The term "grossing" means inspecting the specimens, describing and measuring the tissue, inking if needed, and sectioning the tissue to be processed for diagnosis. The skin sample provides the most diagnostically valuable specimen parts for the pathologist's review. The gross description includes information that aids the dermatologist or dermatopathologist in rendering a diagnosis during microscopic evaluation of the tissue.
Although the topic of skin gross examination is too broad (and varied) to be covered in this course, the content reflects the most common grossing practices in the dermatopathology laboratory. Gross examinations can be performed by pathologists, dermatologists, pathologist assistants, and lab personnel qualified to perform high-complexity testing per CLIA '88.
General Considerations During Gross Examination
- First and foremost, the patient information on the requisition and the specimen container must match. This includes at least two patient identifiers and the specimen site(s). Requisitions typically identify the surgical procedure, such as punch, shave, excision, etc. Any missing, conflicting, or unclear information must be investigated before proceeding. Also, the cassette number/ bar code must match the specimen and the requisition. Most errors occur during this pre-examination phase.
- The grossing station must be well-ventilated to prevent inhalation of formaldehyde fumes. Personal protective equipment (PPE) should include disposable gloves, lab coats, and eyewear. Blades and sharps used during grossing must be disposed of in approved biohazardous "sharps" waste containers.
- One specimen container should be opened simultaneously during grossing to prevent mix-ups.
- The number of pieces in each container should be noted. In the case of curettage, samples are measured in aggregate since over a dozen fragments may be submitted.
- Skin tissue's color description is often "tan, black, or brown." Unusual skin surface or pigmentation should be noted.
- Measurements of the skin surface dimensions and depth should be documented. Any tissue that is small enough to slip through the "open slots" of a tissue processing cassette should be submitted whole and wrapped in processing tissue paper, on sponges, or in a processing mesh bag.
- Tissue should be inked only if it conveys information such as orientation and margins in excisions or which side to embed down. Inking cut surfaces of tissue one color will help the embedding tech determine which surface should be embedded down, where inked surfaces will meet the blade first during the microtomy process. Inking is typically reserved for excisions. Inking margins on biopsies is unnecessary since a second procedure is anticipated based on the biopsy's diagnosis.
- Tissue should be sectioned according to accepted protocols for the laboratory. Generally, the sections should be approximately 3–4 mm thick/wide. Skin grossing protocols must be standardized for all grossing personnel so that the results are consistent and quality is reproducible.
- Tissue should be submitted for the appropriate paraffin processing protocol, such as biopsy or routine processing.
Although most grossing techs are not familiar with the embedding and microtomy of tissue, familiarity with those techniques is a necessary prerequisite to ensure the quality of grossing in dermatopathology. Isn't the focus of grossing, after all, the proper embedding of a skin sample?
