Histology

All skin assessments at The Nurse Clinic involve a full face to face consultation and examination with a Dermatoscope. A Dermatoscope is a hand held magnifying device that can magnify lesions 10 times larger than the naked eye. With the use of polarised and non-polarised light the skin surfaces, colours, characteristics, blood vessels etc can help aid the trained clinician to establish a diagnosis during the clinical history taking and examination however on some occasions it is crucial or favourable to send the excised skin lesion for histology for confirmation.

Why can histology beneficial during skin lesion removal?

To Aid Clinical Diagnosis

Many skin lesions can be identified through taking a detailed clinical history and performing a face to face dermoscopic examination however histology can complement these approaches

Early Detection of Malignancy

Histology helps to identify via microscopic examination if a lesion is 

  • Malignant (cancerous).
  • Completely removed during surgery
  • Pre-cancerous
  • Benign (non-cancerous)

Reassurance

Some patients prefer a definitive diagnosis and histology can provide this

What Skin Lesions Are Sent For Routine Histology?

The following skin lesions are sent to histology as it is considered the gold standard.

  • Cysts
  • Moles
  • Pyogenic Granuloma
  • Dermatofibroma
  • Lipomas 
  • Pigmented Lesions
  • Lesions showing ABCDE features (Asymmetry, Irregular Border, Variable Colour, Diameter > 6mm and Evolution (change in shape, size and colour)
  • Lesions with Clinical Suspicion of atypia or malignancy
  • Lesions with uncertain diagnosis
  • Lesions that have reoccured after previous removal

Occasionally the clinical presentation and characteristics of a lesion will suggest the need for histology and you will be advised of this. The cost will be an additional £180 per sample. If you chose not to follow this advice you will be asked to sign a disclaimer stating you are aware of the risks of not following medical advice.

Can I request Histology as an additional option?

For some lesions that appear clinically benign, histology is not routinely offered . If you wish to have the lesion sent for histology there is an additional charge of £180 per sample

These may include:

  • Seborrheic keratoses
  • Sebaceous hyperplasia
  • Cherry Angioma
  • Lipomas 
  • Skin tags
  • Warts
  • Milia

Why does The Nurse Clinic encourage histological testing?

In the UK, Healthcare Providers are regulated and governed by regulatory bodies such as the Care Quality Commission (CQC) and the National Institute for Health and Care Excellence (NICE). This ensures that compliance and standards are maintained. The CQC sets out clear guidance regarding safe and effective treatment and part of this is ensuring accurate diagnosis through correct testing channels.

Failing to adhere to these regulations and standards breeches patient care and also reduces professionalism.

The Nurse Clinic is also regulated by the Nursing and Midwifery Council (NMC) that outlines the framework for Nurses in the UK to practice. 

By not submitting a suspicious atypical skin lesions for histology breeches the duty of care to patients and leaves the clinician open to medico-legal negligence claims.