Dr. Ata Moshiri highlights his lecture From Report to Reality: Understanding Pathology Results at the 2nd Annual Elevate-Derm Alliance Summer Conference in Park City, Utah at the Grand Hyatt Deer Valley.

In this video

In this conversation with dermatology NP Veronica Richardson, Dr. Ata Moshiri — assistant professor of dermatology and dermatopathology, Dermatopathology Laboratory Operations director, and Dermatopathology Fellowship director at NYU Langone — returns to the adage "garbage in, garbage out." A dermatopathologist is only as good as the tissue provided, so he urges APPs to send a representative sample from the right area: shave small, superficial lesions when you can capture most or all of the lesion, and punch anything that's a rash or deeper — "if it's a rash, the easiest thing to do is just punch it." He makes the case against tiny plugs, noting a two-millimeter punch may not survive processing, can be hard to extract from the tool, and sometimes arrives as an empty bottle; he'll settle for a three-millimeter punch but prefers four.

Moshiri stresses that information matters as much as tissue. Blank forms, reflexive "rule out NMSC," or a bare "rule out melanoma" leave the pathologist guessing, whereas a clinical impression, history, and differential change how a specimen is handled, what's looked for, and which ancillary tests are ordered — all in service of clinicopathologic correlation. He frames a finalized report as often the beginning of the conversation rather than the end, inviting clinicians to call, text, or email whenever wording doesn't make sense. As he puts it, the clinician is the pilot and the dermatopathologist the co-pilot, working as a team toward "a smooth flight" for a patient who belongs to them both.

  • "Tissue is the issue": send a representative sample from the right area — shave small, superficial lesions you can fully capture, and punch rashes or deeper processes to see epidermis, dermis, and subcutis.
  • Avoid one- and two-millimeter punches — they don't send enough tissue, are hard to process and extract, and can arrive as empty bottles; three millimeters is the minimum, four preferred.
  • Fill out the path form with real clinical detail — impression, history, differential, and whether the lesion is solitary or widespread — because it changes how specimens are handled and what tests are run.
  • A blank form or a mismatched "rule out" can send the pathologist down the wrong path; the more information, the more likely the diagnosis is right the first time.
  • Don't fear calling your pathologist — the report is often the start of the conversation, not the end; communication is what makes the clinician–dermatopathologist team effective.