Skin biopsy in the context of dermatological diagnosis: a retrospective cohort study

Dermatopathology Trends in African Americans: A Retrospective Analysis of Biopsies

ABSTRACT

In a retrospective analysis of biopsies from January 1, 2019 to December 31, 2020, at University Hospitals Cleveland Medical Center, we aimed to determine the frequency of dermatologic conditions biopsied in African Americans (AA). Given that AAs constitute 13.4% of the US population, understanding the skin disease profile within this significant demographic is crucial. From a total of 1701 biopsies collected from 1442 AA patients, benign neoplasms emerged as the most common diagnosis, accounting for 26.7%, predominantly in females. Notably, cutaneous T-cell lymphoma was the most frequently biopsied malignancy, whereas pigmentary disorders were the least common at 1.4%. The study highlighted the higher occurrence of squamous cell carcinoma compared with basal cell carcinoma in AA, contrasting trends in other racial demographics. Moreover, recognizing the unique presentations of skin disorders in different racial backgrounds is essential, especially because disparities have been reported in skin of color training among dermatology residency programs. Understanding these racial differences in skin diseases can assist clinicians in refining their diagnostic approach. Future research could further explore the potential gaps between clinical expectations and histologic findings, improving diagnostic accuracy.

Dermatoscopy of primary localised cutaneous amyloidosis - A cross-sectional study in a setting of South Asian public dermatology department

Background

Amyloidosis, deposition of misfolded protein in body, is a fairly common condition. The deposition of misfolded proteins in skin which occurs in absence of systemic comorbidities, namely Primary Cutaneous Amyloidosis (PCA) is also a well-known entity in skin of colour patients of Asian subcontinent. Primary Cutaneous Amyloidosis is usually diagnosed with good clinical acumen and typical clinical phenotype and involved site. Dermoscope has been used as an adjunct non-invasive tool to confirm cases with diagnostic uncertainty and in those in whom biopsy is deferred. Typical dermoscopic features of PCA helps differentiate it from other pigmentary dermatoses and avoids unwanted invasive biopsies and investigations especially in resource poor settings with financial constraints.

Objectives

This study aims to identify and corroborate clinically, typical dermoscopic features in PCA in 42 patients which includes Macular Amyloidosis (MA) and Papular Amyloidosis (PA) predominantly in skin of colour patients from government based hospital of a south east Asian country.

Materials and methods

Patients with classic clinical features of PCA were selected. Primary Cutaneous Amyloidosis was subclassified into MA or PA and their corresponding clinically corroborative dermoscopic features were enlisted respectively. All patients (treatment naïve and previously treated), who consented to participate in the study were included. Patients were diagnosed based on the prototypical clinical features. Dermoscopy was done using DermLite III DL3N Polarised and Fluid Dermoscope w/PigmentBoost Brand (3Gen, DermLite LLC, San Juan Capistrano, CA, USA) and images were obtained to create digital dermoscopy system by attaching camera-equipped mobile device via an optional connection kit (Redmi Note 11, MIUI version 13.0.5, CHINA) and the findings were enlisted concurrently.

Results

In this study of dermoscopic findings of PCA, 42 patients were evaluated for their clinical lesions along with its corroboration with the dermoscopic features. Macular Amyloidosis was seen in 30 patients and 12 patients had typical cutaneous phenotypic and dermoscopic feature of PA. The most common dermoscopic finding seen in patients with MA was shiny to dull white, circular or oval central hub surrounded with halo of light brown dots. Most common configuration of brownish pigmentation around central hub was fine streak type. Also eccrine clues were seen in some cases of MA, which was a unique finding. Similarly in the PA subtype, the central hub was replaced by scar like structureless translucent white area surrounded by brownish black dot like structures, especially in those with large and thick plaques.

Conclusion

Dermoscopic findings of PCA and their clinical corroboration is a much-needed aspect in treating patients with pigmentary disorders and in those with skin of colour, especially in developing countries. Utilization of dermoscope in clinical settings of low income countries and in government based hospitals will decrease the add on economic burden of invasive diagnostic modalities like biopsy and other inadvertent tests done to rule out pigmentary conditions.

Archival skin biopsy specimens as a tool for miRNA-based diagnosis: Technical and post-analytical considerations

Archived specimens, taken by standardized procedures in clinical practice, represent a valuable resource in translational medicine. Their use in retrospective molecular-based studies could provide disease and therapy predictors. Microfluidic array is a user-friendly and cost-effective method allowing profiling of hundreds of microRNAs (miRNAs) from a low amount of RNA. However, even though tissue miRNAs may include potentially robust biomarkers, non-uniformed post-analytical pipelines could hinder translation into clinics. In this study, epidermal RNA from archival skin biopsy specimens was isolated from patients with peripheral neuropathy and healthy individuals. Unbiased miRNA profiling was performed using RT-qPCR-based microfluidic array. We demonstrated that RNA obtained from archival tissue is appropriate for miRNA profiling, providing evidence that different practices in threshold selection could significantly influence the final results. We showed the utility of software-based quality control for amplification curves. We revealed that selection of the most stable reference and the calculation of geometric mean are suitable when utilizing microfluidic arrays without known references. By applying appropriate post-analytical settings, we obtained miRNA profile of human epidermis associated with biological processes and a list of suitable references. Our results, which outline technical and post-analytical considerations, support the broad use of archived specimens for miRNA analysis to unravel disease-specific molecular signatures.

A Clinico-Pathological Multidisciplinary Team Increases the Efficacy of Skin Biopsy and Reduces Clinical Risk in Dermatology

A clinical risk is an inherent risk in healthcare processes, including skin biopsy procedures, and may lead to misdiagnoses, increased healthcare costs and potential harm to patients. Indeed, clinical and histopathological data must be integrated if we are to reduce clinical risks and improve diagnostic accuracy in the diagnosis of dermatologic diseases. Although dermopathology services used to be part of a dermatologist's duty, the recent centralization of these laboratories has caused a loss of expertise and increased both complexity and safety issues. Some countries have implemented clinical-pathological correlation programs aimed at facilitating communication between clinicians and dermatopathologists. However, Italy has regulatory and cultural barriers that make the implementation of these programs difficult. Therefore, an internal analysis was carried out to assess the efficacy and impact that skin biopsy procedures for inflammatory and neoplastic conditions have on the quality of care in our dermatology department. As the analysis evidenced a high number of descriptive pathologic reports and discordant diagnoses, a multidisciplinary group of four dermatologists, four general pathologists and one dermatopathologist was set up. Herein, we present the results of this analysis and project and describe the structure of the multidisciplinary group. We also discuss the pros and cons, possibilities and limitations of our project, including the regulatory barriers of the Italian National Health System.

Clinico-Pathological Correlation in Dermatological Disorders: A Retrospective Audit of 332 Skin Biopsies from a Tertiary Care Center

Background

Skin biopsy is a frequently employed tool by the dermatologists with several factors that are known to influence its diagnostic yield as well as interpretation. The objective of our study was to analyze the clinico-pathological concordance and discordance rates in various dermatological conditions and study the factors affecting the same. Materials and.

Methods

We retrospectively analyzed 332 biopsies conducted over a period of 1 year and looked for clinico-pathological correlation and tabulated the results.

Results

The overall concordance rate observed in the present study was 70.48% (234 out of 332). Out of 234 concordant cases, 175 of them (74.8%) were concordant with the first differential diagnosis mentioned on the histopathology requisition form, thus revealing an acceptable level of clinico-pathological correlation. The concordance was observed to be 66.87% when only one differential was mentioned on the requisition forms, whereas it increased to 73.96% when more than one diagnosis was offered (P = <0.00001). However, the adequacy of clinical description on the histopathological requisition form was not observed to significantly impact the clinico-pathological correlation in the present study.

Conclusion

An acceptable level of clinico-pathological concordance was observed in the present study thus reinforcing skin biopsy as an indispensable tool in the dermatological practice. However, continuous effort in the form of regular audits in the department, interdepartmental discussions between pathologists and clinicians, and repeat biopsies in case of discordancy would help in identifying and addressing the deficiencies that impact the diagnostic yield of histopathology and which would ultimately result in better patient care.

A Review Study Toward Clinical and Histopathological Diagnosis Agreement in Skin Diseases

Background

It is important to evaluate the agreement between clinical diagnosis and histopathological diagnosis. The aim of this study was to review studies and to calculate the degree of agreement between clinical and histopathological diagnosis.

Objective

The aim of this review was to find out the concordance level between clinical and histopathological diagnosis; to find out in which type of pathology concordance was the highest; to identify the types of pathologies for which biopsy was mostly performed and the anatomical region selected for biopsy.

Results and Discussion

Review was carried out in accordance with the PRISMA 2020 flow diagram for the selection of articles that met the criteria (years 2005-2021). Articles were found in Google scholar, PubMed, Scopus databases using different keywords. The main criterion was to involve studies that reported data about clinical and histopathological diagnosis. A mean concordance value was calculated and resulted of 72.8 % (95% CI).

Conclusion

To our knowledge, our study was the first review done regarding concordance between clinical and histopathological diagnosis in skin diseases with the aim to provide researchers with enriched literature and encourage them to bring about an appropriate systematic review study.

Dermatopathological Correlation of Clinically Challenging Cutaneous Lesions: a Single Center Experience of 2184 Cases

INTRODUCTION

Although a trained eye can easily identify typical skin lesions, histopathological examination and clinicopathological correlation are critical in challenging cases.

OBJECTIVES

The primary objective is to organize the final diagnoses reached following clinicopathological consensus in clinically challenging cutaneous lesions, identifying the most common diagnostic scenarios encountered by dermatopathologists and discussing their diverse differentials submitted by clinicians. The secondary objective is to investigate how the case profile and clinician decision-making processes evolved during the COVID-19 pandemic.

METHODS

Skin and mucosa samples collected by the dermatology department between 2016 and 2020 were classified based on pathology reports. For frequent diagnoses, preliminary diagnoses stated by clinicians on pathology requisition forms were reviewed. The years preceding and following the first nationally reported COVID-19 case were compared to investigate the pandemic's impact on the distribution of dermatology and dermatopathology cases.

RESULTS

One thousand nine hundred and eighty-nine reports were classified into 4 major categories: inflammatory (49.8%), neoplastic (30.1%), other diseases (7.1%), and non-diagnostic (12.8%). We further classified inflammatory diseases based on major tissue reaction patterns and neoplasms based on cell origin. We analyzed the leading diagnoses in each category, discussed their differential diagnoses, and provided clinicians with clues to reduce errors in practice. Following the pandemic, the overall number of pathology reports and patient admissions dropped dramatically, with significant changes in case profiles.

CONCLUSIONS

We presented and discussed the frequently encountered confounding cases to sketch the diagnostic landscape. In the authors' experience, clinicopathological correlation can increase the rate of reaching the diagnosis by up to 75.3%.

Access, charge and quality of tele-dermatology e-consults in China: A standardized patients study

OBJECTIVE

Direct-to-consumer telemedicine is rapidly changing the way that patients seek medical care. This study provided the first report on access, cost and quality of text- and image-based tele-dermatology e-consults, in China.

METHODS

We adopted the Standardized Patients approach to evaluate the services of tele-dermatology e-consults in two metropolitan cities, that is, Beijing and Hangzhou, in China. We measured quality from four dimensions: service process, diagnosis accuracy, prescription and treatment comprehensiveness, based on China's national clinical guidelines. We performed logistic regressions to investigate factors that were associated with high-quality care.

RESULTS

For 114 physicians eligible for inclusion, we succeeded in 87 (76%) validated visits. The median waiting time was 100 minutes (IQR 19-243 minutes) and the median length of consultation was 636 minutes (about 10 hours, IQR 188-1528 minutes). Per visit costs varied from $0 to $38, with a median of $8 (IQR 4-9). Among all, 15% of visits showed high quality in service process, 84% arrived in the correct diagnosis, 24% provided high-quality prescriptions and 71% provided comprehensive treatment. Providing images was associated with high quality in service process (OR 7.22, 95% CI 1.49-34.88). Visits in metropolitan Beijing and on non-work days had better prescription quality than that in metropolitan Hangzhou (OR 6.05, 95% CI 1.75-20.95) and that on workdays (OR 3.75, 95%CI 1.27-11.04), respectively.

CONCLUSIONS

Tele-dermatology e-consults seem to be easy to access and less expensive in China. However, great efforts are warranted to ensure that service processes and prescriptions adhere to clinical guidelines.

Clinico-Pathological Concordance Rate of Scalp Lesions Showing Alopecia

Background

Some alopecic diseases can be diagnosed by detailed history taking and physical examination, but in many cases, biopsy must be performed to make a definite diagnosis.

Aims and Objectives

This study aimed to evaluate the clinico-pathological concordance of scalp lesions showing alopecia.

Materials and Methods

We retrospectively reviewed the electronic medical records and biopsy slides of patients who underwent biopsy for evaluating scalp lesions showing alopecia. Based on the definitions of clinico-pathological concordances, scalp alopecic disease was evaluated.

Results

A total of 121 patients were enrolled in the study. A total of 203 clinical differential diagnoses were made before performing a biopsy. Thirty-one patients showed full concordance, and 58 patients showed partial concordance; thus overall concordance was shown in 89 patients (73.55%). Folliculitis decalvans and alopecia areata showed a higher full concordance rate than average (P < 0.05), whereas dissecting folliculitis showed a lower overall concordance rate than average, and folliculitis decalvans showed a higher overall concordance rate than average (P < 0.05). The overall concordance rate of alopecia areata was 100% (P = 0.061).

Conclusion

In diagnosing folliculitis decalvans and alopecia areata, which showed high full and overall concordance, performing a biopsy to make a definite diagnosis is not always necessary, especially when patients show typical clinical features. Dissecting folliculitis, which showed low overall concordance, was less likely to be suspected as a clinical differential diagnosis, making it difficult to distinguish based on clinical findings alone. Therefore, when it is suspected, a detailed evaluation including a biopsy is recommended.

Epidemiological Patterns of Skin Disease in Saudi Arabia: A Systematic Review and Meta-Analysis

Background

Large epidemiological studies on patterns of skin diseases in Saudi Arabia are scarce. Therefore, this systematic review and meta-analysis was conducted to gather available epidemiologic data describing the pattern of skin diseases in different geographical areas in Saudi Arabia.

Methods

A comprehensive literature search of articles was conducted in PubMed, SCOPUS, and Web of Science through October 2019. We included all published cross-sectional studies that provided data on relevant incidence or prevalence of skin disease in Saudi Arabia. The risk of bias within the included cross-sectional studies was assessed using the Hoy tool for the prevalence studies. All statistical analysis was performed using the Comprehensive Meta-analysis software.

Results

The present meta-analysis included 14 studies that reported the frequency of the skin disease patterns in different regions in Saudi Arabia with a total sample size of 30436 patients with an overall low risk of bias. The diseases of skin appendages and dermatitis were the most commonly reported skin diseases in Saudi Arabia (24.8% (95% CI, 24.3–25.3) and 24% (95% CI, 23.6%–24.6%), respectively). Skin infection represented about 18.5% (95% CI, 18.1%–19%), while the papulosquamous disorders represented 5.3% (95% CI, 5%–5.6%) of the skin diseases in Saudi Arabia. Skin cancers were pooled from only two studies. Basal cell carcinoma and squamous cell carcinoma were the most common malignant neoplasm in Saudi Arabia (51.4% and 22.5% of the malignant neoplasm, respectively), while malignant melanoma represents only 3.8% of the malignant skin cancer.

Conclusion

Adnexal disorders and dermatitis are the most common skin disease in Saudi Arabia, followed by skin infection and pigmentary disorders. While skin cancer is more frequent than other countries, awareness campaigns should be initiated to increase knowledge about the harmful effect of long-term sun exposure.

Clinicopathological Concordance in 2216 Cases of Skin Biopsy over One Year: An Indian Experience

Introduction

To determine the spectrum of diseases and the level of clinicopathological concordance in skin biopsies received over a period of one year.

Methods

A total of 2216 skin biopsy cases received over a period of one year at a tertiary care center were retrospectively analyzed. The cases were further divided into further categories in levels of concordance based on the agreement between the clinical and histopathological diagnosis rendered.

Results

Of the cases, 61.01% showed clinicopathological concordance. Cases with a descriptive pathological diagnosis, not matching the clinical diagnosis, constituted 31.54%, whereas 4.02% of cases had a definitive pathological diagnosis, which was discordant with the clinical differentials; 3.29% biopsies were inadequate.

Conclusion

This study highlights the clinicopathological concordance in all the biopsies received from dermatology. It emphasizes the importance of skin biopsies in arriving at the diagnosis. However, it is a tool that must be used judiciously. Skin biopsies are also pivotal in flagging malignancies that may mimic benign lesions.

Clinicopathological concordance in the diagnosis of skin diseases: a retrospective analysis of 5000 histopathology reports

BACKGROUND

The accuracy of clinical diagnoses of skin diseases has not been researched in Saudi Arabia.

OBJECTIVES

Assess concordance between the histopathological and clinical diagnosis in skin diseases.

DESIGN

Retrospective.

SETTING

Academic tertiary care center.

METHODS

Demographic, clinical and pathological data were collected from the medical record for the period 1997-2013.

MAIN OUTCOME MEASURES

Concordance between the pathological and clinical diagnosis.

SAMPLE SIZE

4268 cases.

RESULTS

Of 4268 biopsies, 2440 (58.1%) were females. The mean age (SD) of patients was 36.9 (17.8) years. The three most common locations from which skin biopsies were retrieved in descending order were the lower extremity (1123; 29.1%), head, neck, scalp and hair (1033; 26.7%) and trunk (853; 22.1%). Overall concordance was 75.9% (partial concordance 47.6%, full concordance 28.3%). Biopsies from the oral mucosa and lips had the lowest concordance (overall 58.5%, full 26.4%) at P=.004. Overall concordance was highest for the following three diagnoses: malignant neoplasms, 88%; vesiculobullous diseases 87%; urticarias, erythemas, and purpuras 87%.

CONCLUSION

There is considerable variability in concordance among different histopathological diagnoses. The full concordance between the clinical diagnosis and the pathological diagnosis is low. This is a reflection of the fact that the biopsies were obtained only in cases where the clinical diagnosis was a dilemma.

LIMITATIONS

Single center, retrospective, incomplete medical records, low percentage of biopsies were assessed by dermatopathologists.

CONFLICT OF INTEREST

None.

Dermoscopic Features of Psoriasis, Lichen Planus, and Pityriasis Rosea in Patients With Skin Type IV and Darker Attending the Regional Dermatology Training Centre in Northern Tanzania

Background

Papulosquamous skin diseases can be challenging to diagnose, especially in dark skin. Dermoscopy is reported to be helpful, but few data are available on its use in skin type IV or darker.

Objective

To describe dermoscopic features in plaque-type psoriasis (PP), lichen planus (LP), and pityriasis rosea (PR) patients attending the Regional Dermatology Training Centre in Moshi, Northern Tanzania, and to compare findings with published data.

Methods

A descriptive cross-sectional study was conducted at a tertiary hospital from October 2016 to June 2017. Fifty-six patients with PP, 25 with LP, and 9 with PR were enrolled consecutively. Clinical diagnosis was confirmed with histopathology in 74.4%. Dermoscopic vascular and nonvascular features from 225 lesions were analyzed.

Results

Of the 90 patients enrolled, 58.9% were male and the median age was 50 (interquartile range 32.8–60.0) years. In PP lesions, red dots were found in 64.2% and white scale in 45.5%. In LP lesions the background was violet in 45.5% and 58.2% revealed Wickham striae. In PR lesions a dull red background was found in 50.0%, white scale in 83.3%, but no vessels were detectable.

Conclusion

Dermoscopy features in PP, LP, and PR in dark skin are mostly similar to those in light skin.