Using Dermatopathology to Solve Diagnostic Puzzles

Solving a puzzle is a meticulous task, requiring concentration, logic and, at times, a certain degree of teamwork. Dermatopathologists solve puzzles each day and must excel in these areas, studying biopsies and providing precise diagnoses for patients.

As the name suggests, dermatopathology blends elements of clinical dermatology and pathology, specifically the study of skin disease at the microscopic and molecular levels. Many times, dermatologists are able to make an on-the-spot diagnosis of skin disease, but if the diagnosis is unclear and further information is required, a skin sample may be sent to a dermatopathologist.

My former colleague, Richard Cheney, MD, and I frequently receive skin samples from local health care providers and dermatologists. At Roswell Park, Dr. Cheney and I use state-of-the-art diagnostic tools including molecular tests that can help identify a malignant cell population or identify gene mutations — like BRAF mutation in melanoma — that allow selection of the most effective treatment (e.g., personalized medicine). In an effort to stay ahead of the field, we strive to continuously add to our arsenal of diagnostic tools.

Many people don’t realize how important pathology is to their treatment and recovery. An accurate diagnosis and pathology report determines the best course of therapy for patients and maximizes the chance of successful treatment. Although at Roswell Park our pathology team has special expertise in diagnosing cancer, Dr. Cheney and I also review and diagnose all other types of skin disease such as lupus, psoriasis, or infection.

In coming up with a diagnosis, we collaborate closely with the dermatologist or other healthcare provider who initially delivered the skin sample. In fact, one of the special aspects of this field is the amount of communication and teamwork between dermatopathologists and dermatologists. Dr. Cheney and I are fortunate to have excellent working relationships with area dermatologists and other physicians. Together, we work to obtain the best diagnoses for patients.

Through this process, both sides of the puzzle — the clinical aspect and the histology — are communicated effectively, leading to the most accurate and precise diagnosis for skin disease.