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What are the limits of dermatopathology?

Mark A. Hurt MD


A “limit” is defined as “the utmost extent: a point beyond which it is impossible to go.” Where is that point in dermatopathology?

My answer might surprise the reader, so I will state it outright. The limit of dermatopathology is the diagnosis.

The entire point of the discipline, the “why” we exist as dermatopathologists is because of the diagnosis.

Let's not kid ourselves. Looking at changes in cutaneous tissue under the microscope is often a beautiful and stimulating experience, but our entire purpose is the diagnosis; without it, we literally would not know what to study, we would know neither what nor why we should communicate to clinicians about these tissue changes.

A limit provides such a purpose. A limit is nothing more than an end, while our observations and deliberations, our books, conferences, and research articles are the means.

The “end” in this case is the diagnosis. It sets the limit of our focus. Sure, there may be ancillary information that is added after the diagnosis, but it is a sequela that cannot be separated from the diagnosis as such.

When or if someone attempts to undermine the importance of a diagnosis, it is time to challenge them and ask: what are the limits of dermatopathology?

Webster's Third New International Dictionary, Unabridged, s.v. “limit,” accessed April 27, 2013, [url="http://unabridged.merriam-webster.com/"]http://unabridged.merriam-webster.com[/url].

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Robledo F. Rocha


I do agree that the diagnosis is the “why” we exist as dermatopathologists, our entire purpose. Nonetheless, we are often required or feel ourselves compelled to provide additional information, like prognostic staging, therapeutic suggestion, recommendation for complementary exams, and so forth. Yes, all these additional information are directly dependent on the diagnosis. In fact, they would not exist without the diagnosis.
I therefore perceive the diagnosis not as the limit of dermatopathology, but as the minimum expected from us, which should not be missing. We can go beyond it, and often we really go.
No, I won’t attempt to undermine the importance of the diagnosis. The crucial importance of the diagnosis is undeniable! Anyway, I feel challenged to leave a reply to the last question: the limits of dermatopathology are all the clinically relevant information that the dermatopathologist can obtain from the diagnosis in order to achieve the greatest benefit for the patient.
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