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Inadequate Biopsy Technique and Specimen Size: An Alarming Trend That Compromises Patient Care and an Appeal to Our Clinical Colleagues

Klaus Sellheyer, MD; Paula Nelson, MD; Wilma F. Bergfeld, MD
Arch Dermatol. 2010;146(10):1180-1181. doi:10.1001/archdermatol.2010.293.
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With changes in the delivery of health care in America looming, dermatologists may increase the number of patients they see per time unit and biopsies they perform in an attempt to balance declining reimbursement rates. In addition, roughly one-third of dermatologists employ physician extenders.1 While this is often done with the explanation of a shortage of dermatologists, it may be also motivated by the desire to increase revenues.

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Various biopsy specimens are depicted showing inadequate technique and/or specimen size submitted by health care providers to our dermatopathology practice for evaluation. A-C, Superficial curettage specimen of melanoma. The arrow in A points to the area shown at higher magnification in B; C represents the accompanying melan-a stain. D, Superficial curettage specimen obtained to rule out chondrodermatitis nodularis helicis. Only the superficial papillary dermis was sampled and is present focally only. The typical architectural features of the disease cannot be evaluated, thus precluding a definitive diagnosis. E, This 2-mm punch biopsy specimen extends into the upper reticular dermis only. It was performed to rule out a folliculitis. Despite step sections through the block, a hair follicle was not noted. F, This superficial shave biopsy specimen extends into the midepidermis only, despite step sections. The intended purpose of the biopsy, to rule out basal cell carcinoma, could not be achieved by histopathologic examination. G, This shave biopsy specimen of the scalp was submitted to rule out alopecia areata. Specimens A, D, and F were obtained by board-certified dermatologists; E and G, by physician assistants. Hematoxylin-eosin was used in all specimens except panel C, for which melan-a was used; original magnifications for panels A, B, C, D, E, F, and G were ×12.5, ×200, ×200, ×50, ×50, ×25, and ×25, respectively.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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