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Not everything is as it seems: commentary on ‘Stereophotogrammetric three‐dimensional photography is an accurate and precise planimetric method for the clinical visualization and quantification of human papilloma virus‐induced skin lesions’

Human papillomavirus (HPV)‐associated lesions today seem to be a much more complex issue than just ‘stubborn and recalcitrant warts’ as one of the sexually transmitted diseases (STD) ‘from the list’. However, anogenital warts representing the most common HPV‐related "benign" lesions of the genitourinary tract should by no means be neglected (nothing related to the HPV is completely "benign"). The spectrum of the HPV‐associated genital diseases today ranges from ‘benign’ anogenital warts to malignant cervical, vulvar, anal, penile and even extragenital cancers such as oral and tonsillar. Stereophotogrammetry is a technique that obtains two or more images from different angles, which can subsequently be reconstructed into a 3D image.It is validated for use in scars, basal cell carcinoma, wounds and wrinkle. Rijsbergenet al. in this issue have demonstrated that stereophotogrammetric 3D imaging is an accurate and precise method for the characterization of HPV-related lesions and is applicable for the assessment of these lesions in a clinical setting. It is good additional help in diagnosing cutaneous warts, anogenital warts and anogenital intraepithelial neoplasia. However, one clear limitation of the stereophotogrammetry for routine use in the diagnosis of HPV lesions is the fact that it is time-consuming, especially for anogenital warts which are usually multifocal and numerous.Since it is a portable, hand-held system, we believe that it is useful in the diagnosis of subclinical infections (intraepithelial neoplasms), instead of using colposcope/peniscope/anoscope. There is no definitive first-line aetiological treatment for anogenital and/or cutaneous warts, and no single treatment per se has demonstrated to be ideal for all patients or all warts so far. Most currently available treatments do not eradicate HPV ; they physically remove lesions with a certain degree of recurrences. By measuring the physical dimensions of wounds or scars, clinicians would receive feedback about the success of a selected treatment approach. Following immunotherapy, HPV lesions can at first increase in size before regression (pseudoprogression). Accordingly, 3D photography can help to assess the response, but, on the other hand, it is time-consuming and it might require extra outpatients’ visits, not to speak of the ‘technical and financial’ aspect. However, this technique might give additional and more precise information!Overall, we believe that stereophotogrammetry is an excellent additional technique for more precise visualization and treatment follow-up of the HPV-associated genital lesions and it is certainly a step forward. Nonetheless, stereophotogrammetry, like any other method, has its limitations and should be definitely applied under the strict guidance of the very well-trained clinician experienced in the HPV-genital lesions management.

Human papillomavirus (HPV) ; sexually transmitted diseases (STD) ; Stereophotogrammetry

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