When clinicians make me irritated !!!!
Entry posted by Dr. Mona Abdel-Halim
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It happened a couple of times this month that I have received insufficient specimens from clinicians!!
A keratotic lesion on the forehead was referred to me and my colleague ,Dr Eman El-Nabarawy, as a lesion suspicious to be BCC. The specimen was a punch biopsy that revealed only masses of keratin!!!!! We signed out the report as insufficient specimen, excisional biopsy is required. The excisional biopsy revealed bowenoid actinic keratosis.
A punch biopsy was referred to us from a lesion described by the clinician as an irregular pigmented lesion with a nodular component. The clinician was suspecting melanoma. Is it supposed that I will diagnose a melanoma from a punch biopsy?!!! The punch biopsy was taken from the flat part of the lesion. It was so suspicious with atypical junctional component, small atypical dermal nests, Pagetoid spread and brisk inflammatory reaction. We signed out the report as melanocytic lesion with worrisome histological features which in view of the clinical presentation necessitates complete excision with a safety margin for further histopathological assessment. The complete excision revealed invasive melanoma, Clark level III.
Clinicians sometimes think that dermatopathologists have falcon eyes and are able to know everything about a lesion from tiny pieces given to them!!!!! I am fighting this concept hardly. I have managed to teach younger generations of dermatologists the importance of excisional biopsies but I am still struggling with older generations!!!!!
A keratotic lesion on the forehead was referred to me and my colleague ,Dr Eman El-Nabarawy, as a lesion suspicious to be BCC. The specimen was a punch biopsy that revealed only masses of keratin!!!!! We signed out the report as insufficient specimen, excisional biopsy is required. The excisional biopsy revealed bowenoid actinic keratosis.
A punch biopsy was referred to us from a lesion described by the clinician as an irregular pigmented lesion with a nodular component. The clinician was suspecting melanoma. Is it supposed that I will diagnose a melanoma from a punch biopsy?!!! The punch biopsy was taken from the flat part of the lesion. It was so suspicious with atypical junctional component, small atypical dermal nests, Pagetoid spread and brisk inflammatory reaction. We signed out the report as melanocytic lesion with worrisome histological features which in view of the clinical presentation necessitates complete excision with a safety margin for further histopathological assessment. The complete excision revealed invasive melanoma, Clark level III.
Clinicians sometimes think that dermatopathologists have falcon eyes and are able to know everything about a lesion from tiny pieces given to them!!!!! I am fighting this concept hardly. I have managed to teach younger generations of dermatologists the importance of excisional biopsies but I am still struggling with older generations!!!!!
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