Shave biopsy for mole 3mm on right thigh on 2/2 -(Many of my "freckles" appear similar as cousins) PA did not sent out to lab . Stated it was read "in house" on 2/26 and hand written "compound moderate atypia" - no path report/no details on arch. or cellular changes nor margins. Felt unsure about practice then and certainly now - What to do next?
Shave Biopsy for Mole 3mm Did Not Sent out to Lab . Stated It Was Read "In House". What Now?
Doctor Answers (4)
In House Pathology For Biopsies
Some dermatologists look at or "read" their own biopsies under the microscope. This is commonly referred to as reading the pathology "in house." While many dermatologists are extremely skilled in this area, your question really comes down to what you are comfortable with. In order to look at a biopsy under the microscope, the biopsy has to be processed by placing it in a paraffin block and cutting the tissue to prepare slides. You are allowed to request these slides and paraffin block be sent to another physician for evaluation or a second opinion. physicians with specialized training in dermatopathology are considered the experts in looking at skin biopsies. There are a number of dermatopathology services available to patients.
Diagnosing and treating atypical moles
When a skin biopsy is read "in house", the physician looking at the microscope slide is held to the same standards as a dermatopathologist. Obviously, they are choosing to perform the service of a dermatopathologist. Therefore they are expected to generate a comprehensive report describing cell architecture, cellular changes, and tissue margins at the very least. I agree with your concern and recommend your request your glass biopsy slide be sent to a board-certified dermatopathologist for a second opinion. BTW, I will always recommend a conservative local excision with suture closure for any atypical nevi that have a "moderate" degree of atypia to ensure their complete removal.
In House Reading of Pathology
Most likely they still have the glass slide and the block of tissue (in a paraffin block). Just ask to have the slide sent to an outside dermatopathologist to review the slide and give a second opinion. It's important that you feel confident in the care that you are receiving from your dermatologist. If that isn't the case, see another doctor. That doctor can request (with your permission) your medical records and the glass slide, can review what was done, can send off the glass slide for a second opinion from a dermatopathologist and can make sure that you don't develop any skin cancers or atypical moles in the future. Good luck.
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Reading moles in-house
This is a tough question to answer, but I will say this: if you don't feel like you got good care, go somewhere else. You should always feel confident that you are being heard and well taken care of. There is no way to get the tissue read again or looked at, and if they claimed it was read "in-house" that's on them. (I will say though that removing something on 2/2 and reading it on 2/26 is nuts, usually tissue is read within a few days max!) They need to be confident that what they are doing is medically sound, correct, and in the best interest of their patients. Most physicians will send biopsies out to be read by a lab. If that makes you more comfortable, ask and verify that your next physician does this. So, in your best interest, find a new physician and tell him/her what happened at the last doctor so they can watch the site or any other similar spots for atypical growths or changes.