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Author: Mikael Häggström [note 1]

Gross processing

Gross pathology processing of skin lesions with benign appearance, by lesion size:[1]
<4 mm 4 - 8 mm 9 - 15 mm

Tissue selection from skin excision with lesion less than 4 mm with benign appearance.png

Tissue selection from skin excision with lesion 4-8 mm with benign appearance.png

Tissue selection from skin excision with lesion 9-15 mm with benign appearance.png

In table above, each top image shows recommended lines for cutting out slices to be submitted for further processing. Bottom image shows which side of the slice that should be put to microtomy. Dashed lines here mean that either side could be used. Further information: Gross processing of skin excisions

Microscopic evaluation

A keloid is characterized by wide bands of collagen with large, brightly eosinophilic, glassy fibers, parallel to fibroblasts and myofibroblasts.
Keloid versus hypertrophic scar - Typical findings
Keloid Hypertrophic scar
Histopathology of a keloid.jpg Histopathology of a hypertrophic scar, medium magnification.jpg
Flattening of the overlying epidermis No Yes
Scarring of the papillary dermis No Yes
Collagen Thick hyalinized bundles Whorl-like or nodular arrangements
Vertically oriented blood vessels Yes No
Prominent disarray of fibrous fascicles/nodules Yes No
Tongue-like advancing edge underneath normal-appearing epidermis and papillary dermis Yes No
Horizontal cellular fibrous band in the upper reticular dermis Yes No
Prominent fascia-like fibrous band Yes No


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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  1. ". Ochsner J 5 (2): 22–33. 2003. PMID 22826680. PMC: 3399331. Archived from the original. . 
    - With a "standard histologic examination" that, in addition to the lesion, only includes one section from each side along the longest diameter of the specimen.
    - It also shows an example of circular coverage, with equal coverage distance in all four directions.
    - The entire specimen may be submitted if the risk of malignancy is high.

Image sources