Posted by Jody on Aug.15.18 in Skin Care
Skin lesions don’t come with labels, bells or whistles. Diagnosing skin cancer is way more complicated than you might think. Our two-part article gives you a peek behind the scenes of this little-understood but fascinating area of dermatology. This first part describes how a dermatologist performs a skin exam and determines if all or part of a suspicious spot or lesion should be removed and sent to a lab for a biopsy. It also discusses the highly trained medical specialists who analyze the tissue from your biopsy, and why that is so important. Part two reveals what happens to your biopsy tissue sample, step by step, after your dermatologist ships it off to the lab.
During a skin exam with a dermatologist, you may experience something like this: You’re sitting or lying down in a gown or covered with a cloth. The doctor uncovers one part of your skin at a time, looking closely at any unusual spots, patches, moles or lesions. She’s moving fairly quickly — she’s experienced and knows what she’s looking for. Then she stops and says, “I want to take a closer look at this spot on your shoulder.” She might reach for a small handheld magnifying device called a dermatoscope. “It may be nothing to worry about,” she says, “but I’d like to do a biopsy to be sure.” She numbs the area, then removes all or part of the suspicious lesion, to be sent to a lab for examination. She puts a little ointment on the wound, covers it with a bandage and tells you she will get the results in about a week.
This scenario is common during a full-body skin exam. There’s no reason to panic. Not every biopsy reveals a skin cancer. And even if it does, know that most skin cancers are detected early enough to treat with minimal scarring and a very high chance of a cure. Knowing when and what to biopsy is an important skill set for a dermatologist, but getting an accurate diagnosis is still a complicated process. That’s where a dermatopathologist comes in.
What is a dermatopathologist?
With seven syllables, that’s a mouthful. First, the “pathologist” part: It comes from the Greek pathos (“suffering”), plus logia (“study”). A pathologist is a physician specially trained to study tissue under a microscope to diagnose diseases, determine the stage of a tumor or even help solve crimes through forensics, for example. (You may have an idea of what forensic pathologists do from watching crime shows like CSI.)
The “dermato” part comes from the Greek derma, meaning “skin.” “Dermatopathology is a very specialized niche of pathology, where the only tissue that is being examined is skin,” says Lyn Duncan, MD, director of dermatopathology at Massachusetts General Hospital, and professor of pathology at Harvard Medical School. These specialists are on the lookout for skin cancers as well as other skin conditions, and also diseases of the hair and nails.
To become a dermatopathologist, a physician must have completed a residency in either dermatology or pathology and then have additional training in dermatopathology, explains Michael G. Hitchcock, MBChB (a New Zealand-based medical and surgical degree). He is a dermatopathologist in Winston-Salem, North Carolina, and president of the American Society of Dermatopathology, the largest professional organization devoted to the specialty. “We’re the doctors’ doctor, like the navigator of an aircraft, providing information and feedback to help them make the correct diagnosis.”
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