Dermoscopy May Improve Pathology Interpretation of Skin Tumors Interview with:
Marc Haspeslagh, MD
Dermpat, Ardooie, Belgium
Department of Dermatology
University Hospital, Ghent, Belgium

Medical Research: What is the background for this study?

Dr. Haspeslagh: In daily practice, most pathology laboratories process skin biopsy specimens without access to the clinical and /or dermoscopic images. In pigmented skin tumors, this information can be crucial to process and diagnose the lesion correctly. With increasingly smaller diameter lesions undergoing biopsy, these focal changes are only visible with dermoscopy; therefore, communication of this dermoscopic information to the pathologist is important. In many dermatopathology laboratories, this communication is often insufficient or totally absent, and one can presume that these suspicious areas are often missed with the standard random sectioning technique that examines less than 2% of the tissue. To overcome this diagnostic limitation we developed in 2013 a new method for processing skin biopsies, were we routinely take an ex vivo dermoscopic image of most tumoral skin lesions. In combination with marking specific and suspected areas seen on the ex vivo dermoscopy (EVD) with nail varnish, EVD with derm dotting is a simple and easy method that brings this crucial information to the pathologist and in the slides to be examined (Am J Dermatopathol 2013; 35(8),867-869).

Medical Research: What is the design of the study?

Dr. Haspeslagh: Although several studies have already compared in vivo dermoscopy (IVD) and EVD, no systematic comparison by multiple observers in a real-world community setting has been performed. Therefore, 101 EVD images of consecutive tumoral skin lesions excised in a single dermatology practice were scored independently for different dermoscopic colors, structures, and vessels by 4 independent observers. We compared the results of both techniques to define similarities and relevant differences.

Medical Research: What are the main findings?

Dr. Haspeslagh: We found that EVD images are broadly similar to the IVD images, but also have clearly differences. The differences pertain mainly to the colors with appearance of more white and blue and loss of red. In general, most structures observed on IVD can also be recognized on EVD. The loss of red is mainly caused by the loss of vessel structures. These changes create an image with loss of some in vivo diagnostic characteristics like vessels, but in other lesions new important dermoscopic information appears only on the EVD. Also for evaluation of section margins and orientation of the gross specimen the EVD can be crucial. In this setting however training in dermoscopy is required for the pathologist and the technical staff.

We think that ‘EVD with derm dotting’ has the potential to improve the pathologic diagnosis of skin tumors providing direction to target tissue for processing and examination. It also enables the dermatopathologist to better understand the lesion and make a mirror correlation with the dermoscopic information. Black dots, blue zones, depigmentation zones, and areas of hemorrhage are easily traceable and find their histological explanation. We believe that this derm dotting technique of dermoscopically selected areas makes diagnosing a lesion by the dermatopathologist more fun, more accurate, and at the end makes him more confident when signing out the protocol. 

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Haspeslagh: We are actually further evaluating the effect of this technique on the margin evaluation and accuracy of diagnosis and appropriate staging of skin tumors. Moreover we will also measure the economic repercussions in term of run through time and laboratory staff. We believe that the implementation of this method has also a time and money saving effect due to a lesser need of deeper cuts.


Haspeslagh M, Vossaert K, Lanssens S, et al. Comparison of Ex Vivo and In Vivo Dermoscopy in Dermatopathologic Evaluation of Skin Tumors. JAMA Dermatol.Published online January 06, 2016. doi:10.1001/jamadermatol.2015.4766.

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Marc Haspeslagh, MD (2016). Dermoscopy May Improve Pathology Interpretation of Skin Tumors 

Last Updated on January 8, 2016 by Marie Benz MD FAAD