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Role of dermatopathology in improving health care.


Dr. Mona Abdel-Halim

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Dermatopathology is an important branch in medicine. It is not only crucial for establishment of diagnosis in various skin conditions in which clinical examination alone is not enough, but it is also important in guiding clinicians and surgeons for the subsequent management of various skin tumors.

This puts great responsibility on dermatopathologists in writing their reports. I came across an interesting article in the JAAD* in which the authors found that clinicians are becoming more likely to biopsy pigmented lesions with a clinical margin of normal-appearing skin than they were before margin comments were routinely included in dermatopathology reports of dysplastic nevi.

The same applies to the benefits of including the depth of BCC in the dermatopathology report. Many dermatologists nowadays manage their patients with BCC in their own clinics with topical immunomodulators, electrocautery or cauterization. Knowing the depth is important in planning appropriate management.

In our department, dermatopathologists guided clinicians to perform excisional biopsies of all pigmented lesions (whatever size) and all papules or nodules suggestive of any form of skin tumors rather than taking just a punch biopsy from them. This was made even easier with many of our juniors now interested in and practicing dermatosurgery. This approach greatly made it easier and less time consuming to establish a correct diagnosis and thus provided patients with better standards of care.

In such ways, dermatopathologists can contribute in improving health care and reducing health care costs.

[b] [size=4]* Margin comments in dermatopathology reports on dysplastic nevi influence re-excision rates[/size][/b]

[b] [size=4][url="http://www.jaad.org/article/S0190-9622%2813%2900659-2/abstract"]Comfere[/url] et al., JAAD, November 2013; 69(5): 687-692. Affiliations[/size][/b]
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Mark A. Hurt MD

Posted

Mona, in the USA, dermatologists rarely do as you suggest, but I wish they did! I can't begin to tell you how expensive it is to sort out the meaning of tiny shaves of melanocytic lesions, which I'm sure you can appreciate.

The is another article about the follow-up of Clark's nevi; the authors found favorable long-term outcomes despite margin involvement, but this assumes that the diagnosis was correct!

Select item 23127472
1.
Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border.
Hocker TL, Alikhan A, Comfere NI, Peters MS.
J Am Acad Dermatol. 2013 Apr;68(4):545-51. doi: 10.1016/j.jaad.2012.09.031. Epub 2012 Nov 3.
PMID: 23127472 [PubMed - indexed for MEDLINE]
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