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Dermatology (Expert Forum)
Biopsy vs My Derm: Dueling Diagnosis
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
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Biopsy vs My Derm: Dueling Diagnosis
by BiopsyBoy, Dec 07, 2005 12:00AM
Dear Dr Rockoff,
I really enjoy this forum and the service you provide. I come to you with a situation that has been most perplexing, I suppose I'd better start at the beginning...
I went to my dermopathologist with a rash (eczema I thought) on my thighs and underside of my arms. While looking around in my pubic area he said he saw Molluscum. Ok, I can deal with that, although I told him it just appearead when the rash did. He told me to trust him and to come back in two weeks to see if they multiply...but then it got worse!
While still looking around, this time on my right inner thigh/groin (not on my genitals proper) he said "oh a wart!" I sat up with a start and looked at what didn't appear to me to be a wart, looked like a long(ish) skin tag with a slightly ragged surface. I was panicking and insisted on a biopsy, which he agreed to although he said it was not neccesary. He then surgically removed it and sent me home to panic for two weeks to await the biopsy results.
So, two weeks go by (and the so-called "molluscum" have VANISHED) and the nurse sees my panic and says the biopsy did not indicate virus and gave me a "patient copy" with very dumbed-down wording. So I asked to see the REAL version and it read as follows:
DIAGNOSIS: Inflamed Pigmented Squamous Acanthoma.
NO ATYPICAL CELLS OBSERVED
MICROSCOPIC DESCRIPTION: Sections demonstrate expansion of the epidermis by bland keratinocytes with associated cytoplasmic melanin pigmentation. Overlying hyperkeratosis is noted. There is perivascular lymphocytic inflammation.
Then I noticed a "note" that "Due to the anatomical site" that they couldn't rule out HPV. Huh??? They found nothing irregular but they just assume since someone has a lesion below their waistline that it's HPV? I asked the nurse and she said they say that kind of thing as a precaution and that the diagnosis indicated nothing atypical. She indicated it could all have come from abrasion.
Anyhow, enter the doctor who looks surprised that the "molluscum" is gone and checks the surgical site of the "wart" and claims victory. I asked why he kept calling it a wart when the biopsy found no virus-infected cells. He was just like it doesn't matter cause we made it go away. He then points to a small bump on my thumb (which has been there for years) indicated that I most likely autoinnoculated my groin while washing and proceeded to freeze off the bump with liquid nitrogen. So, now I have a huge blister on my thumb a biopsy and a dr that are not in accordance.
Doesn't assuming all groin/thigh lesions to be HPV seem rather alarmist? This is troubling as I'm in a new relationship and do not wish to alarm my partner without need. The Dr said not to worry about it, "it's gone." The biopsy was not an HPV diagnosis just a "maybe" what use is that? Are they just covering their legal butts?
So, Dr. Rockoff, what do you think? Should I believe my biopsy? I'm extremely confused and concerned. Thank you
I really enjoy this forum and the service you provide. I come to you with a situation that has been most perplexing, I suppose I'd better start at the beginning...
I went to my dermopathologist with a rash (eczema I thought) on my thighs and underside of my arms. While looking around in my pubic area he said he saw Molluscum. Ok, I can deal with that, although I told him it just appearead when the rash did. He told me to trust him and to come back in two weeks to see if they multiply...but then it got worse!
While still looking around, this time on my right inner thigh/groin (not on my genitals proper) he said "oh a wart!" I sat up with a start and looked at what didn't appear to me to be a wart, looked like a long(ish) skin tag with a slightly ragged surface. I was panicking and insisted on a biopsy, which he agreed to although he said it was not neccesary. He then surgically removed it and sent me home to panic for two weeks to await the biopsy results.
So, two weeks go by (and the so-called "molluscum" have VANISHED) and the nurse sees my panic and says the biopsy did not indicate virus and gave me a "patient copy" with very dumbed-down wording. So I asked to see the REAL version and it read as follows:
DIAGNOSIS: Inflamed Pigmented Squamous Acanthoma.
NO ATYPICAL CELLS OBSERVED
MICROSCOPIC DESCRIPTION: Sections demonstrate expansion of the epidermis by bland keratinocytes with associated cytoplasmic melanin pigmentation. Overlying hyperkeratosis is noted. There is perivascular lymphocytic inflammation.
Then I noticed a "note" that "Due to the anatomical site" that they couldn't rule out HPV. Huh??? They found nothing irregular but they just assume since someone has a lesion below their waistline that it's HPV? I asked the nurse and she said they say that kind of thing as a precaution and that the diagnosis indicated nothing atypical. She indicated it could all have come from abrasion.
Anyhow, enter the doctor who looks surprised that the "molluscum" is gone and checks the surgical site of the "wart" and claims victory. I asked why he kept calling it a wart when the biopsy found no virus-infected cells. He was just like it doesn't matter cause we made it go away. He then points to a small bump on my thumb (which has been there for years) indicated that I most likely autoinnoculated my groin while washing and proceeded to freeze off the bump with liquid nitrogen. So, now I have a huge blister on my thumb a biopsy and a dr that are not in accordance.
Doesn't assuming all groin/thigh lesions to be HPV seem rather alarmist? This is troubling as I'm in a new relationship and do not wish to alarm my partner without need. The Dr said not to worry about it, "it's gone." The biopsy was not an HPV diagnosis just a "maybe" what use is that? Are they just covering their legal butts?
So, Dr. Rockoff, what do you think? Should I believe my biopsy? I'm extremely confused and concerned. Thank you
Doctor's Answer
by Alan Rockoff, MD, Dec 07, 2005 12:00AM
, Dec 07, 2005 12:00AM
I think you had a skin tag. They commonly grow in the groin in the place you describe, whereas warts tend to be on the penile shaft. The biopsy did not show an HPV wart--the pathologist was just saying that sometimes warts can show this picture, but the overall clinical context (shape, location, single lesion) all argue against a wart. The molluscum and the rash were innocent bystanders. I agree with your doctor--I'd forget about it.
Take care.
Dr. Rockoff
Take care.
Dr. Rockoff
