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Sasi Attili's Blog

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Update from the Dermatopathology Society of India Meeting (2014), Bangalore.

I had the privilege of attending the [url="http://dermpathindia.org/meetings.html"]DSI meeting[/url] held in Bangalore last week. This was my first such attendance in India. It was heartening to see that the majority (60%) of attendees (around 450 in total) were dermatologists. The meeting started with an informative pre-conference workshop on Immunofluorescence techniques. The main conference was held over 3 days, with the agenda being dominated by the 'Glass Slide Challenge' comprising of 40 s

Sasi Attili

Sasi Attili

Porokeratosis: Is it a single 'disease'?

Many a time in life we take things for granted because that is what we have been taught to believe. The human mind is too bogged down by events in daily life that we do not ponder to question what is already believed to be 'known'. Take the case of Porokeratosis. What is it? Porokeratosis is defined by the presence of the pathognomonic coronoid lamella, a finding certainly not specific to porokeratosis, found in a number of other inflammatory and neoplastic conditions. So essentially the

Sasi Attili

Sasi Attili

Dermatopathology needs to be simplified

It is a well-known fact that trainees in Dermatology & Dermatopathology are overawed by the hundreds and thousands of entities in our field, particularly with a new entity being named on a weekly basis! For a novice in the field, the prospect of getting to terms with these entities is daunting and is probably one of the reasons most dermatologists are happy to outsource pathology to someone else. How many of these entities are actually truly unique and how many of these can be 'lumped' to

Sasi Attili

Sasi Attili

Sentinel Lymph Node Biopsy for melanoma- what is new?

It is now virtually routine in most centers around the world to consider SLN biopsy for all patients with melanoma's of stage 1b and above. Current evidence suggests that this is only a prognostic exercise and has no influence on long-term outcome for patients. However, patients still do end up having SLN biopsy and lymphadenectomy (when SLN +ve), depending on the individual surgeon's enthusiasm regarding the procedure and the ability to sway the patient either way through 'informed consent'!

Sasi Attili

Sasi Attili

Superficial BCC- Why it is important to measure depth

I have seen pathology colleagues in my career who scoff at the idea of Dermatologists asking for depth measurements for BCC's. There is a valid reason for this as thin (<1mm) lesions are more likely to respond to non-surgical treatments like Imiquimod and PDT, than thicker ones. This recent paper below in the BJD, however suggests that the cut off should be <0.4mm. However we do need larger studies and re-think how we define superficial BCC. The authors raise very interesting points reg

Sasi Attili

Sasi Attili

Keratoacanthoma: Controversies and the confusing RCP dataset

There is much controversy as to whether Keratoacanthoma (KA) is a valid and safe diagnosis to make or whether all KA's should be labelled as SCC. Much of the confusion I believe is because of the lack of consensus regarding the definition of a KA. The [u]main reason[/u] KA was originally thought to be a unique tumour, distinct from SCC, is because of its tendency to [i]spontaneous regression[/i]. Yes, it has certain unique histological features distinct from SCC [1][size=3];[sup] [/sup][size=

Sasi Attili

Sasi Attili

lichen planus follicularis tumidus- Is this really a variant of LP?? #misnomers

I had [url="https://dermpathpro.com/blog/12/entry-109-follicular-psoriasis-is-this-a-true-entity/"]recently posted[/url] about a case in the JCP describing a relatively rare variant of Psoriasis, 'Follicular Psoriasis', and expressed my skepticism . I think that we as clinicians are too eager to lump diseases that we don't really know, into known entities, so that we feel elated about making a specific 'diagnosis' rather than admitting to not knowing! [url="http://www.ncbi.nlm.nih.gov/pubmed

Sasi Attili

Sasi Attili

Follicular Psoriasis- Is this a true entity?

I came across [url="http://onlinelibrary.wiley.com/doi/10.1111/cup.12221/abstract"]this cover quizlet[/url] in the recent edition of the JCP and was debating as to what I would have called this! The authors called this Follicular Psoriasis on the basis of the histology which showed follicular plugging with abundant parakeratotic keratin and neutrophils. The infundibular epithelium showed mild hyperplasia and minimal spongiosis. The perifollicular epidermis showed mild psoriasiform hyperplasia

Sasi Attili

Sasi Attili

Kamino Bodies and Colloid bodies: How do we differentiate?

We had an interesting conundrum a couple of days ago at our daily lunchtime 'interesting cases meeting', where we looked at a biopsy of a 'Halo Nevus' (Clinical description). H&E stains revealed a small, well circumscribed partly nested melanocytic lesion with epithelioid cells suggesting a spitzoid origin/ features. The tumour was underpinned by dense a lichenoid inflammatory reaction associated with degenerate nevus cells, in places destroying the entire epidermis, in keeping with the clin

Sasi Attili

Sasi Attili

Misnomers in dermatopathology: drug induced immunobullous disorders

I currently have the privilege of sitting with Dr. Richard Carr in Warwick and looking at his cases/ slide collection. This is my first week and have to say that so far, the experience has been absolutely brilliant! I would like to share an interesting thought that crossed my mind this morning after seeing quite a dramatic case of a drug induced bullous disorder. We all are aware that drugs can mimic a myriad of cutaneous disease patterns including dermatitis, psoriasiform, lichenoid, bullous

Sasi Attili

Sasi Attili

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