Letters

Is histological examination of tissue removed by GPs always necessary?

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7133.778a (Published 07 March 1998) Cite this as: BMJ 1998;316:778

Even specialists get the clinical diagnosis wrong

  1. P Cross, Consultant histopathologist
  1. Department of Cyto-Histopathology, Queen Elizabeth Hospital, Gateshead NE9 6SX
  2. Department of Dermatology, Royal Liverpool and Broadgreen Hospitals Trust, Liverpool L69 3BX
  3. Department of Histopathology, Northern General Hospital NHS Trust, Sheffield S5 7AU
  4. Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
  5. Greenwood Institute of Child Health, Leicester LE3 0QU
  6. Queen Victoria Hospital, Morecambe, Lancashire LA4 5NN
  7. Royal Lancaster Infirmary, Lancaster LA1 4RP

    EDITOR—Because of increasing workloads and perceived lack of important diagnoses Lowy et al advocate that general practitioners should not routinely send skin tissue specimens for histological diagnoses unless they “have even a slight suspicion that the lesion may be serious.”1 As a histopathologist I agree that the vast majority of skin biopsy specimens from general practice are of no clinical consequence. However, this can be said only when the specimens have been sent for histological examination.

    Most general practitioners who excise skin biopsy specimens are not trained dermatologists, and even the most “obvious” clinical lesion may not turn out to be what it was thought to be. This happens even to experienced specialist surgeons. A policy of selective histological referral when the doctor is not necessarily an expert dermatologist will certainly miss important diagnoses, but it also misses the basic point that these specimens are diagnostic and, once lost, can never be retrieved. It is also, I would argue, on dubious grounds legally if complications should develop. I am unaware of any histology department that has succumbed to “laboratory chaos,”2 and both doctor and patient are grateful for the dialogue and reassurance that examination of these specimens gives them. I will certainly not be changing my advice to general practitioner colleagues on the basis of this article alone.

    References

    1. 1.
    2. 2.

    Clinically important skin lesions would have been missed with a selective histological approach

    1. Richard Parslew, Senior registrar,
    2. Lesley Rhodes, Consultant
    1. Department of Cyto-Histopathology, Queen Elizabeth Hospital, Gateshead NE9 6SX
    2. Department of Dermatology, Royal Liverpool and Broadgreen Hospitals Trust, Liverpool L69 3BX
    3. Department of Histopathology, Northern General Hospital NHS Trust, Sheffield S5 7AU
    4. Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
    5. Greenwood Institute of Child Health, Leicester LE3 0QU
    6. Queen Victoria Hospital, Morecambe, Lancashire LA4 5NN
    7. Royal Lancaster Infirmary, Lancaster LA1 4RP

      EDITOR—Lowy et al compare a selective and non-selective approach by general practitioners to submission of skin lesions for histological assessment.1 They suggest that histological evaluation of all tissue specimens is work intensive, is not a cost effective means of detecting serious skin pathology, and does not pick up clinically important lesions that could have been missed by a more selective approach.

      We performed a 25 year retrospective analysis of all histologically confirmed malignant melanomas diagnosed in our university hospital …

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