Dermatopathology Pathology Assessment Form
Assess a dermatopathology pathology case by entering specimen details, clinical context, key microscopic findings, diagnostic impression, and follow-up recommendations.
Case Identification
Specimen/Case Reference
*
Referring Clinician
*
Specimen and Clinical Context
Specimen Type
*
Biopsy
Excision
Shave
Punch
Curettage
Other
Anatomical Site
*
Clinical History / Indication
*
Dermatopathology Assessment
Diagnosis Impression
*
Benign
Inflammatory/Dermatosis
Premalignant
Malignant
Indeterminate
Other
Diagnostic Confidence
*
Low confidence
1
2
3
4
5
6
7
8
9
High confidence
10
1 is Low confidence, 10 is High confidence
Microscopic Features
*
Rows
Absent
Mild
Moderate
Marked
Epidermal change
1
2
3
4
Dermal inflammatory infiltrate
5
6
7
8
Margin involvement
9
10
11
12
Cytologic atypia
13
14
15
16
Special features
17
18
19
20
Interpretive Comments / Notes
Follow-up Recommendation
*
No further workup
Clinical-pathologic correlation
Additional levels/ancillary studies
Re-excision recommended
Specialist review suggested
Other
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