Enhanced Worldwide Dermatology–Pathology Interaction via Facebook, Twitter, and Other Social Media Platforms

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Dermatologists often use skin biopsy to arrive at a diagnosis; interpretation of such biopsies requires an expert pathologist/dermatopathologist. In many medical colleges across India, skin pathology is a neglected specialty and is not adequately taught to trainees in pathology. India has very few expert pathologists to deal with skin pathology, and those experts that are available are usually in large metropolitan areas. Dermatologists practicing in small cities or rural areas often struggle to find a pathologist with dermatopathology expertise to opine on a difficult skin biopsy. A dermatologist in such a setting often must send the skin biopsy bottle through postal or courier service to an expert pathologist/dermatopathologist in a larger city who will process the tissue and send the diagnosis back to the dermatologist through email or courier service. This method often requires 15 days for a dermatologist to acquire the report, and this may lead to delay in initiation of appropriate treatment especially for serious or urgent diagnoses. Furthermore, as many remote areas lack adequate courier and transportation services, the problem is compounded, and the dermatology consultant is often forced to provide empirical treatment without histologic confirmation of the diagnosis. A great portion of the rural Indian population is therefore lacking access to advanced medical care for complex or serious cutaneous disease, which is a significant public health problem.
Online social media and networking sites (Facebook, Twitter, and Whatsapp) may help circumvent this vexing problem. Dermatologists can locally process the skin biopsy with the help of a pathology laboratory, procure the slides, and obtain photomicrographs. If a mounted microscope camera is not available, smartphones may be used to capture the microscopic images, either through an adaptor1,2 or through a free-hand technique (see YouTube demonstration video by Dr. Annie Morrison: https://youtu.be/cfd9ViHBlR4).3,4 Photomicrographs along with clinical photographs and clinical history of the patient can then be shared with pathologists and dermatopathologists from around the world through Facebook discussion groups, Twitter, or other online forums (Figs. 1A–E).5 This allows numerous pathologists and dermatopathologists from around the world to view the case and to share their diagnostic ideas and opinions in real-time. Some cases receive multiple comments within only hours of posting to a Facebook group. Other users are able to ask the original posting dermatologists questions about the clinical scenario, as well as to help triage cases that may require more complex workup including immunohistochemical stains or molecular testing. Those latter ancillary tests may not be available locally, but this information may be useful in helping the local treating dermatologist to decide whether referral of the patient on to a larger medical center may be the best course of action. Thus, a variety of opinions can potentially be obtained very quickly from a plethora of pathologists/dermatopathologists. Online forums allow 2-way live interaction between dermatologists and pathologists, a valuable form of interaction that is usually lacking in most traditional medical practice settings in India and the United States. Such interactions are fruitful to both parties: they allow the dermatologist to learn about the finer nuances of skin pathology and likewise for the pathologist to learn more about the clinical aspects of dermatology. Pathologists may gain greater appreciation of the struggles faced by dermatologists and patients in developing areas of the world. There are also many differences in how to approach dermatopathology diagnosis when ancillary techniques are not available; these online interactions may help to enhance and further develop clinical thinking skills, diagnostic triage, and reliance on morphologic features in those pathologists and dermatopathologists participating in online discussions about these kinds of cases.

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