What is the gold standard for being able to detect pseudopods? Pseudopods can indicate precancerous problems. What if the histological sectioning of a specimen misses the presence of pseudopods?
"In addition, if a biopsy is performed, it makes the dermoscopy moot."
Brian, you are a wonderful, kind, knowledgeable teacher that is always appreciated, however
however I do have a difference of opinion:
I learned at the Memorial Sloan Kettering that if a biopsy is performed without dermoscopy, that biopsy is missing valuable horizontal information that is so helpful in sectioning specimens and getting the most accurate diagnosis.
The example I gave above "If a pathology lab actually used such dermatopathologic images and sectioned them properly and found irregularly distributed pseudo-pods this just might save lives. Dermoscopy just might save lives."
An irregular distribution of pseudopods are not the only structures missed on a biopsy specimen without
horizontal information gotten from dermoscopy.
Another example might be a misdiagnosis of a blue nevus when a melanoma is actually present. (Without dermoscopy, if a superficial shave biopsy is taken, a blue nevus could be a possible misdiagnosis) Dermoscopy would clearly show such deep blue color absent in sections of the questionable lesion. Such nonuniform presence of a deep blue color would be the additional information needed by the pathologist to ultimately diagnose that melanoma. (In a blue nevus the blue color is horizontally throughout the lesion and likely seen by the dermatopathologist provided with a dermatoscopic image.)
Including dematoscopic images sets a new standard in podiatric pathology reporting which I believe is the future gold standard. If dermatoscopes are available and if images can be sent to any lab that has dermatopathologists or podiatry consultants that have experience with dermatoscopic images, patients will likely benefit. Podiatrists who recieve reports that used such additional information would likely result in a report with a greater possibility for a more accurate diagnosis.
If the dermatologists at Sloan Kettering are using dermoscopy with their biopsy specimens, if I have succeeded in having a dermatopathologist add such information to the report I received, then why can't other podiatrists consider doing the same?There are laboratories out there that will include dermatoscopic images in their reports.
Brian, I believe you have lectured on dermoscopy, Any podiatric laboratory that has you as a consultant is very fortunate.
"What makes you think that a dermatopathologist would know what he or she is looking at when given a dermatoscopic image."
I went to google and typed in the words "dermatopatholgist and dermoscopy"
I found this link: https://www.ncbi.nlm.nih.gov/pubmed/18087006
Dr. McClain was one of the authors of the article. So is Dr. Marghoob who lectured at Memorial Sloan Kettering during the 2 day intensive seminar 2016.
McClain Laboratories has Dr. McClain who I believe is a dermatopathologist.
There are other dermatopathology labs. If a dermatopathologist is not familiar with dermoscopy, they can probably ask for help from a podiatry consultant that knows about this modality. Dermatopathologists also can attend future dermoscopy courses such as the intensive 2 day course held at Memorial Sloan Kettering.
I was finally successful in having a podiatric pathology report sent back to me with a copy of the dermatoscopic image taken from my Dermlite 4. This sets a new standard in podiatric pathology reporting which I believe will be the future gold standard.
What makes you think that a dermatopathologist would know what he or she is looking at when given a dermatoscopic image.
Anyway, the discussion is way overdone at this point and it is time to move away from pseudopods.
Dan, I am concerned at the volume of your posts and tendency to mix several issues. Back to pseudopods....again even if seen on a slide it is a designation of architecture, geometry or configuration. It is not a cellular level parameter. I applaud your diligence on learning this technique but putting verbiage in these posts that is foreign to most if not all of your colleagues in question form creates confusion.
Brian, thankyou so much for sharing your opinion.
1. Dermoscopy is a huge topic and contains a lot of volume.
2. There are several issues that are mixed into this subject matter.
3. Foreign verbiage is needed anytime a new topic is brought up.
4. Even if pseudopods are not a cellular level parameter, their distribution as seen on a dermatoscopic image contributes valuable additional information. This better enables the dermatopathologist to make a more accurate diagnosis.
5. If a podiatrist is not experienced at interpreting strutures, they still may be performing biopsies of dermatologic lesions. Once a decision is made to biopsy, this is an opportunity for even inexperienced podiatrists to send dermatoscopic pictures to an experienced dermatopathologist with the biopsy specimens. Such additional information can ultimately lead to a more accurate dermatopathology report.
Brian, you are a wonderful teacher and I appreciate all that you have taught me. Thank you.
Jeff, of course you are not wrong but in a typical podiatry day there are not enough instances to look at skin specifically in enough volume to become proficient quickly. However, you have to start somewhere and if one has patience and takes courses and LOOKS AT LESIONS regularly, proficiency will occur.
Thank you. I believe you answered the medico-legal implications of a missed or mis-diagnosis.
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