Document Detail

Utility of step sections: demonstration of additional pathological findings in biopsy samples initially diagnosed as actinic keratosis.
MedLine Citation:
PMID:  10768645     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To discover additional diagnostic findings on step sections of biopsy samples showing features of actinic keratosis on the initial section and to correlate such findings with clinical and histological variables. DESIGN: Prospective study comparing initial histological findings with those noted on deeper tissue levels. SETTING: University-based dermatopathology practice. PATIENTS: Fifty-seven patients (36 men and 21 women) with biopsy samples from 69 skin lesions. MAIN OUTCOME MEASURES: Identification of additional pathological diagnoses in step sections and correlation with clinical diagnosis, size and location of lesion, history of skin cancer or immunosuppression, size and handling of specimen, and presence of ulceration on the initial level. RESULTS: Additional diagnostic findings were present on step sections in 23 specimens (33%), including 9 (13%) with squamous cell carcinoma in situ, 3 (4%) with basal cell carcinoma, and 2 (3%) with invasive squamous cell carcinoma. Three variables were significantly correlated with the discovery of cancer on step sections: (1) ulceration on the first level, (2) clinical diagnosis of skin cancer, and (3) history of skin cancer diagnosed by biopsy examination. The latter 2 variables were also correlated with the discovery of any additional finding, whether benign or malignant, on step sections. CONCLUSIONS: In biopsy samples initially diagnostic of actinic keratosis, examination of step sections contributes clinically important information. Step sections are particularly useful when a clinical diagnosis of skin cancer is present. The results of this study confirm the pathogenetic importance of actinic keratosis as a precursor to fully evolved malignant neoplasia and suggest that such lesions merit thorough histological study.
H R Carag; V G Prieto; L S Yballe; C R Shea
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of dermatology     Volume:  136     ISSN:  0003-987X     ISO Abbreviation:  Arch Dermatol     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-05-04     Completed Date:  2000-05-04     Revised Date:  2008-03-17    
Medline Journal Info:
Nlm Unique ID:  0372433     Medline TA:  Arch Dermatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  471-5     Citation Subset:  AIM; IM    
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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MeSH Terms
Aged, 80 and over
Biopsy / methods
Carcinoma, Squamous Cell / pathology
Histological Techniques
Keratosis / pathology*
Middle Aged
Prospective Studies
Skin / pathology*
Skin Neoplasms / pathology
Sunlight / adverse effects*
Comment In:
Arch Dermatol. 2000 Apr;136(4):535-7   [PMID:  10768653 ]
Arch Dermatol. 2001 Mar;137(3):375-7   [PMID:  11255352 ]

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