Grossing in Dermatopathology



Dermatology can compete only with psychiatry on the number of clinical diagnoses owing to the skin’s easy exposure to irritants and the variety of reactions to them. Dermatologists do not hesitate to put many question marks in their clinical diagnosis because at the end of the day the pathology diagnosis rules. However, dermatologists are the most proficient in surgical pathology. It is common practice, especially in academic institutions, for dermatologist to sit with a dermatopathologist before the microscope, trying to follow the pass how the pathology diagnosis is generated. Sometimes, dermatologists do pathology by themselves.

Surprisingly, few manuals address skin grossing techniques. One of them is Clifford Chapman’s Dermatopathology: A Guide for the Histologist (2003). It presents diagrams and, specifically, histology processing methods. The Susan Lester’s Manual of Surgical Pathology (2005) largely targets residents and pathologists without focusing on the details of grossing techniques. Scarce materials written on the topic are dispersed; some are in general grossing manuals and some are in dermatology textbooks.

The materials here present skin grossing techniques in dermatopathology. They summarize my personal experience on the background of literature data to make them comprehensive and relevant to different grossing situations in small and large laboratories. I expect the line of potential readers to be in the following sequence: histotechnologists, pathologists’ assistants, pathology residents, hopefully pathologists, and perhaps some dermatologists interested in skin grossing. The goal of these materials is to present methodology of grossing in dermatopathology in maximal simple way.

Familiarity with embedding and microtomy techniques is a necessary prerequisite to ensure the quality of grossing in dermatopathology. The main goal is to present the skin as an organ. There is no other example in surgical pathology where grossing is permanently focused on the embedding of the sample.

The manual uses photographs from the grossing table. Sometimes, images of the procedure or its sequence are displayed. In general, techniques are not easy to learn out of a book. These materials try to bring some spatial orientation in the learning process. The next step in presentation would be a video clip.

Every manual or textbook is outdated at the moment it is printed. The electronic form of these resource materials has the advantage of being open to updates, edits, and incorporation of different experiences. Soon, iPad-like tablets will be used as tools for individual use in the grossing room. Some pages could be printed out and placed on the grossing table in a laminated form.

This manual invites suggestions to change or add some materials that will be appreciated and recognized. It can become a living body of a methodological exchange of experience.


Introduction to skin grossing

Common skin grossing techniques

Shave biopsies

Punch biopsies

Skin excision

Partially, these materials are presented in our book Dermatopathology Laboratory Techniques co-authored with Clifford Chapman.





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