ARTICLE
Auteur(s) : H Kerl, R Cerio, G Burg, R Yavuzer Anadolu, S
Chimenti, D Forsea
Definition
Dermatopathology is a subspecialty common to both dermatology and
pathology concerned with the study and diagnosis of diseases of the
skin and the adjacent mucous membranes, cutaneous appendages, hair,
nails, and subcutaneous tissues by histological, histochemical,
immunohistological (including immunofluorescence and
immunohistochemistry), ultrastructural, molecular, and other
related techniques.
Impact
Dermatopathology is the most important single auxiliary diagnostic
technique in dermatology. In addition, it is an effective teaching
vehicle for students and residents in both dermatology and
pathology because it conveys insight into the causes, mechanisms,
and even the treatment of various cutaneous disorders.
In no other field of medicine is correlation of clinical and
histopathological features as crucial for establishing a correct
diagnosis as in dermatopathology. This correlative method is
especially important in the diagnosis of inflammatory diseases of
the skin where, in many cases, a final accurate diagnosis can only
be made by wedding the clinical picture with the findings by
microscopy. The diagnosis of cutaneous neoplasms, especially the
distinction between benign melanocytic nevi and melanomas, may be
extraordinarily difficult in the absence of an appreciation of
clinical nuances.
The role of dermatopathology has expanded in the past decades in
both clinical and basic research because many modern and highly
effective, scientific techniques have been integrated into its
armamentarium. Immunopathology, including immunofluorescence and
immunohistochemistry, is an important section of dermatopathology.
Techniques developed in the last decades are essential for the
exact diagnosis of autoimmune diseases (lupus erythematosus and
bullous disorders) and cutaneous lymphomas.
Dermatopathology can therefore be regarded as the combination of
macroscopic pathology (i.e. clinical diagnosis of skin diseases)
and microscopic pathology of the skin (i.e. histologic diagnosis of
skin diseases with a microscope). Investigative pathology of skin
diseases should be integrated into the academic practice of
dermatopathology (table 1). Some of the
exciting new areas into which investigative dermatopathology is
expanding are listed in table 2.
Table 1 Principles of dermatopathology
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– Macroscopic pathology of the skin – Microscopic
pathology of the skin – Investigative pathology of the
skin
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Table 2 Modern dermatopathology
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Dermatopathology informatics: – Virtual microscopic slide –
WEB-slide (electronic visualization of the specimen)
– Tele-dermatopathology (practice of dermatopathology at a
distance by using video imaging and telecommunication)
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New optical instruments – microscopes: – Atomic force
microscope – Laser capture microscope – In vivo confocal
scanning laser microscope
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Immunopathology – Application of antibody identification
methods to biopsy material (e.g. diagnosis of cutaneous tumors –
lymphoma, melanoma)
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Molecular dermatopathology: – Genetic rearrangements
– Infectious disease – genetic disease testing
– Molecular cytogenetics – Genomics/proteomics (molecular
fingerprint: tumor behavior; selection of therapy)
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Requirements and infrastructure
Dermatopathology institutions must provide the following facilities
to fulfill their purposes as service units for clinical dermatology
and for training in dermatopathology:
- a) Laboratories with adequate technical equipment
for:
- – routine histology including special stains;
- – immunofluorescence;
- – immunohistochemistry;
- – molecular biological techniques.
- b) A Program director with documented experience
and qualification in dermatopathology, who is responsible for the
administration of the laboratory and the training in
dermatopathology.
There must be a sufficient number of qualified physicians
(dermatologists, pathologists) and qualified technicians to support
and meet the services.
- c) Dermatopathology specimensThe number of
dermatopathology specimens from within the institution and/or from
outside must be at least 3000-5000 per annum.
Suggestions
At present there is a need for the definition of competence in
dermatopathology in most countries of Europe.
How to bring dermatopathology to pre-eminence in Europe:
- a) Need for full-time dermatopathologists with special
qualification;
- b) Curriculum for specialty training in
dermatopathology;
- c) Identification of training centers – regulations for
accreditation of training programs;
- d) Certifying Board Examination for special
qualification in dermatopathology (Diploma in
Dermatopathology);
- e) Program for residency education in
dermatopathology;
- f) Continuing professional development in
dermatopathology
Suggested reading
1 Association of Directors of Anatomic and Surgical Pathology:
Curriculum content and evaluation of resident competency in
anatomic pathology: a proposal. Hum Pathol 2003; 34: 1083-90.
2 Ackerman AB. A philosophy of practice of surgical
pathology: Dermatopathology as model. Ardor Scribendi,
Philadelphia, 1999.
3 Drake LA, Goltz RW, et al. Recommendations for
credentialing and privileging. J Am Acad Dermatol 1998; 39:
765-86.
4 Kerl H. Dermatopathology in Europe – Dreams and realities.
Arch Dermatol 1999; 135: 21-4.
5 Kerl H. Über die Situation der Dermatopathologie in Europa.
Pathologe 2002; 23: 1-3.
6 Ladanyi M, Gerald WL. Expression profiling of human tumors.
Humana Press, Totowa, New Jersey 2003.
7 Liebler DC. Introduction to proteomics. Humana Press, Totowa,
New Jersey 2002.
8 Staudt LM. Molecular diagnosis of the hematologic cancers. N
Engl J Med 2003; 348: 1777-85.
9 Weinstein RS. A futurist meets the 21st
century: Love at first sight. Hum Pathol 2000; 31: 1-2.
(Editorial)
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