Track: Clinical Studies

Abstract:

Specialized dermatopathology services are limited or absent in many regions, contributing to diagnostic uncertainty and delayed care. U.S. tertiary centers increasingly receive consultations from resource-limited countries, yet the diagnostic spectrum, specimen limitations, and ancillary testing needs in this setting are not well characterized. We retrospectively reviewed all international dermatopathology consultations received at a U.S. tertiary care health system over a 12-month period (August 2024–August 2025). Data collected included referring country, diagnostic category, specimen quality, ancillary testing requested or performed, final diagnosis, and clinical impact (diagnostic reclassification, recommendation for further testing, or management change). A total of 118 cases were received from six countries (Afghanistan, Myanmar, Armenia, Uganda, Rwanda, and Kenya). Diagnoses included 49 (41.5%) neoplastic (malignant, benign, lymphoid), 60 (50.8%) inflammatory, and 8 (6.8%) infectious. Specimen quality issues occurred in 20 (16.9%) cases, commonly due to poor fixation or tangential sectioning. Ancillary testing (immunohistochemistry or special stains) was requested in 25 (21.2%), often to distinguish primary from metastatic tumors or confirm infectious etiologies. Clinical impact was documented in 28 (23.7%) cases, including reclassification from benign to malignant and management changes. Three lessons emerged: (1) inflammatory dermatoses are the most frequent referral category, (2) poor fixation is the most common specimen limitation, and (3) targeted ancillary testing can meaningfully change management, but access remains limited. International dermatopathology consultations from resource-limited settings frequently involve inflammatory dermatoses, complex neoplasms, and technical limitations that hinder diagnosis. Strengthening global dermatopathology capacity will require strategic initiatives, including telepathology, laboratory partnerships, and expanded access to advanced diagnostics.

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Esther Freeman