Dermatopathologist: Work with me

A dermatopathologist has a message for dermatologists whose patients need nail biopsies: Work with me.

Dermatologists can help their patients by assisting dermatopathologists with issues like nail clippings, nail templates and clinical photos, says Molly Hinshaw, M.D., an associate professor at the University of Wisconsin School of Medicine and Public Health.

Dr. Hinshaw spoke with Dermatology Times prior to her presentation titled “Tips From Your Dermatopathologist/Help Me Help You: Nail Specimens” at the summer meeting of the American Academy of Dermatology in Boston.

The first step, she says, is to choose a proper dermatopathologist, one who has experience in making clinical-pathologic correlations in nail disorders.

“Interpretation of nail specimens is a time-consuming process that relies on a thorough understanding of nail anatomy, distribution of melanocytes in healthy nail unit epithelium, pathologic processes that affect different portions of the nail unit and much more,” she says. “The report generated should assist the dermatologist in managing the patient.”

When a dermatologist sends in a nail specimen for biopsy, he or she should focus on helping the dermatopathologist visualize the cause of the nail pathology, Dr. Hinshaw says.

“One useful technique for accomplishing this is partial nail avulsion as opposed to total nail avulsion,” she says. “Partial nail avulsions can be performed transversely or longitudinally and offer the advantage of subsequent direct visualization of the nail problem as it arises from the matrix or bed. In addition, post-operative pain is better managed when the partially avulsed plate is laid back down after the specimen has been surgically removed.”

Another tip: Take special care when obtaining the nail specimen.

“My schedulers instruct patients coming to my office for a nail-related condition to grow their nails out prior to the appointment,” she says. This helps to make sure enough nail plate is available for clipping.

“I use a dual-action nail nipper for obtaining nail clippings, which has the advantages of being able to cut through even the thickest of nails and having a surface I can cover when clipping so that the fragments can be easily collected.”

Dr. Hinshaw also provides these pair of tips to fellow dermatopathologists:

• “Provide nail templates to your referring dermatologists,” she says. “These are filter papers on which is printed a drawing of a nail.  These go on a sponge in a cassette immediately after the tissue is obtained. These help keep the tissue where it should be in the cassette and keep the nail specimens from rolling and being difficult to handle in the lab.”

• “Ask your submitting physicians to submit a clinical photo with the biopsy, particularly of pigmented lesions. This will greatly assist the clinical-pathologic correlation and therefore the clinical utility of the dermatopathology report.”

Disclosure: Dr. Hinshaw reports no relevant disclosures.