System for marking the surface of a patient's tissue in the course of imaging

A marking apparatus 10 for marking tissue imaged through an imaging device 12. Apparatus 10 comprising: a viewing element with an imaging window 50, which provides a tissue imaging zone; a coupling device 64, which connects with a marker implement 58. Coupling device 64 operates to position marker 58 at a first position that is outside of the imaging window 50 and a second position that is within the imaging zone of the imaging window 50. In the second position, marker 58 applies a mark to the tissue in the imaging zone with apparatus 10 remaining on the tissue. Also a system for imaging tissue and marking imaged tissue. Also a configurable viewing element for an imaging device 12, the viewing element comprising: a spacer element with front and rear faces, where the front face has an imaging window 50 to provide an imaging zone through which tissue can be imaged; and a length adjustment mechanism coupled to the spacer element to adjust a distance between the front and rear faces to effect a change in focal position of imaging device 12. Imaging device 12 may be an OCT, a dermoscopy, a confocal microscopy or an ultrasound imaging device.