Identifying the Distinct Characteristics of Steatocystoma

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

If you encounter a patient with bumps, typically measuring one to two centimeters wide (though they can be larger in diameter), that formed under relatively normal-looking skin and appear predominantly on the person’s chest, upper arms, neck, face, and legs, it may be steatocystoma. 

In this episode of Digital Dermpath Digest, Rajni Mandal, MD, a dermatopathologist at PathologyWatch, discusses distinct features of steatocystoma and how to identify it.

What Is Steatocystoma?

Occurring mainly in teenagers and young adults, steatocystoma is a benign and rare cyst that originates in the hair follicle or sebaceous duct, where the sebaceous gland drains into the hair follicle. When incised, a steatocystoma, often referred to as a sebaceous cyst, will secrete a thick, oily, yellowish fluid, and the area collapses when sectioned. 

Signs Below the Surface

But what’s happening below the skin’s surface that makes a steatocystoma so unique? 

“Viewed under a digital viewer, the multiplex variant of steatocystoma can be seen with keratin type 17 mutation,” explains Mandal.

The most notable symptom is the cyst’s epidermal lining that has a “red roof” or a “shark tooth” cuticle appearance devoid of a granular layer. “Sebaceous glands also appear in the cyst wall,” says Mandal. 

Though the cysts grow slowly, most patients desire to have them removed to avoid infection and discomfort should the cyst become inflamed or burst.

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

Identifying a Proliferating Pilar Cyst 

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Consider this: An elderly female patient presents with a nodule on her scalp, which has recently grown in size. It currently measures 10 cm in diameter and is ulcerated. What features would you look for in order to diagnose it as a proliferating pilar cyst?

In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, dermatopathologist at PathologyWatch, explains the characteristics of proliferating pilar cysts. 

“Proliferating pilar cysts are most commonly seen in adult women in the scalp,” Mandal says. “Most cases arise from a pre-existing pilar cyst, due to unknown triggers.”

In the video, Mandal goes on to identify the defining features of two categories of proliferating pilar cysts: 

Benign Proliferating Pilar Cyst

Cyst epithelium proliferates within the center of the cyst, giving it a “rolls and scrolls” appearance. The proliferating cells are trichilemmal, with small nuclei having smooth nuclear contours and a uniform chromatin pattern. The cyst lining has no granular layer, with abrupt dense, compact, pink keratin formation.

Malignant Proliferating Pilar Cyst

Also known as trichilemmal carcinoma, malignant proliferating pilar cysts differ from the benign version in key ways. In addition to the above characteristics, malignant cysts show cell crowding and cellular atypia (i.e., nuclei of varying size and shape). These cysts display mitotic activity, infiltrative growth, and cytologic atypia.

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.

Identifying Warty Dyskeratoma

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A warty dyskeratoma is an uncommon but benign skin lesion, normally presenting as a solitary (sometimes umbilicated) papule on sun-exposed areas of the head and neck. In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, dermatopathologist at PathologyWatch, explains the common characteristics of a warty dyskeratoma.

“It is an endophytic lesion . . . growing into the skin,” says Mandal. “It can also be cup-shaped and can be centered around a follicle.”

The warty portion of the dyskeratoma presents papillomatosis and hypergranulosis. They also present villi projecting into the lesion, as well as a central keratin plug. You will also find suprabasilar clefting.

In addition to these attributes, Mandal describes the following characteristics:

Acantholytic Dyskeratosis

Warty dyskeratoma is primarily characterized by acantholytic dyskeratosis. Dyskeratosis refers to the premature keratinization of keratinocytes, characterized by dense encephalitic cytoplasm.

Corps Grain and Corp Ronds

Corp ronds are dyskeratotic cells that still have a rounded nucleus. Core grains, on the other hand, are dyskeratotic cells with a flattened nucleus. Both are present in warty dyskeratoma, giving it a similar histological appearance to Darier’s disease.

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.


Look for These EMR Features for Dermatologists

The medical industry is turning to the convenience and efficiency of electronic medical records (EMRs) to safely share patient data, increase staff productivity, and reduce paper storage. In fact, 88 percent of providers indicate they gain clinical benefits from their EMR system. 

There are specific EMR features for dermatologists that can help your practice to increase productivity and satisfaction. By examining some of these useful tools, understanding the onboarding process, and looking at ways to integrate your software, you can make the most of your EMR system and continue to focus on the health of your patients.

Helpful Features

Your EMR system uses structured data to condense and organize thousands of records into a secure and easily accessible repository. There are special features and shortcuts to help the 85 percent of the office-based physicians who use EMRs to take advantage of this framework.

Some of these features include the following:

  • Built-in Templates —Tracking clinical documentation is straightforward, with built-in fields designated for each record. While the provider is free to create additional custom fields, they can also elect to follow along and enter the applicable data into the existing format.
  • Body Maps — Providers can use model imagery to document patient visits and pinpoint treatment areas by using thousands of anatomical locations.
  • Linking Images — An organized EMR system will keep all of your patient data at your fingertips. This includes pictures of tissue specimens and lab results, which are instantly accessible via secure cloud storage. Going one step further, displaying patient photos in your EMR records can reduce order errors by 35 percent.
  • E-Prescribing — Some EMRs make their robust pharmacy software so easy to use, providers can send error-free prescriptions straight to a pharmacy. This simplifies the process for the practice, pharmacist, and, most importantly, the patient. 
  • Auto-Coding — Providers and staff can save time and ensure maximum reimbursements by allowing the EMR to recommend codes based on different procedures and diagnoses. Additionally, electronic billing will always be attached to the patient’s EHR to make pulling an invoice simple.
  • Medical Inventory — Consistent inventory management is significant in meeting the needs of your dermatology practice and patients. Utilizing EMR business processing keeps you supplied and helps to protect revenue.

By utilizing the many built-in EMR features, dermatologists can streamline their workflow and spend more time giving their patients attention.


Once your clinic decides to employ a new EMR system, it’s essential to do so with calculation and precision to avoid rushing the learning process. Because physicians who claim they received inadequate EHR training are more than 3.5 times more likely to indicate their EHR does not help them deliver quality care, the initial training period can be critical to long-term success.

Remember that you’re enlisting the EMR to simplify your workload as a provider and make your staff more efficient so they can spend more time ensuring patients receive the personalized attention they require. That’s why most EMR systems are accessible by laptop or tablet, giving you the flexibility to access files from anywhere at any time. While the software vendors that produce EMR systems strive to make them user-friendly, you should plan on investing time into training to understand how it works. Doing so will enable your dermatology clinic to keep patient data precise and secure while embracing the convenience of digital records.


Your EMR system’s flexibility to integrate with other software frameworks makes them valuable administrative tools to keep your dermatology practicing running smoothly. For instance, combining with practice management software will enable you to use your EMR to schedule patients, oversee check-in, track medical billing, manage insurance, and monitor financial reporting.

At the same time, 71 percent of healthcare organizations use revenue cycle management solutions with their EMR. Designed to assess and enter accurate case information, these solutions strengthen patients’ financial outcomes and free up time for providers and staff to concentrate on patient care. 

Dermatopathology labs like PathologyWatch can also integrate with your EMR to create digital communication with your dermatology clinic. As a result, the lab’s detailed reports interface directly to your patient charts, giving you 24/7 access to diagnoses and digital slides. This electronic workflow eliminates handwritten forms, which can result in fewer errors.

When you examine the EMR features for dermatologists, it’s easy to see why so many providers have made the switch from traditional health record management. With careful consideration of the beneficial features, onboarding process, and integration possibilities, your EMR system can empower you and your team to continue to make the coordination of patient care your highest priority.

What Do You Know about Pilomatricoma?

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

Often mistaken clinically for a more common skin growth like an epidermoid cyst, pilomatricoma is the focus of this Digital Dermatopathology Digest episode with Rajni Mandal, MD.

Pilomatricoma is a benign skin growth that typically occurs in children and young adults. Studies show that around 40 percent of cases happen to patients under age 10, and 60 percent of cases appear before age 20. Interestingly, research also shows girls are about 50 percent more likely to develop a pilomatricoma than boys.

This growth is associated with the somatic mutation of CTNNB1 in the hair matrix cell, which leads to increased beta-catenin (decreased cell adhesion) and uncontrolled cell division through the Wnt signaling pathway.

Pilomatricomas have very distinguishing pathologic features. “The keratin within the center of pilomatricoma is quite characteristic,” explains Mandal. “You can see multiple holes, or ghosts, of the keratinocyte nuclei.”

Although pilomatricomas aren’t painful or malignant in nature, they don’t resolve on their own. Dermatologists may recommend a skin biopsy to rule out cancer—and because they continue to grow and often appear on the head and neck, most patients opt to have them removed.

To learn more about pilomatricoma and other skin conditions, click here for more episodes of PathologyWatch’s Digital Dermatopathology Digest.

The Pros and Cons of EMR Systems for Dermatologists

Running a promising dermatology clinic means continuously seeking ways to enhance patient care quality and maximize staff efficiency. For proof, consider that over 40 percent of practices claim to have implemented EMR systems to help them grow.

While implementing an EMR system for dermatologists has many advantages, there are still some disadvantages to consider. This article will look at the pros and cons of electronic medical record systems for dermatologists, including reducing paper, image management, billing, lab interaction, and EMR limitations to ensure you have the facts when considering ways to maintain quality diagnosis and patient care.

Reducing Paper

One main advantage to an EMR is the ability to access your notes and patient information anywhere. In an increasingly digital world, we are often communicating with patients while out of the office. Still, 25 percent of dermatologists continue to use traditional paper systems to support their operations.

Here are some of the standard paper shortcomings and the ways an EMR system solves them:

  • Repetitive tasks: Completing the same functions repeatedly takes time and energy away from vital patient interaction. In addition to autopopulating fields, an EMR sends data electronically, so it doesn’t have to be re-entered. 
  • Errors: Entering and re-entering data into the LIS introduces the possibility of human error. Entering data one time using an EMR removes the chance of making mistakes on repeat entries. 
  • Access: Pulling a patient’s paper file can only be done in the office, requiring time and physical space to store the physical records. Using electronic medical records means patient information is stored securely in the Cloud, which providers can instantly access from anywhere with a Wi-Fi connection.

Unlike paper, EMR systems make it increasingly advantageous for dermatologists and their staff to do things more efficiently and conveniently. It is important to ensure staff is adequately trained on a new system and receives regular review sessions to maintain a good standard of EMR charting, as updates occur several times per year.

Managing Images

Patient images in dermatology are valuable, as much of the specialty relies on visual recognition. It is also important when tracking the correct site of a biopsy, especially for referring to other providers like Mohs surgeons. 

Digital images are easy to capture, but often cumbersome to organize. If not using an EMR, these will have to be organized in folders with patient name and date and kept in a secure digital environment. Many EMRs resolve this arduous process by allowing you to take photos within the patient chart and automatically assigns the images to the correct biopsy location. These images can be accessed immediately, making it easier for dermatologists to share them with partners and patients or review them on the next visit. Also, being able to review them in the context of your visit with relevant labs and other notes helps in diagnosis, especially of difficult cases.

Reliable Billing

While necessary, billing is not the favorite activity of most providers. However, billing takes time and diligence to communicate with insurance companies and resubmit claims when appropriate. With that in mind, another benefit of electronic medical records is the autobilling feature. 

Many EMRs will issue invoices based on coding applications. In addition, some EMR systems claim up to 98 percent first-pass claim acceptance, which means you and your staff can spend time focusing on patient care instead of going back and forth with insurance companies.

Also, EMRs automatically track any changes to Medicare’s Merit-Based Incentive Payment System (MIPS), ensuring your practice receives accurate reimbursement for qualifying services. This eliminates manual tracking and helps you to maintain focus on patient care.

Lab Interaction

Communication with your dermatopathology lab partner is vital to ensure the highest quality of diagnosis for your patients. Full-service dermatopathology labs like PathologyWatch will integrate an EMR interface, which allows them to access the data and fields entered into your EMR system. 

Equally important, an EMR interface grants you instant lab results and images sent directly to your device. The EMR also helps you send e-faxes to providers or drop notes directly to the patient’s record, instead of requiring your staff to print out, fax, scan, and wait for a confirmation.

EMR Limitations

While EMR systems embed many time-saving and workflow advantages, they also contain quirks and constraints that users learn to navigate. For instance, 82 percent of physicians indicate it takes too long to enter data that isn’t directly related to patient care.

The EMR could also make it difficult to communicate outside of the prescribed default descriptions. Thus, if you indicate eczema when you’re trying to describe a rash, it may take you longer to type in a custom description than selecting the available options. To make the system work right, you have to be willing to customize your process with templates, adding quick text or macros when possible to aid in customizing each note, and take time to delete unused or irrelevant items within your templates. 

Sometimes, adding digital elements can create slow-downs if the interface is down or you experience an error after an update, for instance. This can be challenging if you can’t print out a requisition from your EMR or can’t access patient records while you are seeing patients in the clinic.

In the end, the benefits of implementing an EMR into your dermatology practice often outweigh the disadvantages. By understanding how EMR systems can reduce your reliance on paper, manage images, increase billing efficiency, and boost lab communication, your clinic can make a qualified decision that can help you continue to provide quality care for your patients.