Vivas A, Kirsner RS. Practice Gaps—Submitting Clinical Photographs to Dermatopathologists to Facilitate InterpretationsComment on “The Utility of Clinical Photographs in Dermatopathologic Diagnosis: A Survey Study”. Arch Dermatol. 2010;146(11):1308-1309. doi:10.1001/archdermatol.2010.316
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Advances in immunohistochemical stains, molecular analysis, and laboratory technology have facilitated dermatopathologic diagnostic accuracy. Nevertheless, patients and clinicians are often frustrated when dermatopathologists render nonspecific diagnoses, which may lead to diagnostic and/or therapeutic uncertainty. Given the importance of clinicopathologic correlation (CPC), a practice gap exists between what dermatopathologists desire and what the clinicians provide.1,2
Mohr et al point out that one of the most important tools used to assist accurate dermatopathologic diagnosis is the information supplied on the dermatopathology form accompanying tissue specimens. They also report that dermatopathologists find the addition of a clinical photograph useful in rendering a microscopic diagnosis, especially when dealing with inflammatory skin diseases. The use of clinical photographs may be particularly helpful when dermatopathologists receive specimens with an inadequate clinical description on the dermatopathology form, which may be more of a concern with specimens submitted by nondermatologists who have less CPC experience.
Although clinical photographs are desired, it is extremely infrequent for a dermatopathologist to be provided with one. Barriers to sending clinical photographs with biopsy specimens include the time it takes to create and implement standard operating procedures (SOP), which include identifying the body region to be photographed, obtaining consent from the patient, taking the digital photograph, downloading the photographic file, labeling the photograph, and either printing or electronically sending the picture to the pathologist. Other barriers are limited computer file storage space; costs of obtaining 1 or more digital cameras for the physician office; and compliance with the secure data transfer standards of the Health Insurance Portability and Accountability Act and Health Information Technology for Economic and Clinical Health. It is also possible that some patients may object to photography, particularly of specific body parts.
This gap between what dermatopathologists desire and what the clinicians provide can be narrowed by improving the quality of information supplied by the clinician to the dermatopathologist. Education directed at office efficiency should include instruction on efficient processes to incorporate patient photography. Mohr et al underscore that patient care will benefit when clinicians improve the quality and quantity of the information provided, and they encourage incorporation of photography as part of routine biopsy procedures. Development of a more comprehensive way of communicating information to dermatopathologists is needed. Clinician-friendly pathology forms and reminder systems to include clinical photographs may help.
Considering patient volume and increasing time limitations of office visits, it would optimal for clinicians to train an assistant to take and process the photographs for relevant patients. The SOP should be defined for this process to assist personnel in implementation without loss of efficiency. Creating an SOP for a proper and complete provision of information including completion of requisition forms and taking clinical photographs will help establish uniformity of photographic information to the dermatopathologist.
Hard copies of photographs are not always necessary. Digital technology provides a variety of media to safely transmit images, including secure Internet connections and storage on compact discs and flash drives, to protect the confidentiality of patient photographic information, usually considered personal health information. Data transfer between dermatologists and dermatopathologists can be optimized to maximize the quality of dermatopathology diagnosis.
Correspondence: Dr Kirsner, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB, Room 2023-A, Miami, FL 33136 (firstname.lastname@example.org).
Financial Disclosure: None reported.