The history of the microscope reflects advances in science and medicine.

Microscopes, more than any other instrument, reflect advances in clinical medicine over the past several hundred years. As the primary tool of the pathologist, they were, and continue to be, a key connector between the bedside and basic sciences. One specific example is the science of clinical dermatology, which relies on clinical-pathologic correlation to make a definitive diagnosis. The microscopes used by pathologists, however, are more than scientific artifacts. Many antique microscopes are hand-crafted works of art. Even while recognizing that light microscopes may soon be obsolete as scanned slides and computer joy-sticks replace optical instruments in patient care and teaching, their significance will not be diminished. The microscope will never be forgotten in the history, art, and science of medicine, for these instruments set the social and cultural stage for modern, scientific patient care.

Clinical-pathologic correlation: The impact of grossing at the bedside.

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 form.3-5 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.

hTERT Epigenetics Provides New Perspectives for Diagnosis and Evidence-Based Guidance of Chemotherapy in Cancer.

Strong epigenetic pan-cancer biomarkers are required to meet several current, urgent clinical needs and to further improve the present chemotherapeutic standard. We have concentrated on the investigation of epigenetic alteration of the hTERT gene, which is frequently epigenetically dysregulated in a number of cancers in specific developmental stages. Distinct DNA methylation profiles were identified in our data on early urothelial cancer. An efficient EpihTERT assay could be developed utilizing suitable combinations with sequence-dependent thermodynamic parameters to distinguish between differentially methylated states. We infer from this data set, the epigenetic context, and the related literature that a CpG-rich, 2800 bp region, a prominent CpG island, surrounding the transcription start of the hTERT gene is the crucial epigenetic zone for the development of a potent biomarker. In order to accurately describe this region, we have named it "Acheron" (Ἀχέρων). In Greek mythology, this is the river of woe and misery and the path to the underworld. Exploitation of the DNA methylation profiles focused on this region, e.g., idiolocal normalized Methylation Specific PCR (IDLN-MSP), opens up a wide range of new possibilities for diagnosis, determination of prognosis, follow-up, and detection of residual disease. It may also have broad implications for the choice of chemotherapy.

Dermatology workforce in the United States - Part I: Overview, transformations, and implications.

The dermatology workforce continues to evolve to meet the growing and diversified demands of the US population. Part 1 of this continuing medical education series is designed to provide an overview of the dermatology workforce as well as delineate the motivators and socioeconomic implications of significant workforce transformations which are impacting dermatologic health care. Part 2 of the series will consider the impact of workforce challenges on patient outcomes and discuss potential actions that may help to optimize workforce organization and care delivery.

Dermatology workforce in the United States - Part II: Patient outcomes, challenges, and potential solutions.

This continuing medical education (CME) series assesses key features and ongoing transformations within the dermatology workforce. Part 1 of this series described precipitants and implications of recent workforce changes. Part 2 reviews the influence that these workforce dynamics have had on patient access, outcomes, and satisfaction. Additionally, it assesses potential solutions for optimizing care for underserved groups and the broader dermatologic patient population.

Dermatopathologic features of cutaneous squamous cell carcinoma and actinic keratosis: Consensus criteria and proposed reporting guidelines.

BACKGROUND: There is considerable variation in the literature regarding the dermatopathologic diagnostic features of and reporting guidelines for actinic keratosis (AK) and cutaneous squamous cell carcinoma (cSCC). OBJECTIVE: To develop consensus recommendations regarding diagnostic criteria, nomenclature, and reporting of AK and cSCC. METHODS: Literature review and cross-sectional multiround Delphi process including an international group of expert dermatopathologists followed by a consensus meeting. RESULTS: Consensus was achieved regarding the key dermatopathologic features necessary for diagnosing cSCC, AK, and associated variants; grading of degree of cellular differentiation in cSCC; utility of immunohistochemistry for diagnosis of cSCC; and pathologic features that should be reported for cSCC and AK. LIMITATIONS: Consensus was not achieved on all questions considered. CONCLUSION: Despite the lack of clarity in the literature, there is consensus among expert dermatopathologists regarding diagnostic criteria and appropriate reporting of AK and cSCC. Widespread implementation of these consensus recommendations may improve communication between dermatopathologists and clinicians, facilitating appropriate treatment of AK and cSCC.

Bread loaf sections provide useful information on more than 0·5% of surgical margins.

It is often quoted that classic bread-loaf sectioning of excisional specimens assesses 0.5% of the margin, but careful mathematical analysis reveals that bread-loaf sectioning appraises far more than that and is an effective and economical means to check margins.

The iso-oncotopic response: immunotherapy-associated bullous pemphigoid in tumour footprints.

This case report describes a unique distribution of bullous pemphigoid induced by cemiplimab therapy. The patient preferentially developed bullae in the scar "footprints" of previous non-melanoma skin cancers, yet traumatic scars were spared. We propose to describe this distribution as an 'iso-oncotopic response'.

Adult colloid milium is clinically distinguishable from its histopathologic mimic cutaneous amyloidosis.

Colloid milium, also known as colloid degeneration of the skin or dermal hyalinosis, is a cutaneous deposition disease that presents as three subtypes: juvenile, nodular, and adult. Adult colloid milium is characterized by amyloid-like depositions in the dermis, mimicking cutaneous amyloidosis histologically. A 70-year-old man presented with lesions on the sun-exposed skin of the face, dorsal hands, and dorsal forearms resembling adult colloid milium. A punch biopsy was performed on the left zygoma and histopathological features were consistent with this diagnosis, though cutaneous amyloidosis was considered. A case of adult colloid milium is presented to emphasize the clinical and histopathologic differentiation from cutaneous amyloidosis.

Clinical interventions aimed at expanding access to dermatologic care.

In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-specific research. It is clear that dermatologists, using a "bottom up approach," can significantly expand access to care in their communities in a manner that is economically viable and maintains quality of care and patient satisfaction.

The ethical foundation for honesty and the focused use of deception in dermatology.

Physicians have a fiduciary duty to be honest and to act in the patients' best interest. There are times when these two duties conflict. Honesty is paramount in supporting the physician-patient relationship and loss of patient trust is devastating. Furthermore, even minor deception can suggest a return to the physician authoritarianism of the past century that has been decried by modern ethicists. Nonetheless, circumstances can arise in which good judgement may require less than complete honesty to avoid harm to the patient. If the benefit for the patient is large and the risk from deception is small, thoughtful application of minor deception could be designed to benefit patients. Of course, research is required to fully assess this strategy.