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We read with keen interest the path breaking article by Calista et al regarding the successful treatment of an eyelid squamous cell carcinoma with intralesional cidofovir.1 The dramatic response of this highly malignant lesion to such a non-invasive form of therapy is remarkable and certainly worth further clinical evaluation. However, we would like to raise a few crucial issues pertaining to the documentation of this case.
The authors have presented an extreme close up of the affected eye in Figure 1, which highlights the pretreatment appearance of the lesion quite adequately. However, the post-treatment photograph (Fig 2) is almost half the magnification of Figure 1. Therefore, although there is an indisputable reduction in the size of the tumour, the two clinical photographs are not strictly comparable since a decrease in magnification results in visual clues that lead to the lesion being perceived as smaller in size.
Secondly, the pretreatment view (Fig 1) has been taken in primary gaze and reveals a right lower lid retraction as well as the semblance of a mild lid notch. In contrast, the post-treatment view (Fig 2) has been photographed on the left and slight downgaze and does not show either of the above findings. Now, it is difficult to discern whether there is an actual disappearance of these pretreatment findings or it is due to the inherent lack of comparability of these pictures because of their being in totally different positions of gaze, which is compounded by the magnification factor mentioned earlier. It would be of immense benefit to the readers if the authors could kindly clarify these points of discrepancy, which have arisen due to dissimilar photographs.
It is imperative that extremely high standards of clinical photography be maintained in plastic surgery/oncology and photographs be taken with similar parameters to ensure valid pretreatment and post-treatment comparisons that accurately reflect the results.2,3 The standards and recommendations for clinical photography have been widely documented and should be universally practised.4 These include using the same camera lens, settings, lighting, film, magnification, and patient position to ensure reproducibility and comparisons.2 Even small variations in the pictures may cause drastic changes in the clinical and research value of photography and, unless stringent criteria are met, the photographs may lose their relevance and overall impact.5