Nodule photo for clinical follow-up

A palpable nodule after a procedure alarms the patient and leaves the professional facing a decision: observe, treat or refer. Whichever path is taken, the basic question is the same: is it growing, stable or shrinking? Memory does not answer precisely, and neither does a photo without method. A standardized record, with the right light and a scale, makes progress visible.

This page covers photographing the nodule for follow-up. Diagnosis and treatment are decisions for the qualified professional, after an in-person examination.

Why does a nodule need different light?

A nodule is an elevation of the surface, and an elevation is seen by the shadow it casts. Under frontal light, the nodule blends in with the surrounding skin and may seem to disappear. Under raking light, coming from the side, the shadow reveals contour and height. That is why the ideal record has two images: a soft frontal one, which shows color, and a raking one, which shows relief.

For the concept, see nodule and granuloma. For the biostimulator picture, see nodules after a biostimulator.

How do you set up raking light?

1. Place the light source beside the area, at a low angle to the skin, at a distance that does not dazzle.
2. Use diffuse light (a flashlight with parchment paper, a lamp with a diffuser) so the shadow is soft, with no hard edge.
3. Darken the other sources to avoid mixed light.
4. Keep the camera perpendicular to the skin and the light always on the same side.
5. Note the light position in the chart (for example, right side, at 30 cm).

More on shadow and light in shadow on the face in the clinical photo and light for the facial clinical photo.

Scale and angle

Without a scale, apparent size varies with distance. Place a ruler or measuring tape next to the lesion, on the same plane, and keep the camera perpendicular so the proportion is not distorted. The method is in photo with a ruler to measure a nodule or lesion. Avoid a wide-angle lens (wide-angle lens distorts the face) and digital zoom (phone zoom).

Which photos should you take?

How often should you take photos?

The professional decides, according to the case. In general, it is worth photographing at each follow-up and at agreed intervals, keeping the same interval between images. The most important things are regularity and equal conditions: same light, distance, angle and background. Note the date and time on each photo.

If the nodule is in an area of movement (for example, near the mouth or chin), record whether the photo was taken at rest. See neutral expression in the clinical photo.

What should you note?

• date, time and who took the photo;
• precise location (area, side, anatomical landmark);
• size in millimeters from the clinical measurement;
• consistency and mobility, when assessed;
• reported symptoms;
• related procedure and when it was done;
• action taken and next follow-up;
• light, distance and device used.

Storage follows the chart rules: chart and documentation in HOF and photo retention in the chart.

Privacy

A photo of a nodule on the face identifies the patient and is health data. Store it with restricted access, do not send it through personal apps and use proper consent, as in consent and LGPD (Brazil's data protection law) in photos. To share with another professional (for example, in a referral), see sharing a photo with another professional.

And in Harmy?

Harmy does not track nodules: it marks areas for a procedure and generates an illustrative simulation of how the area might look. Follow-up of a complication or a nodule is a chart record, made outside the app. For the starting photo of the projection, an area with an active nodule or swelling is not a good starting point and should wait for the professional's assessment.

Telling a nodule from a contour irregularity

Not every elevation is a nodule. Swelling, an organized bruise, a localized buildup of product and anatomical variation can look similar in the photo. Raking light helps show the shape, but telling them apart depends on palpation, the procedure history and progress over time. So describe in the chart what you palpated in addition to what the image shows, and avoid labeling the photo with a diagnosis. Use descriptive terms, such as an elevation of so many millimeters in a given area, and leave the conclusion to the clinical assessment.

Summary

Two lights, scale, a perpendicular camera, a defined frequency and complete notes. That way the nodule is followed with method, and the clinical decision rests on comparable images.