Digital Dermatopathology Digest: Identifying Hair Follicle Tumors

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

There are a number of different hair follicle tumors, each with its own distinguishing features. In the Digital Dermatopathology Digest series, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, discusses these different variants in greater detail.

Trichilemmal cells come from the outer root sheath of the hair follicle. The cells show abrupt keratinization and pink to clear cytoplasm with a lack of keratohyalin granules.

Trichilemmoma cells have a lobular proliferation of cells that can push into the dermis. They can also present as pink to clear due to glycogen, and there can be peripheral palisading at the periphery of the islands as well as a thick pink basement membrane deposition. Multiple trichilemmomas are associated with Cowden syndrome.

Trichoadenoma cells can have multiple epithelial islands of keratin-filled cysts in the dermis. These cysts can frequently rupture, shoring a foreign body giant cell reaction to keratin fibers. Cyst islands are lined by epithelium, and the majority of the squamous epithelium lacks keratohyalin granules.

Trichoblastoma cells typically have multiple blue islands with fibrotic stroma and are associated with nevus sebaceous.

Cells on the trichofolliculoma, fibrofolliculoma, and trichodiscoma spectrum are all different stages of the same tumor. They can present with branches of anastomosing epithelium originating out of the hair follicle and often occur in small antigen hair follicles.

  • In a fibrofolliculoma, there can be a proliferation of fibrous cells or fibrous stroma, which can have a concentric pattern around the tumor.
  • Fibrous proliferations are most prominent in a trichodiscoma.
  • Cells can show peripheral palisading, but there is no retraction artifact or myxoid stroma surrounding them, which would be seen in basal cell carcinoma.
  • Multiple fibrofolliculomas and trichodiscomas are commonly associated with Birt-Hogg-Dubé syndrome.

The Digital Dermatopathology Digest series provides educational information for both students and professionals on a number of topics. To view the complete series, click here.

Digital Dermatopathology Digest: Identifying Sebaceous Neoplasms 

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

Sebaceous neoplasms are abnormal growths of cells originating in the oil glands of the skin. As part of the ongoing Digital Dermatopathology Digest series, Rajni Mandal, MD, a clinical research associate in dermatopathology for PathologyWatch, discusses the characteristics of sebaceous differentiation, up to and including sebaceous carcinoma.

Sebaceous glands found in the dermis are formed by mature sebocytes and immature sebaceous cells. Mature sebocytes show evacuated cytoplasm, which can indent the nucleus in contrast to the immature cells that show increased nuclear-cytoplasmic ratio, sometimes with foamy cytoplasm.

“Neva sebaceous has an increased risk of basal cell carcinoma, trichoblastoma, and syringocystadenoma papilliferum,” says Rajni.

Sebaceous adenoma is defined as having greater than 50 percent mature sebaceous cells as compared to basaloid cells, in contrast to a sebaceoma. It can present as multiple nests in the dermis, with a predominance of the immature basaloid cells, as compared to the mature sebocytes.

The malignant counterpart of a sebaceous neoplasm is sebaceous carcinoma. It is most common in the eyelid, originating from the Meibomian gland. It can include the dermis as a proliferation of predominantly immature cells. In the epidermis, sebaceous cells—which are predominantly immature—can infiltrate in a pagetoid manner, which can mimic squamous cell carcinoma.

To learn more about sebaceous neoplasms, check the Digital Dermatopathology Digest video series, which provides detailed information and examples on a number of skin conditions, click here.

Digital Dermatology Digest: Identifying Syringomas

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

If you happen across a small cluster of brown, yellow, or pink bumps (or papules), around the eyes or on the neck, it may be a case of syringomas. In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, briefly discusses the distinct characteristics of this benign growth of the sweat gland. 

According to Rajni, syringomas are common in the periorbital and genital regions. Growths can be associated with Down’s syndrome, and disseminated, solitary, or eruptive types sometimes indicate Nicolau-Balus syndrome. 

“Note that the eccrine ducts have an eccentric lumen and can have a tadpole shape,” says Rajni, referring to a common variant of syringomas. “And a clear cell syringoma is often associated with diabetes.” 

Another type of syringomas, a mixed tumor called chondroid syringoma, is common in elderly males and appears on the head and neck. It’s characterized by a circumscribed dermal tumor, and it also appears as an apocrine/eccrine proliferation in fibrous, myxoid, or chondroid stroma. 

“Women, especially of Japanese heritage, are affected more than men,” explains the American Osteopathic College of Dermatology. “Syringomas tend to first erupt in adolescence, but could start at any age.” The AOCD adds that young people may be predisposed to “eruptive syringomas,” wherein the growths occur suddenly.  

Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.

PathologyWatch Ranked Top MedTech Innovator of the Year

PathologyWatch was recently ranked by MedTech Innovator as one of the top 50 most transformative device, diagnostic, and digital health technologies from around the globe. PathologyWatch will participate in a flagship, four-month Showcase and Accelerator program that offers unparalleled visibility and access to some of the medtech industry’s leading manufacturers, providers, investors, and other industry stakeholders. 

“Our goal at MedTech Innovator is to find the most promising medical innovations and make sure they actually reach the patients who need them,” said Paul Grand, CEO of MedTech Innovator. “We are thrilled with the caliber of the startups participating in this year’s cohort and we look forward to providing them with the resources and mentorship they need to succeed.”

Since 2017, PathologyWatch has been an innovative leader in intuitive, easy-to-implement digital dermatopathology solutions that aim to streamline the diagnostic process while improving patient care models. 

Compared to its competitors, PathologyWatch focuses on enhancing services available in outpatient clinics by offering a fully interfaced EMR reporting process, access to top dermatopathologists with the option to interpret and bill for their cases, and provide their clients 24/7 access to digital slides. 

“I believe PathologyWatch is the future of dermatopathology for dermatologists. The group combines academic expertise with the efficiency of a private lab. It is a huge timesaver for me and my staff,” said April Larson, a certified dermatologist, and VP of client experience and advisory board at PathologyWatch. “By reviewing my own cases, I am able to make better clinical decisions for my patients. It’s a win-win for everybody.”

With PathologyWatch, clinics can significantly reduce the time it takes from completing the patient examination to diagnosis with high-quality reads that lead to improved patient-provider relationships in shared medical decisions. What typically takes two weeks to receive a diagnosis can now potentially take two days through the efficient workflow that PathologyWatch has developed.

The 50 companies selected by MedTech Innovator will compete in the final competition at The MedTech Conference in September 2021. 

To read the full list of the medtech companies honored, click here

Identifying Sweat Gland Tumors

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

In this episode of Digital Dermatology Digest, things are starting to heat up as dermatopathologist Rajni Mandal, MD, at PathologyWatch discusses sweat gland tumors.

What is a sweat gland tumor?

These skin tumors are often benign and derive from cells related to sweat glands. “Normal sweat glands have ducts and secretory components,” explains Dr. Mandal, noting the different appearance, which shows clear apocrine and eccrine cells.

Here are highlights of the four common types of sweat gland tumors.

  1. Hidradenoma papilliferum, which is common in the vulvar area. The distinct appearance of this dermal tumor includes papillary folds and the apocrine gland’s decapitation secretion.
  2. Papillary adenoma often appears in the axilla, the patient’s scalp, and other sites. This is a tumor of the skin, also known as eccrine papillary adenoma, where the tumor forms tubular and tubulopapillary structures.
  3. Apocrine hidrocystoma is common in the patient’s head and neck as well as the Moll’s gland in the eyelid. It’s a multiloculated cyst with apocrine cells and is often associated with Schöpf–Schulz–Passarge syndrome.
  4. Poroma is common on the patient’s palms, soles of their feet, and scalp. This benign adnexal neoplasm is composed of epithelial cells that show tubular (usually distal ductal) differentiation.

What is the treatment for sweat gland tumors?

Sweat gland tumors are often benign. However, some patients may prefer to have them removed surgically.

To learn more about this skin condition and other common diseases, join us for each episode of Digital Dermpath Digest right here on

Don’t Miss the International Confocal Working Group’s 2nd World Congress on Confocal Microscopy on May 21–23 

Three days.

Three time zones.

One incredible experience.

That’s what we can expect from the International Confocal Working Group’s 2nd World Congress on Confocal Microscopy on May 21–23, 2021. 

This simulive interactive virtual event, sponsored by SUNY Downstate Departments of Pathology and Dermatology, will broadcast from Brisbane, Madrid, and Chicago.

We reached out to Nina McMurray, who, along with the Business Boutique team, is facilitating this virtual event. We wanted to learn more about in vivo and ex vivo laser scanning confocal microscopy and what we can expect from this year’s event. 

PathologyWatch: How are in vivo and ex vivo laser scanning confocal microscopy impacting the dermatopathology field?

Nina McMurray: In vivo reflectance confocal microscopy (RCM) is noninvasive dermatopathology. RCM and histopathology alike have their advantages and disadvantages. By embracing both, we can not only improve patient satisfaction by avoiding scars and pain associated with unnecessary biopsies, but we can also deliver safer, higher-quality care by ensuring biopsies are taken from the most diagnostically important area and minimizing false-negative results related to histopathology sampling errors.

Ex vivo laser scanning microscopy may revolutionize and could eventually replace frozen-section pathology. However, the greatest impact it could have on dermatopathology is enabling real-time invasive biopsy diagnosis, bypassing the need for tissue processing.

PW: Have you seen significant adoption of this technology in the medical fields?

NM: Confocal microscopy is still most widely adopted in Europe due to differences in reimbursement and healthcare delivery. However, since the recent development of specific CPT codes, adoption has grown in the US. It is disseminating as more US doctors and patients learn about the technology and more insurance plans begin covering the procedure.

We are proud to say that all active pioneers of this technology are faculty at this meeting. The combined experience of the presenters is unsurpassed. Furthermore, these key opinion leaders are also renowned for their complementary expertise in their fields of medicine. 

PW: What sets this upcoming May 21–23 event above other virtual events?

NM: This is a truly global event with 106 global experts from 22 countries, providing 113 lectures, and delivering 20 hours of CME-accredited points in three time zones. 

It is also the most comprehensive and inclusive meeting on this topic in history. Not only does this event provide the delegates with the highest level of the most up-to-date education on the current breakthroughs in the world of in vivo and ex vivo laser scanning confocal microscopy, but it is also delivered on an exciting interactive virtual site. This means you can speak directly with leading global experts or privately chat with colleagues from across the world in real time while sitting in the comfort of your own home.

You can raise your knowledge through high-quality education at an event that allows you to be safe and secure during the pandemic while simultaneously reducing your carbon footprint and minimizing your CME expenditure.

PW: How many people signed up for this event?

NM: Over 200 people have already registered. Pricing is set for accommodating so that we can reach as many of our students and fellows as well as our key physicians.

We have also set aside a pool of tickets for attendees with financial hardship. This event is barrier-free and inclusive. There is still time to book and spaces available, and no concerns about the impact of COVID, travel, or loss of earnings. We would love for you to join us!

PW: How has the response been since going virtual in 2021?

NM: There has been a buzz of excitement in the confocal community. The meeting had to be canceled last year due to the unprecedented effects of COVID-19. Melissa Gill and Orit Markowitz, the copresidents, were undeterred and have created this exciting platform to deliver the best of global experts. There is a real focus on the necessity of dermatology, pathology, and surgical specialists working together to ensure the safest forms of practice and best patient outcomes. The speakers and faculty are extremely excited to be a part of this meeting and deliver cutting-edge education to the broader community. This meeting is breaking boundaries educationally and in delivery alike. 

PW: What can attendees expect to experience during this event? 

NM: Although virtual, this platform is a significant step away from Zoom. The event will take place live across three different time zones, ensuring the delegates can interact with the speakers, ask questions, meet privately in the chat rooms to discuss current topics, visit the booths of their top manufacturers and companies in the exhibition hall, and visit the abstracts room to see what’s new in the world of confocal microscopy. 

In fact, it has been suggested that you will have better direct contact with these experts within this platform while also interacting with some of the key manufacturers and companies within a virtual exhibition. 

This interactive platform recreates the convention center experience but without the usual challenges of navigating the space. Moreover, direct access to global experts across multiple disciplines over three days sets this meeting apart from in-person and Zoom-style meetings. Certainly, everyone is ready to get together, share their knowledge, and deliver the most up-to-date trials and studies published. There will even be an interactive quiz and opportunities to win some very exciting prizes throughout the event.

PW: What can participants hope to take away from attending this event?

NM: To ensure active learning and development, we want our participants to enjoy the whole experience. We want our attendees to become part of our confocal microscopy community, enjoy sharing and learning from one another in a global setting, and have fun! Our mission is to grow the field of confocal microscopy through collaboration, inclusion, and education to improve patient safety and outcomes. 

Clinically, the key learning objectives are below:

  • Understand how in vivo and/or ex vivo confocal microscopy could be incorporated into the dermatologist, surgeon, or pathologist’s workflow to improve patient care
  • Identify the many applications of in vivo and ex vivo confocal microscopy
  • Improve diagnostic confidence and accuracy by incorporating recent advances in image acquisition and interpretation in addition to quality control steps when utilizing RCM for the diagnosis and management of a variety of skin diseases
  • Assess clinical endpoints while also evaluating potential complications and/or pitfalls when using confocal microscopy
  • Understand how machine learning techniques are being applied in the field of confocal microscopy

PathologyWatch will be there! Be sure to visit the PathologyWatch booth to discover what makes us the groundbreaking leader of digital dermatopathology services. Our friendly pathologists and representatives can answer your questions about our full-service dermpath lab and share the ways we can help you maintain optimal patient outcomes while reducing staff burdens.

For more information on the International Confocal Working Group’s 2nd World Congress on Confocal Microscopy on May 21–23, click here.