Dermatopathology

Dermatopathology is a subspecialty that involves the study of skin diseases under a microscope and at the molecular level. It is a combination of dermatology and pathology (or surgical pathology) and aims to understand the underlying causes of skin diseases. Dermatopathologists work closely with dermatologists, and many of them have received additional clinical training in dermatology.

Definition and Overview

Dermatopathology is a subspecialty of dermatology and pathology (or surgical pathology) that focuses on the study of skin diseases at a microscopic and molecular level. Dermatopathologists examine skin biopsies and other samples to diagnose and study the underlying causes of skin conditions, such as skin cancers, infections, autoimmune disorders, and inflammatory skin diseases. They work closely with clinical dermatologists to provide accurate diagnoses and help guide treatment decisions.

Dermatopathology is an important field in the management of skin diseases, as it allows for a more detailed understanding of the biological mechanisms behind various skin conditions. (1)

Types

There are various common procedures performed in dermatology to diagnose and treat skin cancer and noncancerous and precancerous growths. 

• Skin biopsy

A procedure in which a small sample of skin is removed for examination under a microscope to diagnose skin conditions such as skin cancer, infections, and inflammatory skin diseases.

• Shave removal

Moles, lesions, and tumors can all be removed from the skin with a simple process called shave excision. A razor with a good edge is the main instrument utilized in this process.

• Cryosurgery

To eradicate cancerous cells and aberrant tissue, a procedure known as cryosurgery uses extremely freezing temperatures created by liquid nitrogen or argon gas. It is a local treatment, meaning it is focused on a particular area of the body.

• Topical chemotherapy

Topical chemotherapy is a type of treatment for skin cancer that involves the application of a topical medication, typically a cream or lotion, directly to the affected area of the skin. The medication contains chemicals that destroy cancer cells by interfering with their ability to grow and divide.

• Photodynamic therapy

In photodynamic therapy, the precancerous or cancerous growth is treated with a chemical (aminolevulinic acid or methyl aminolevulinate). The treated area is exposed to light after a few hours, which photo activates the chemical and kills the precancerous or cancerous cells.

• Electrodessication and curettage

The doctor initially injects medication to numb the area during this therapy. To remove the skin tumor, a long, thin instrument with a sharp looping edge on one end is used (called a curette). To eliminate any leftover cancer cells, the region is next treated with an electric needle (electrode).

• Conservative excision

A conservative excision entails removing the tumor along with a small patch of healthy skin surrounding it.

• Mohs micrographic surgery

Mohs micrographic surgery is a highly precise surgical technique used to treat certain types of skin cancer. It involves the removal of skin cancer layer by layer, with each layer examined under a microscope until all cancer cells have been removed. (2)

Candidates

Dermatopathology is a specialized field of dermatology and pathology that focuses on the diagnosis of skin diseases at a microscopic and molecular level. Patients who may be candidates for dermatopathology include those who have:

• Skin lesions that are difficult to diagnose: When a dermatologist is unsure about the diagnosis of a skin lesion, a dermatopathologist can examine a tissue sample from the lesion under a microscope to make an accurate diagnosis.
• Complex skin conditions: Dermatopathology is often used to diagnose and manage complex skin conditions such as autoimmune diseases, blistering disorders, and infectious diseases.
• Skin cancers: Dermatopathology is used to diagnose and stage skin cancers such as melanoma, basal cell carcinoma, and squamous cell carcinoma.
• Recurrent skin conditions: If a skin condition has been treated but continues to recur, dermatopathology can help determine the cause and guide treatment decisions.
• Skin conditions that require specialized treatment: Dermatopathology is often used in conjunction with other dermatologic treatments such as Mohs surgery and laser therapy.

A dermatologist can help determine if dermatopathology is necessary for a patient's specific condition. (3)

Risks and Side Effects

Dermatopathology procedures involve the analysis of skin tissue samples to diagnose skin diseases and conditions. While the procedures themselves are typically low risk, there are potential risks associated with any medical procedure, including:

• Infection: There is a small risk of infection at the site where the skin sample was taken.
• Bleeding: There may be some bleeding or bruising at the site of the skin biopsy.
• Pain or discomfort: Patients may experience pain or discomfort at the site of the skin biopsy for a few days after the procedure.
• Scarring: In some cases, the skin biopsy site may leave a small scar.
• Incorrect diagnosis: In rare cases, a dermatopathologist may misinterpret the results of a skin biopsy, leading to an incorrect diagnosis.

However, the risks associated with dermatopathology procedures are generally considered to be very low. Patients can help reduce their risk of complications by carefully following their dermatologist's pre- and post-procedure instructions, and promptly report any unusual symptoms or signs of infection. (4)

Post-Procedure and Follow-up

After a dermatopathology procedure, patients may experience minor pain, swelling, or bruising at the biopsy site. They can resume normal activities immediately but should avoid strenuous activity or contact sports for at least a day or two to allow for healing. Patients must keep the biopsy site clean, dry, and covered with a bandage for a day or two, and avoid scratching or picking at the site or applying any creams or lotions without consulting their dermatologist. The dermatologist provides post-procedure instructions, medications, or topical treatments, and schedules a follow-up appointment to review biopsy results and discuss treatment options. (5)

Recovery

The recovery from dermatopathology procedures is typically quick, with minimal discomfort or downtime, depending on the size and location of the skin biopsy and the patient's overall health. Patients can return to their normal activities immediately after the procedure but should avoid strenuous activity or contact sports for a day or two. Mild pain, swelling, or bruising at the biopsy site may occur but should improve within a few days. Attending follow-up appointments is important for the proper management of the skin condition, including reviewing biopsy results and discussing treatment options. (6)

Results

The results of a dermatopathology procedure can provide valuable information about the underlying cause of a patient's skin condition. The results of a dermatopathology procedure are typically available within a few days, and the dermatologist reviews the results with the patient and develops a treatment plan as necessary.