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Presentation

Medical Dermatology Pearls

Description

In this lecture, Dr. Bob Brodell shares valuable insights into the practice of medical dermatology, particularly emphasizing the importance of clinical-pathologic correlation in dermatopathology. He advocates for the technique of bisecting punch biopsy specimens at the bedside to improve diagnostic accuracy for conditions like vitiligo, morphia, and blistering disorders. By placing a line on the specimen before bisecting it, clinicians can ensure that both normal and affected skin are adequately represented for the dermatopathologist. This method not only provides vital internal controls, like melanocyte density, but also aids in identifying features crucial for accurate diagnoses, such as the presence of blisters or ulceration in melanoma. Brodell highlights that direct communication with dermatopathologists can enhance specimen interpretation and prevent misdiagnoses. He concludes by reinforcing the utility of this bisecting technique in clinical settings, which enhances the diagnostic yield from samples sent for analysis, and ultimately improves patient care.

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Conclusions

Bedside grossing allows dermatopathologists to obtain more accurate diagnoses by ensuring clinically relevant specimens are provided.
Bisecting biopsy specimens at the bedside improves the likelihood of obtaining both normal and affected tissues for comparison.
Providing both normal and abnormal skin samples enhances the evaluation of conditions like vitiligo and morphea.
A technique termed 'the twofer' allows for the analysis of multiple lesions from a single biopsy, thereby optimizing diagnostic yield.
Sampling the thickest or ulcerated part of lesions (e.g., melanoma) while ensuring the cut edges are properly oriented increases diagnostic precision.
Utilizing a specific technique for tense blisters facilitates the collection of valuable diagnostic information while ensuring that the blister is not missed.
The advantages of these bedside techniques include the potential for one biopsy to yield two informative specimens, enhancing both sensitivity and diagnostic accuracy.

Noble CA, Bhate, C, Duong, B, Cruse AR. Clinical-pathologic correlation: The impact of grossing at the bedside, Seminars in Diagnostic Pathology, Accepted March 1, 2021.
Braswell, MA, McCowan NK, Schulmeier JS, Brodell RT. High-Yield Biopsy Techniques for Subepidermal Blisters. Cutis. 2015
Hodge B, J Roach, JL Reserva, TJ Patel, A Googe, J Schulmeier, RT Brodell. The spectrum of histopathologic findings in pemphigoid: avoiding diagnostic pitfalls. J cutan pathol. (2018) 45: 831-838. Doi.Org10.1111/cup.13343.