Dermatopathology: Understanding the Pathology Report, Basic Biopsy Tips

Arash Mostaghimi, MD, MPA, MPH

Credit: swhr.org

At the Society of Dermatology Physician Assistants (SDPA) 2023 Annual Summer Dermatology Conference, Arash Mostaghimi, MD, MPA, MPH, gave a presentation titled ‘Introduction to Dermatopathology: Understanding the Pathology Report and Basic Biopsy Tips.’

Mostaghimi is known for his work as an Assistant Professor of Dermatology, as Director of the Dermatology Inpatient Service, and as Co-Director of the Complex Medical Dermatology Fellowship for Brigham & Women’s Hospital.

In the talk, he highlighted some of the most important things to remember once clinicians have a biopsy, reviewing how to make sure doctors receive the right information from a biopsy, and how to interpret confusing results.

“So when thinking about biopsies, it’s something that we do all the time, right?” Mostaghimi explained. “...For us it is so standard and so fast that we don't really pause and think about it, and some of the things we're doing subconsciously. I'm going to argue there are a lot of them we should be doing more actively, more consciously.”

Mostaghimi expressed his view that when biopsies are being performed, the steps that need to be taken involve looking at one’s intent.

“When you're ruling something out that you care about, it’s a little different and you don't care about what it is,” he said. “You care about what it’s not. It’s a really different way of looking at it, right? So when it comes back and it doesn't say something bad, you feel good. You don't particularly care if you get an answer."

He added that when clinicians make sure to ask themselves why they are performing biopsies, they come across the realization that the test is being done at the wrong time, for the wrong reasons.

“The ideal way to use dermatopathology is when dermatopathology can give you a really, really clear answer,” he said. “When you can't get one clinically.”

The first big step of biopsies, Mostaghimi stated, is choosing where to biopsy. He added that another major question to ask oneself is ‘How hard is it for this patient to return to my office to be able to do these additional things if they have to?’

“A lot of that comes into the basic socioeconomics of the patient, who has to take time off, have a transportation system, and have a phone call at which can reach them,” Mostaghimi noted. “For a lot of our patients, this is not something that we can do in a day or more than once.”

He also mentioned that a major question to discuss with a patient is what his or her insurance coverage may be, as it should influence certain decisions.

“If you have to be parsimonious with the evaluation, because the patient is paying out of pocket, you might much rather go in sequence and hit an answer versus all this stuff in which only 10% is necessary,” Mostaghimi stated. “These are times where it's very nice to be open with the patient and to do shared decision making.”

Mostaghimi added that clinicians should ask themselves how to ensure that they are doing the right biopsy to get the right answer in this scenario, which is based on the anatomy of a patient.

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The quotes contained in this description were edited for clarity.