454-467. DOI:10.1111 /bjd.18125 PMID: 31077336 7. Chan N, Charette J, Dumestre DO, Fraulin FO. Should ‘smart phones’ be used for patient photography? Plast Surg 2016;24: 32-34. PMID: 27054136 8. Conforti C, Lallas A, Argenziano G, et al. Impact of the COVID-19 Pandemic on Dermatology Practice Worldwide: Re- sults of a Survey Promoted by the International Dermoscopy Society (IDS). Dermatol Pract Concept 2021;11:e2021153. DOI:10.5826/dpc.1101a153 PMID: 33614221 9. Zoltie T, Blome-Eberwein S, Forbes S, et al. Medical photography using mobile devices. BMJ 2022;378:e067663. DOI:10.1136 /bmj-2021-067663 PMID: 36028231 10. Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept 2018;8:214-223. DOI:10.5826/dpc.0803a13 PMID: 30116667 11. Number of mobile devices worldwide 2020-2025. Statista. Accessed October 14, 2024. https://www.statista.com/statistics/245501 /multiple-mobile-device-ownership-worldwide/ Limitations One of the main study limitations is the low response rate, comparable to previous studies among IDS members[8]. However, the low response rate in this case does not nec- essarily indicate a bias in the results since the geographical distribution of IDS members and respondents overlaps signifi- cantly. It is possible that the non-respondents were not inter- ested in the topic of DIPP and dismissed the invitation. Even though 91.7% of respondents used some device to capture the digital dermoscopic image, few considered that the method may compromise image quality. Moreover, about half of the respondents who declared never having used DIPP had never heard of it. On the other hand, it is possible that the positive attitude towards DIPP shown here is biased by the sampling method, as those uninformed about DIPP or more skeptical may have declined the invitation. The variability in approach towards perceived usefulness and safety across the geographic regions (even though statistically insignificant) may reflect the different pace and extent of application of image manipula- tion. As expected, the majority of survey respondents origi- nated from Europe, which has a long and strong tradition of dermoscopy. Lower interest in dermoscopy among typically fair-skinned populations can be explained by the relatively recent rise of dermoscopy use in patients with skin of color. Conclusions The role of DIPP in medicine (dermatology, pathology, ophthalmology, and others) is expected to increase. Being adopted by humans and AI software, the question of its re- liability remains relevant. In this study, we investigated the perceived advantages and limitations of DIPP. Despite low awareness of DIPP, it can be applied to images of neoplastic and non-neoplastic dermatoses. We have demonstrated that image processing is regarded as safe and reliable and is used by a significant portion of respondents in their daily practice. Knowing the extensive use of digital dermoscopy, scientific societies and centers of excellence should be encouraged to develop special training programs for all healthcare profes- sionals involved with dermoscopic image acquisition and ar- chiving to ensure its responsible implementation. Acknowledgements The authors would like to thank all the respondents who completed the questionnaire. The authors would like to Original Article | Dermatol Pract Concept. 2025;15(3):5366 7