Gross Examination: General Considerations

The term "grossing" means inspecting the specimens, describing and measuring the tissue, inking if
needed, and sectioning the tissue to be processed for diagnosis. The skin sample provides the most
diagnostically valuable parts of a specimen for the pathologist's review. The gross description
provides information that aides the dermatologist or dermatopathologist in rendering a diagnosis
during microscopic evaluation of the tissue.

Although the topic of skin gross examination is too broad (and varied) to be covered in its entirety in
this course, the content is reflective of the most common  grossing practices in the
dermatopathology laboratory. Gross examinations can be performed by: pathologists,
dermatologists, pathologist assistants, lab personnel qualified to perform high complexity testing per
CLIA '88.

General Considerations During Gross Examination

1. First and foremost, the patient information on the requisition and on the specimen
container MUST match in its entirety. This includes at least three patient identifiers as well
as the specimen site(s). Requisitions typically identify the surgical procedure, such as punch,
shave, excision, and so on. Any missing, conflicting, or unclear information must be
investigated before proceeding. Also, the cassette number/ bar code must match the
specimen as well as the requisition. Most errors occur during this pre-analytic phase.

2. The grossing station must be well ventilated to prevent inhalation of formaldehyde fumes.
Personal protective equipment (PPE) should include disposable gloves and lab coat, as well
as protective eye wear. Blades and sharps used during grossing must be disposed of in
approved biohazardous waste containers.

3. One specimen container should be opened at one time during grossing to prevent mix-ups.

4. The number of pieces in each container should be noted. In the case of curettage, samples
are measured in aggregate, since there may be over a dozen fragments submitted.

5. The color description of skin tissue will be most often "tan." Unusual skin surface or
pigmentation should be noted.

6. Measurements of the skin surface dimensions and depth should be documented. Any tissue
that is small enough to slip through the cassette holes should be submitted whole and
wrapped in processing tissue paper or a processing mesh bag.

7. Tissue should be inked only if it conveys information such as orientation and margins in
excisions, or which side to embed down. Inking cut surfaces of tissue one color will help the
embedding tech determine which surface should be embedded down, where inked surfaces
will meet the blade first during the microtomy process. Inking is typically reserved for
excisions. Inking margins on biopsies is not required since a second procedure is anticipated
based on the diagnosis of the biopsy.

8. Tissue should be sectioned according to accepted protocols for the laboratory. Generally,

the sections should be approximately 3 -4 mm thick/wide. Skin grossing protocols must be
 standardized for all grossing personnel so that the results are consistent and quality is
reproducible.

9. Tissue should be submitted for the appropriate paraffin processing protocol, such as biopsy
or routine processing.

Although most grossing techs are not familiar with the embedding and microtomy of tissue,
familiarity with those techniques is a necessary prerequisite to ensure the quality of grossing in
dermatopathology. Isn't the focus of grossing, after all, the proper embedding of a skin sample?