Atlas of Surgical Pathology Grossing

This book is a unique surgical pathology grossing atlas, comprised of a collection of photos of various anatomic specimens frequently encountered in routine and frozen surgical pathology practice, including various organ systems. The photos in this atlas have been collected over many years of practicing surgical pathology in one of the largest medical centers in the world, and include emphasis on important anatomic landmarks and explanations on how to properly orient, section and sample anatomic specimens. The use of actual gross images allows readers to more readily apply the grossing tips to actual specimens that they encounter at the grossing bench. Each chapter is arranged by organ system and includes essential tips for grossing each specimen and sample dictations with all the essential elements that must be addressed for proper assessment of each organ specimen.

Written by expert pathologists, Atlas of Surgical Pathology Grossing is an excellent resourcefor pathologists, medical and pathology assistant students, residents, both in surgery and pathology, and pathology assistants.

• Language: English
• Publisher: Springer
• Release date: Jul 3, 2019
• ISBN: 9783030208394

Book preview

© Springer Nature Switzerland AG 2019

Monica B. Lemos and Ekene Okoye (eds.)Atlas of Surgical Pathology GrossingAtlas of Anatomic Pathologyhttps://doi.org/10.1007/978-3-030-20839-4_1

1. Skin

Monica B. Lemos¹   and Patricia Chevez-Barrios¹, ²

(1)

Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA

(2)

Weill Cornell Medicine, New York, NY, USA

Monica B. Lemos

Email: [e-mail]

Keywords

SkinExcisionOrientationMarginsEllipsePigmented lesionO’clock position

Dermatologic specimens, including skin biopsies and skin excisions, are commonly encountered in the surgical pathology grossing suite. This chapter focuses on skin excisions and provides instruction on how to properly handle such specimens.

Skin Excision

Skin excisions are performed primarily for complete removal of a lesion and to ensure accurate diagnosis of the lesion in question. Skin excisions are often in the shape of a circle or ellipse , but they can have irregular or non-symmetrical shapes. (For specimens with complex shapes, a picture or diagram made before sectioning can be a useful tool). Margins include all of the soft tissue that was cut by the surgeon deep to the skin surface.

Orientation is often indicated by the surgeon with sutures. It is frequently designated in terms of clock positions (1 o’clock to 12 o’clock all around). Typically, 12 o’clock is at the superior-most portion, 3 o’clock and 9 o’clock are at the medial and lateral positions, and 6 o’clock is at the inferior-most portion (Figs. 1.1, 1.2 and 1.3). Inking is performed in such a way that this orientation can be reconstructed while examining the specimen microscopically, so that if microscopic lesions are detected close to or involving a specific margin, the location of the positive margin can be accurately conveyed to the surgeon, in order to aid in a more localized and precise re-excision, if necessary (Figs. 1.4, 1.5 and 1.6).

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Fig. 1.1

Skin excision: orientation. The excision specimen is oriented with a long stitch placed by the surgeon at 12 o’clock and a short stitch at 9 o’clock. An ulcerated lesion can be clearly seen at the center, with a surrounding area of normal skin extending to the margins circumferentially