Top 10 Questions for Dermatopathologist Interview

1. What are the key features that distinguish a melanocytic nevus from a melanoma?

• Melanocytic nevi are symmetric, with a well-demarcated border and uniform pigmentation.
• Melanomas are often asymmetric, with an irregular border and variegated pigmentation.
• Melanocytic nevi usually show a nested or compound growth pattern, while melanomas may exhibit a pagetoid or lentiginous growth pattern.
• Melanoma cells often show nuclear atypia, mitotic figures, and ulceration.

2. Describe the histologic features of a basal cell carcinoma.

Basaloid pattern

• Cells are arranged in small nests or cords, resembling the basal layer of the epidermis.
• Nests may be surrounded by a palisading layer of peripheral cells.

Peripheral palisading

• Cells at the periphery of nests are taller and more columnar, with their nuclei oriented perpendicular to the basement membrane.
• This feature is most prominent in early, well-differentiated lesions.

3. How do you differentiate between a seborrheic keratosis and an actinic keratosis?

• Seborrheic keratoses are usually larger and more elevated than actinic keratoses.
• Seborrheic keratoses have a characteristic “stuck-on” appearance, while actinic keratoses are often more scaly and crusty.
• On histologic examination, seborrheic keratoses show a thickening of the epidermis with a warty appearance, while actinic keratoses show atypical keratinocytes and solar elastosis.

4. Discuss the different types of cutaneous lymphomas (CL).

• Mycosis fungoides: The most common type of CL, presenting as scaly, erythematous patches or plaques that may evolve into tumors.
• Sézary syndrome: A leukemic variant of mycosis fungoides, characterized by erythroderma and circulating atypical lymphocytes in the peripheral blood.
• Follicular lymphoma: May present as solitary or multiple, firm, painless nodules in the skin, lymph nodes, or other organs.
• Peripheral T-cell lymphoma, not otherwise specified: A heterogeneous group of aggressive lymphomas that can involve the skin and other organs.
• Cutaneous B-cell lymphoma: A rare type of CL, presenting as solitary or multiple, painless nodules or tumors in the skin.

5. How would you approach the diagnosis of a suspected autoimmune blistering disorder?

• Obtain a detailed history, including a description of the lesions and any associated symptoms.
• Perform a physical examination, noting the distribution and morphology of the lesions.
• Order laboratory tests, including a blood count, chemistry panel, and autoimmune antibody profile.
• Consider performing a skin biopsy for histologic and immunofluorescence studies.

6. What are the key histologic features of a discoid lupus erythematosus (DLE) lesion?

• Interface dermatitis with vacuolar degeneration of the basal layer.
• Thickening of the basement membrane zone.
• Dermal fibrosis with a lichenoid infiltrate.

7. Describe the histologic findings in a bullous pemphigoid (BP) lesion.

Subepidermal blistering

• Blisters form beneath the epidermis, separating the epidermis from the dermis.
• The roof of the blister is composed of epidermis, while the base is composed of dermis.

Eosinophilic infiltrate

• Large numbers of eosinophils are present in the blister fluid and the underlying dermis.
• Eosinophils release cytotoxic granules that damage the basement membrane zone.

8. What are the most common cutaneous manifestations of syphilis?

• Primary syphilis: Characterized by a painless, indurated ulcer (chancre) at the site of inoculation.
• Secondary syphilis: Occurs weeks to months after the chancre heals and may include a maculopapular rash, lymphadenopathy, and fever.
• Tertiary syphilis: Develops years after the initial infection and may involve the skin, bones, cardiovascular system, and central nervous system.

9. How would you diagnose a case of pityriasis rosea?

• Obtain a detailed history, including the time course of the eruption and any associated symptoms.
• Perform a physical examination, noting the distribution and morphology of the lesions.
• Consider performing a skin biopsy if the diagnosis is uncertain.

10. What are the key histologic features of a lichen planus lesion?

• Hyperkeratosis
• Acanthosis
• Liquefactive degeneration of the basal layer
• Band-like infiltrate of lymphocytes in the upper dermis
• Pigmentation incontinence

1. Microscopic Examination and Diagnosis

Examine skin biopsies under a microscope to identify abnormal cellular and tissue structures.

• Determine the type and severity of skin lesions.
• Provide histopathological interpretations to assist in diagnosis and patient management.

2. Consultation and Collaboration

Consult with dermatologists, medical oncologists, and other specialists to provide expert opinions on skin conditions.

• Participate in patient consultations to discuss findings and recommend treatment plans.
• Collaborate on research projects to advance the understanding and management of skin disorders.

3. Research and Education

Conduct or participate in research studies to enhance diagnostic techniques and treatment strategies.

• Publish findings in peer-reviewed journals and present them at conferences.
• Educate medical students, residents, and other healthcare professionals on dermatopathology.

4. Quality Assurance and Improvement

Maintain high standards of accuracy in diagnostic interpretations.

• Implement quality control measures to ensure reliable and timely reporting of results.
• Participate in proficiency testing programs to evaluate diagnostic skills.

Study the job description carefully and identify the essential qualifications. Understand the specific responsibilities and expectations of the role.

1. Research the Organization and Industry

Research the hospital, clinic, or institution you are applying to. Learn about their mission, values, and areas of expertise.

• Demonstrate your knowledge of the organization’s history, research, and clinical programs.
• Show that your values and career goals align with the organization’s objectives.

2. Practice Your Technical Skills

Review the key techniques and procedures used in dermatopathology, such as biopsy interpretation, immunohistochemistry staining, and molecular diagnostics.

• Be prepared to discuss specific cases where you have demonstrated your technical expertise.
• Consider bringing a portfolio of your work to showcase your diagnostic skills.

3. Emphasize Your Communication and Collaboration Skills

Dermatopathologists interact with a diverse range of healthcare professionals. Highlight your ability to communicate effectively, build relationships, and collaborate on complex cases.

• Share examples where you have successfully consulted with clinicians and patients.
• Describe your experience in presenting complex medical information in a clear and understandable manner.

4. Demonstrate Your Passion for Dermatopathology

Convey your enthusiasm for the field and explain why you are passionate about dermatopathology.

• Discuss your research interests, publications, or volunteer experiences in the field.
• Show that you are actively engaged in professional development opportunities and stay updated on the latest advancements in dermatopathology.