Skin Biopsies - Why Are the Reports Always So Vague?

I expect we have all received a histology report that says ‘superficial perivascular dermatitis’ and most of us will wonder what that means. So, why are so many pathology reports so vague and so ‘unhelpful’?

A skin biopsy is one of the most powerful tools in dermatology because many conditions have pathognomonic histology/cytology. However, the skin can only respond to insult in a defined number of ways and so subtleties of clinical and pathological evidence may be required to differentiate the differential diagnoses. Although a morphological diagnosis is generally seen as being clinically unhelpful it is unreasonable to expect the pathologists to ‘guess’ the diagnosis based solely on the histological evidence, particularly when tissue is collected inappropriately. The clinically significant outcome (diagnosis) is heavily dependent upon the information supplied with the biopsy and the care taken in sample collection and handling. The correct choice of sample is often overlooked in favour of ease of collection.

A biopsy can of course be diagnostic but in some circumstances, even when a definitive/precise diagnosis cannot be made, it can be very useful as a diagnostic ‘rule-out’; it may also be helpful in establishing the type of disease to consider.

The pathologist cannot be expected to make a diagnosis without supportive information. Therefore, all available information should be supplied to the pathologist (photographs annotated to indicate the sites of biopsy are a really useful addition). […]