Track

Clinical Studies

Abstract

Over two months of routine signout, dermatopathologists requested additional information on 167 cases for clinical pathologic correlation. Photos of the biopsy site were requested in 135/167 (80.8%), clinical notes for 3/167 (1.8%), and both photos and clinical information for 29/167 (17.4%).  Additional information was requested with similar frequency for punch (79/167, 47.3%) and shave biopsies (79/167, 47.3%), with the remainder of requests for excisions (9/167, 5.4%). Of punch biopsy cases, the majority 76.0% (60/79) were rashes, 10.1% (8/69) melanocytic, 6.3% (5/79) keratinocytic, and 7.6% (6/79) for other (nodules, cysts, dermatofibroma, angiomas, and more). The majority of shave biopsies were melanocytic 53.2% (42/79), keratinocytic  22.8% (18/79), rashes 10.3% (8/79), and 13.9% (11/79) for others. Most photos requested were adequate for clinical correlation (135/164, 82.3%). The remaining case photos were inadequate (29/164, 17.7%) or missing (5/164, 3%). Approximately a third of cases (27.6%) had two or more reasons for inadequacy. Blurry or out of focus was the most common reason (44.8%). Others were distorted or blanched by local anesthesia (41.4%), obscured by marking pen (20.7%), missing sites of involvement specified in the requisition (17.2%), or dermoscopy was not provided (13.8%). This quality improvement study identifies areas of improvement to optimize clinical and pathologic correlation, ensuring the most accurate diagnosis for our patients.