J Clin Aesthet Dermatol. 2023;16(9 Suppl 2):S41
by Margaret A. Bobonich, DNP, FNP-C, DCNP, FAANP
Dr. Bobonich is Assistant Professor at Case Western Reserve University in Cleveland, Ohio, and Founder of Center for Dermatology Nursing Practice in Silver Lake, Ohio.
I wish to congratulate the Journal of Clinical and Aesthetic Dermatology (JCAD)’s NP+PA Perspectives in Dermatology in stepping up to provide NP and PA education and practice with a new journal section dedicated to dermatopathology. I am so very excited that dermatology NPs and PAs will now have an opportunity to not only learn dermatopathology, but to address some of the hurdles that we face in daily practice.
Dermatology NPs and PAs acquire requisite knowledge and skills for the diagnosis and management of dermatologic conditions. Skin biopsies are an essential diagnostic procedure that dermatology clinicians perform to diagnose skin cancers, skin eruptions, and sometimes underlying systemic disease. However, one of the gaps in the education and training of advance practice providers is in dermatopathology. The clinicopathologic correlation of any biopsy is dependent on the clinician’s ability to interpret the dermatopathology report from the biopsy specimen.
It was a privilege to talk with Dr. Maria Robinson, a dermatopathologist who has worked extensively with NPs and PAs. I worked with Dr. Robinson during her dermatology residency. Working shoulder to shoulder, you quickly realize when colleagues not only understand HOW to teach us, but also CARE about teaching us. When I saw the time and effort she dedicated to her online learning program (www.dermpathforapc.com), I realized the extent of her commitment to teaching dermatopathology to NPs and PAs. I share our recent conversation together here.
Dr. Bobonich: Welcome Dr. Robinson. Tell us about the new dermatopathology column in JCAD NP+PA Perspectives and what prompted you to present this education.
Dr. Robinson: I’m thrilled to partner with JCAD’s NP+PA Perspectives on their new column “Pearls from the Scope—What Your Dermatopathologist Wants You to Know.” Throughout my dermatology and dermatopathology career, I’ve had the opportunity to work with excellent dermatology NPs and PAs. But there is a bit of a knowledge gap when it comes to dermatopathology, largely due to the varying degrees of dermatopathology education. In helping to fill this gap, my hope is that clinicians will get the most out of their biopsies and enhance their patient care.
Dr. Bobonich: Can you tell us what information about the patient would be helpful for the dermatopathologist to help me narrow my differential diagnosis?
Dr. Robinson: This is a really important topic, and it’s actually the focus of our first column in the journal. In addition to the detailed information there, it’s important to clarify a frequent misconception about the clinical information on the biopsy requisition form. Some clinicians may believe that supplying clinical information will “bias” the dermatopathologist. This is not the case at all. Clinical information is critical to the clinicopathological correlation, especially with inflammatory processes. Some completely different clinical diagnoses (such as an epidermal nevus and confluent and reticulated papillomatosis) can have identical histologic findings. Accurate and thorough clinical information helps us give you a more specific diagnosis and can help you narrow your differential diagnosis.
Dr. Bobonich: What should I do if I receive a dermatopathology report that I don’t understand?
Dr. Robinson: First, make sure it’s the correct patient. In addition to looking at the name and date of birth, check the gross description in the report to make sure the tissue type and size match what you submitted. For example, if you submitted a 4mm punch, the gross description should reflect this same information. Switched cases are uncommon, but they do happen. If this checks out and you want clarification on a case, you can always reach out to your dermatopathologist to review the case and discuss the findings. Sometimes a conversation can help clarify the report findings or provide important additional information for the case. Remember, the dermatopathologist’s goal is to work with the clinician to correctly diagnose the condition.
Dr. Bobonich: When a clinician performs a biopsy of a rash that is a suspected allergic contact dermatitis, often the patient wants to know what is causing the rash. What should we consider in the clinicopathologic correlation?
Dr. Robinson: When a clinician does a biopsy of a suspected allergic contact dermatitis (ACD), the histologic findings can support a diagnosis of ACD. However, the biopsy can’t identify the causative agent. A thorough history, clinical exam, and patch testing are needed to do this. It’s also important to understand that the findings in ACD (a spongiotic dermatitis) are not specific to ACD. Other spongiotic processes, such as nummular eczema, can have identical histologic findings. This is another example of why clinical information and clinical correlation are so important.
Dr. Bobonich: Thank you, Dr. Robinson, for your enthusiasm and commitment to teach dermatopathology to NPs and PAs. We look forward to the many clinical pearls in dermatopathology you’ll be sharing in each issue of the journal.