When dealing with skin specimens, the pathologist relies on the clinician to perform the most important part of the gross tissue examination, while the lesion is in vivo. Good communication between clinician and pathologist is imperative to ensure the most accurate histologic diagnosis.
The specimen requisition need not include all the details of the patient's history and physical; however, a pertinent history can be critical. The checklist to the right lists the most important information that should be included on the requisition for a skin specimen.
The pathologist interpreting the skin biopsy specimen should be someone in whom you have confidence and with whom you have close and excellent communication. A laboratory handling a significant number of skin specimens should have as a member of its professional staff a board-certified dermatopathologist. When choosing a laboratory, it is also important to consider the future care of the patient. A patient with a significant skin malignancy could potentially require extensive surgery, lymph node examination, radiation therapy, and chemotherapy during his/her treatment course. One obvious advantage to using a local, hospital-based laboratory is that in such complex patient scenarios, the pathologist not only serves the role of diagnostician, but also acts as the hub through which important clinical, diagnostic, and staging information is disseminated to various clinicians participating in the patient's care. Additionally, it is helpful to have a biopsy archived "in house" when a patient has a follow-up surgical excision.
The pathology report you receive should include a concise, accurate diagnosis and, when appropriate, a comment on the adequacy of surgical margins. The report may also include information pertaining to tumor grade, pathologic stage, and recommendations for follow-up and/or further treatment.
Finally, sometimes the best way to diagnose skin cancer is to have the patients do it themselves! A skin self-exam (like a breast self-exam) is a great way to get patients involved in their health care. No special equipment is necessary - all patients need is a bright light and a mirror (older patients might require a magnifying glass). Patients with a personal or family history of skin cancer should be educated in the signs and symptoms of skin cancer and perform a self-exam monthly. Recommendations on skin cancer screening by a physician vary widely - from no formal recommendation to recommending annual screening for all adults.