Pathologist

Pathology is the study of disease origin and it paves a way for comprehensive diagnosis of medical conditions for effective prognosis. The role of a pathologist offers significant diagnostic approach in the field of clinical laboratory science. It is important position as it requires exceptional interpretational skills associated with anatomical and physiological changes in the cells, tissues and body fluids.

Pathologists have diverse responsibilities ranging from cytology to molecular studies. Studies such as autopsy are essential in the field of forensic medicine, identification of genetic disorders and also the origin of disease. The results are interpreted by a pathologist. Biopsy on the other hand is a routine procedure for many major health complications to detect the presence of inflammatory diseases and cancer. Many important fields such as microbiology, hematology, biochemistry, immunohistochemistry, transfusion medicine come under clinical pathology, which is very important to determine the cause of any disease. Pathologists in clinical research pave the way for the discovery of new drugs and better diagnostic ventures for comprehensive patient care.

Skin Biopsy

A biopsy of the skin is done to clear what is the condition of the skin such as psoriasis, to diagnose a disease such as skin cancer and to diagnose any bacterial or fungal skin infection. A skin biopsy is routinely done in a doctor's clinic as an outpatient procedure. You have to inform the doctor if you suffer any allergies to medications, especially any adverse reactions to local anesthetics or to iodine cleaning solutions. Keep the doctor informed if you are under any medication, are pregnant or suffer bleeding problems.

Skin biopsy procedures

If it is an excision biopsy, the entire suspect skin is cut out. Excision is normally done with a scalpel and the incision is closed up by stitches. If it is a punch biopsy, a sharp cutter is used to remove a small cylinder of skin. Stitches are made to close this type of biopsy wound as well. Such punch biopsies are quick, convenient and done for small wound. A pathologist can get a full thickness view of the skin. Sometimes more than one punch biopsy is necessary. The punch biopsy blade takes a small round core of tissue ranging from 2-6mm dia although 3-4mm is the usual size.

In a shave biopsy, the outermost part of a lesion is shaved off with a scalpel. Only if the top layer of the skin is suspected, a shave biopsy is adopted. A dermatologist will take a superficial slice of skin from the area of affected with a scalpel, dermablade or a razor blade. Although there are no stitches required, there will be a small scar that should heal in about a week's time. An aspiration is used to remove the skin that is fluid filled and not solid. The doctor inserts a small needle attached to a syringe into the lesion and the fluid is sucked out.

The biopsy site is cleaned with an iodine type solution with alcohol and with a sterile soap solution. A sterile towel is placed around the area once the skin is cleaned. A local anesthetic is injected into the skin to make it numb. You may feel a brief prick and stinging sensation as the medicine is injected. The doctor can perform the biopsy once the skin is numb. Now the tissue is removed and sent to the laboratory for analysis by a pathologist. If needed, the wound is stitched up.

A bandage is wound over the biopsy site. You may also be advised to wash the wound and apply antibacterial ointment and change the bandage daily. If you experience any pain in the biopsy site, consult the doctor about medication to relieve it.

• Unexpected bleeding may occur; especially if you are on any blood thinning medications such as aspirin. For instance, arterial puncture on the forehead or temple may take time to stop bleeding.
  
  
• There could be wound infections in about 1-5% of surgeries. There could be ulcerated or crusted skin wounds. Antibiotics may be used to clear this up.
  
  
• Infection is also common in diabetics, elderly patients and those on immunosuppressive medicines.
  
  
• If large scars, called keloids, there is an increased chance of forming a scar over the biopsy site.

Melanoma

Melanoma is a type of skin cancer that develops from abnormal moles, or the pigment skin present in the skin. Because of its nature to spread to other parts of the skin, melanoma is more serious that other forms of skin cancer. It can cause serious illness and death. Derived from Greek origin 'melas' which means 'dark', melanocytes are cells that produce dark pigment called melanin which is responsible for the color of the skin. Melanoma is a most common form of cancer and the risk can increase with age. However, melanoma affects people of all ages, races, and genders and ethnicity.

Signs and symptoms

As melanoma occurs in the skin and it can be seen, patients themselves are the first to detect many melanomas. If caught early, melanomas can be cured by relatively minor surgery. However, early diagnosis and detection are crucial as it may otherwise invade healthy tissues and spread to other parts of the body making it out of control. The ABCD of melanoma can be described as:

Asymmetry: that is the shape of one half does not match with the other half.
Border: the edges are blurred, irregular.
Color is uneven and includes shades of black, brown and tan.
Diameter: there is a change in size as it increases.

Causes of Melanoma

Researchers opine that a gene known as BRAF plays a lead role in causing melanoma. As BRAF is a switch gene, it allows other cells to divide and grow. Mutations in this gene can cause explosive growth and the resultant melanoma skin cancer.

• Sunburns, especially slow daily sun exposure, even without burning.
  
• White ancestry (Caucasian)
  
• Fair skin, light hair and light colored eyes
  
• Intense exposure to sun especially during childhood
  
• Many moles in the body, to the tune of more than hundred
  
• Large irregular funny looking moles
  
• History of close relatives especially parents, siblings or children with melanoma- presence of close family melanoma is a high risk factor; although only 10% of cases run in families.
  

Melanoma can occur on any skin surface – it is common on the area between a man's shoulders and hips. For women, melanoma generally develops on the lower legs. People with darker skin develop melanoma on their palms and soles as well as under toe and fingernails.

Diagnosis of melanoma

Get the dermatologist to examine your body fully and find out whether the moles are odd. The medical term for such moles is 'atypical'. The dermatologist will perform a skin biopsy to evaluate if the mole is cancerous or not. The doctor will remove all or part of the skin under local anesthesia and send the specimen to a pathologist for analysis. The biopsy report will reveal:

• A totally benign condition that requires no further treatment, as in the case of a regular mole.
  
• An atypical mole which depends on the judgment of the pathologist to treat – either conservative removal by taking off a bit of the normal skin all around to make sure that the spot is completely out or
  
• A melanoma requiring surgery
  
• Some doctors may perform epiluminescence or dermatoscopy.
  

Melanoma treatment

Once melanoma is diagnosed as cancer and staged, then the doctor will discuss the treatment options with the patient. Treatment is based on the stage of cancer and other related factors. In case of normal moles, which are small brown spots or growths of skin that appear in the first few decades of life in almost everyone, no treatment is necessary.

People with classic atypical mole syndrome have more than 100 moles, with many moles over 8 mm diameter and one or more moles are atypical. Treatment options include Surgery, chemotherapy, and immunotherapy and radiation therapy. Sometime a combination of treatment is used. In general melanoma is treated by surgery alone. But surgery need not be extensive, as was some years ago. During early stages of melanoma, surgeons will remove only a centimeter or even less of normal tissue around the melanoma. Whereas, deeper and more advanced cancers would require extensive surgery. The removal of nearby lymph glands depend upon factors that include tumor thickness, body location, age etc. If the stage is pretty advanced, immunotherapy treatments are adopted.

Prevent melanoma

Reduce sun exposure. Perhaps avoidance of sun exposure is the best means to prevent melanoma. Wear hats and tightly woven clothing and apply sunscreens liberally when going out. Although there is a controversy among dermatologists about sunscreen protecting against melanoma, it is certainly preferred to unprotected sun exposure.

Early detection is the key to prevention. Get your skin checked at least once every few years. In the US, the American Academy of Dermatology sponsors free skin cancer screening clinics every year all over the country. Special pigmented lesion clinics have also been established in many medical centers to allow close clinical and photographic follow ups of patient with high risk. But a reference from a concerned dermatologist is essential to undergo the screening.

Any person with high risk and having a close relative who has/had melanoma should be screened by a doctor for cancer of the skin. As with any other cancer, early diagnosis and proper evaluation and treatment is the essence.