Available online 5 January 2024

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The unenlightened clinician may submit a skin specimen to the lab and expect an “answer.” The experienced clinician knows that in performing skin biopsies, it is critical to select the most appropriate: 1) anatomic location for the biopsy1,2; 2) type of biopsy1,2; 3) depth and breadth of the biopsy; and 4) medium for hematoxylin and eosin staining (formalin) or direct immunofluorescence (Michel's Transport Medium or normal saline)2. Demographic information, anatomic location, clinical context, and differential diagnosis are all critical components of a properly completed requisition form3,4,5. Proper biopsy design and appropriate grossing of the tissue at the bedside should be added to this list. In this article, we review the basics of gross pathologic examination and then provide four examples to demonstrate that optimal clinical-pathologic correlation requires the clinician consider the needs of the pathologist when tissue is presented to the lab.

Section snippetsClinical-pathologic correlation starts and ends in the clinic

Gross examination (or simply, grossing) involves the macroscopic inspection of specimens. When large tissue specimens or organs are received, the pathologist must decide which portions of the specimen will be submitted for microscopic examination6,7,8. In the case of skin biopsies, the entire specimen is nearly always submitted for analysis. Specimens are described, measured, inked to establish margins, and divided. Typically, dermatopathology lab manuals call for the vertical bisection of

#1 Porokeratosis of Mibelli (PM)

The potential for a correct pathologic diagnosis is increased if punch specimens are properly bisected at the bedside. Porokeratosis is an uncommon disorder of keratinization that presents clinically with scaling plaques surrounded by a characteristic thin, raised border that corresponds to the hallmark histologic feature of porokeratosis: the cornoid lamella14,15. A biopsy sectioned perpendicularly to the cornoid lamella demonstrates a column of parakeratotic cells arising from a depression in

A final note for the Grossing Technician

When a bisected punch biopsy specimen is submitted in one container, the grossing technician should place the straight/cut edges in the block for first sectioning on the microtome. The two specimens can be placed side-by-side in the same block.

Figure 1 demonstrates four potential histopathologic sections based upon these, less than ideal, cuts in relation to the cornoid lamella. Figure 1A displays a parallel cut outside the clinically apparent ring and results in a diagnosis of normal skin.

Declaration of competing interest

The authors have no relevant financial conflicts of interest to disclose.

Acknowledgements

We would like to thank Kyle Cunningham for providing the illustrations depicted in this article.

Funding Sources

None

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