How Often Do Additional Levels on Cutaneous Specimens Influence the Final Diagnoses Made on Microscopy? Under What Specific Scenarios are Additional Levels Most Useful?

Summary: Histopathologic evaluation plays a pivotal role in diagnosing cutaneous pathologies, from benign lesions to malignant tumors. While initial histologic sections are often sufficient, additional levels may be requested to confirm a diagnosis or exclude serious conditions, such as melanoma. This study investigated how often additional levels impacted the final diagnosis. A two-month prospective analysis was conducted on skin specimens reviewed by principal dermatopathologist (HS). Key variables included biopsy type (punch vs. shave), lesion type, grossing method (whole vs. sectioned), and availability of clinical history. Of 207 cases reviewed, 15% (31 cases) required additional levels. Clinical history was provided in 87.1% of these cases and 70.97% were submitted whole rather than sectioned. Among these, 19.35% (6 cases) resulted in a revised diagnosis (e.g., no lesion to lentigo, nonspecific folliculitis to molluscum), while 80.65% (25 cases) confirmed the initial diagnosis. Melanocytic specimens predominated in both groups. These findings emphasize the importance of additional levels in refining dermatopathological diagnoses in a small subset of cases, with implications for clinical management. Levels are most often utilized when evaluating melanocytic neoplasms or when biopsy size limits gross sectioning. By understanding these trends, we can enhance diagnostic accuracy and improve skin biopsy practices, benefiting patient care.