Dermatology Image Annotation FHIR Implementation Guide
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: ExampleMelanomaAnnotation - XML Representation

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<Observation xmlns="http://hl7.org/fhir">
  <id value="ExampleMelanomaAnnotation"/>
  <meta>
    <profile
             value="https://annotatemd.com/fhir/ig/StructureDefinition/dermatology-image-annotation"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Observation ExampleMelanomaAnnotation</b></p><a name="ExampleMelanomaAnnotation"> </a><a name="hcExampleMelanomaAnnotation"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-dermatology-image-annotation.html">Dermatology Image Annotation</a></p></div><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category imaging}">Imaging</span>, <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-type dermatology-annotation}">Dermatology Annotation</span></p><p><b>code</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-type lesion-classification}">Lesion Classification</span></p><p><b>subject</b>: <a href="Patient-example-patient.html">Jane Smith  Female, DoB: 1975-06-15</a></p><p><b>effective</b>: 2026-03-27 14:30:00+0000</p><p><b>issued</b>: 2026-03-27 15:45:00+0000</p><p><b>performer</b>: <a href="Practitioner-example-dermatologist.html">Practitioner Robert Johnson </a></p><p><b>interpretation</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation A}">Abnormal</span></p><p><b>note</b>: </p><blockquote><div><p>Irregularly bordered lesion with satellite lesions noted superiorly. ABCDE criteria: Asymmetry present, Border irregular, Color variegated, Diameter &gt;6mm.</p>
</div></blockquote><p><b>bodySite</b>: <span title="Codes:{http://snomed.info/sct 40983000}">Upper arm structure</span></p><p><b>method</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-method expert-annotation}">Expert Manual Annotation</span></p><p><b>derivedFrom</b>: <a href="DocumentReference-example-clinical-photo.html">DocumentReference: status = current; type = Photographic image</a></p><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 106076001}">Skin finding</span></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 372244006}">Malignant melanoma</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-type confidence-score}">Confidence Score</span></p><p><b>value</b>: 0.92 score<span style="background: LightGoldenRodYellow"> (Details: UCUM  code1 = '1')</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-type qa-review-status}">QA Review Status</span></p><p><b>value</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/qa-status approved}">QA Approved</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{https://annotatemd.com/fhir/ig/CodeSystem/annotation-type inter-annotator-agreement}">Inter-Annotator Agreement</span></p><p><b>value</b>: 0.87 kappa<span style="background: LightGoldenRodYellow"> (Details: UCUM  code1 = '1')</span></p></blockquote></div>
  </text>
  <status value="final"/>
  <category>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/observation-category"/>
      <code value="imaging"/>
    </coding>
  </category>
  <category>
    <coding>
      <system
              value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-type"/>
      <code value="dermatology-annotation"/>
    </coding>
  </category>
  <code>
    <coding>
      <system
              value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-type"/>
      <code value="lesion-classification"/>
      <display value="Lesion Classification"/>
    </coding>
  </code>
  <subject>🔗 
    <reference value="Patient/example-patient"/>
  </subject>
  <effectiveDateTime value="2026-03-27T14:30:00Z"/>
  <issued value="2026-03-27T15:45:00Z"/>
  <performer>🔗 
    <reference value="Practitioner/example-dermatologist"/>
  </performer>
  <interpretation>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"/>
      <code value="A"/>
      <display value="Abnormal"/>
    </coding>
  </interpretation>
  <note>
    <text
          value="Irregularly bordered lesion with satellite lesions noted superiorly. ABCDE criteria: Asymmetry present, Border irregular, Color variegated, Diameter &gt;6mm."/>
  </note>
  <bodySite>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="40983000"/>
      <display value="Upper arm structure"/>
    </coding>
  </bodySite>
  <method>
    <coding>
      <system
              value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-method"/>
      <code value="expert-annotation"/>
      <display value="Expert Manual Annotation"/>
    </coding>
  </method>
  <derivedFrom>🔗 
    <reference value="DocumentReference/example-clinical-photo"/>
  </derivedFrom>
  <component>
    <code>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="106076001"/>
        <display value="Skin finding"/>
      </coding>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="372244006"/>
        <display value="Malignant melanoma"/>
      </coding>
    </valueCodeableConcept>
  </component>
  <component>
    <code>
      <coding>
        <system
                value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-type"/>
        <code value="confidence-score"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="0.92"/>
      <unit value="score"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="1"/>
    </valueQuantity>
  </component>
  <component>
    <code>
      <coding>
        <system
                value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-type"/>
        <code value="qa-review-status"/>
      </coding>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="https://annotatemd.com/fhir/ig/CodeSystem/qa-status"/>
        <code value="approved"/>
        <display value="QA Approved"/>
      </coding>
    </valueCodeableConcept>
  </component>
  <component>
    <code>
      <coding>
        <system
                value="https://annotatemd.com/fhir/ig/CodeSystem/annotation-type"/>
        <code value="inter-annotator-agreement"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="0.87"/>
      <unit value="kappa"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="1"/>
    </valueQuantity>
  </component>
</Observation>