Skin

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Author: Mikael Häggström [notes 1]

Fixation

Generally 10% neutral buffered formalin.

See also: General notes on fixation

Presentations

Most common requests

Gross processing of skin excisions

Gross pathologic processing of skin excisions[3][notes 2]
Lesion size
<4 mm 4 - 8 mm 9 - 15 mm
Benign appearance

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

Suspected malignancy Tissue selection from skin excision with less than 4 mm suspected malignant lesion.png Tissue selection from skin excision with 4-8 mm suspected malignant lesion.png Tissue selection from skin excision with 9-15 mm suspected malignant lesion.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

If the referral does not point to any particular request (see "Most common requests" above), the following algorithm may be applied:

Reporting

Preferably see specific articles from algorithm in section above.

  • Optionally, the presence of a keratinized squamous epithelium.
  • Any abnormalities, generally preceded by location in terms of epidermal, dermal or more specific layers thereof.
  • If malignant:
  • Degree of differentiation
  • Radicality/Least distance to a margin
  • Perineural or vascular invasion if present

Notes

  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.
  2. The excision examples show a normal mole (upper row, benign appearance) and a superficial basal cell carcinoma (lower row, suspected malignancy).

References

  1. Page 678 in: Chhabra, Seema; Minz, RanjanaWalker; Saikia, Biman (2012). "Immunofluorescence in dermatology ". Indian Journal of Dermatology, Venereology, and Leprology 78 (6): 677. doi:10.4103/0378-6323.102355. ISSN 0378-6323. Archived from the original. . 
  2. Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-09.
  3. There are many variants for the processing of skin excisions. These examples use aspects from the following sources: ". 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.