Stereophotogrammetric three-dimensional photography is an accurate and precise planimetric method for the clinical visualization and quantification of human papilloma virus-induced skin lesions

J Eur Acad Dermatol Venereol. 2019 Aug;33(8):1506-1512. doi: 10.1111/jdv.15474. Epub 2019 Mar 12.


Background: The quantification of human papilloma virus (HPV)-induced skin lesions is essential for the clinical assessment of the course of disease and the response to treatment. However, clinical assessments that measure dimensions of lesions using a caliper do not provide complete insight into three-dimensional (3D) lesions, and its inter-rater variability is often poor.

Objective: The aim of this study was to validate a stereophotogrammetric 3D camera system for the quantification of HPV-induced lesions.

Methods: The camera system was validated for accuracy, precision and interoperator and inter-rater variability. Subsequently, 3D photographs were quantified and compared to caliper measurements for clinical validation by Bland-Altman modelling, based on data from 80 patients with cutaneous warts (CW), 24 with anogenital warts (AGW) patients and 12 with high-grade squamous intraepithelial lesions of the vulva (vulvar HSIL) with a total lesion count of 220 CW, 74 AGW and 31 vulvar HSIL.

Results: Technical validation showed excellent accuracy [coefficients of variation (CV) ≤ 0.68%] and reproducibility (CVs ≤ 2%), a good to excellent agreement between operators (CVs ≤ 8.7%) and a good to excellent agreement between different raters for all three lesion types (ICCs ≥ 0.86). When comparing 3D with caliper measurements, excellent biases were found for diameter of AGW (long diameter 5%), good biases were found for diameter of AGW (short diameter 10%) and height of CW (8%), and acceptable biases were found for the diameter of CW (11%) and vulvar HSIL (short diameter 14%, long diameter 16%). An unfavourable difference between these methods (bias 25%) was found for the assessment of height of AGWs.

Conclusion: Stereophotogrammetric 3D imaging is an accurate and reliable method for the clinical visualization and quantification of HPV-induced skin lesions.

MeSH terms

  • Clinical Trials, Phase II as Topic
  • Condylomata Acuminata / pathology*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / pathology*
  • Photogrammetry / methods*
  • Placebos
  • Randomized Controlled Trials as Topic
  • Reproducibility of Results
  • Skin Diseases, Viral / pathology*


  • Placebos