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Dermatopathology: Practical & Conceptual July - September 2007
3. Question: Dermatopathologist, do you really need a microscope?
Mihaela Costache, M.D.
The assessment of sections at scanning magnification is an essential step in making a diagnosis in dermatopathology, but the inspection of stained sections on a slide with the naked eye is almost never mentioned to be useful for coming to a diagnosis.
To identify lesions that can be diagnosed with surety with the naked eye alone in a section stained with H & E.
Sections were first studied without a microscope and a diagnosis was rendered, which then was confirmed by studying the same slide at scanning, intermediate, and high magnifications under the microscope.
Various cystic, verrucous, and fibromatous lesions can be identified with near surety even without a microscope. Some dermal proliferations also display features that can be identified with the naked eye. Criteria for diagnosis and limitations of the method presented are discussed.
A number of lesions can be diagnosed without a microscope. The method demonstrates compellingly the importance of pattern and silhouette for making a diagnosis and it creates a continuum between clinical dermatology and dermatopathology.
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