PANP360 Videos

Biopsy technique starts with a simple question: where is the pathology you are trying to capture? In this hands-on demonstration, Danielle Spatholt, PA-C, walks through shave and punch biopsy technique from setup through specimen handling and wound care, emphasizing how the suspected depth of disease should guide the procedure. She reviews practical details that matter in the room, including site photography, anesthesia, counter-tension, specimen transfer, hemostasis, avoiding crush artifact, and closure, while showing how shave biopsy is generally suited to more superficial lesions and punch biopsy to full-thickness or deeper processes. The demonstration also addresses situations that require more planning before the biopsy begins. When vasculitis or an inflammatory blistering disorder is in the differential, an additional specimen may be needed for direct immunofluorescence, with transport medium determined by laboratory protocol. For deeper inflammatory disease involving the subcutis, Spatholt discusses extending the biopsy to the necessary depth. Across both techniques, the focus remains the same: match the procedure, specimen depth, and tissue handling to the clinical question so the dermatopathologist receives tissue capable of answering it. .mcq-block { padding: 1rem 1.25rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin: 0 0 0.75rem; } .mcq-form label { display: block; margin: 0.4rem 0; cursor: pointer; } .mcq-form input { margin-right: 0.5rem; } .mcq-feedback { display: none; margin-top: 0.9rem; padding-top: 0.75rem; border-top: 1px solid #e3e3e3; } .mcq-result { margin: 0 0 0.4rem; font-weight: 600; } .mcq-result.is-correct { color: #137a4a; } .mcq-result.is-incorrect { color: #b3261e; } .mcq-rationale { margin: 0; } Question: A patient has tense blisters and itchy, hive-like plaques on the trunk, and you’re thinking bullous pemphigoid. You plan two punch biopsies. How should you send them? Lesional in formalin; perilesional in formalin Lesional in formalin; perilesional in Michel’s medium (or whatever your lab uses) Lesional in Michel’s medium; perilesional in formalin Lesional in formalin; a second lesional in Michel’s medium Rationale:The lesional biopsy goes in formalin for routine pathology. The DIF sample should come from the skin next to the blister, not the blister itself, and it can’t go in formalin. Use Michel’s or saline, depending on your lab. Biopsying the blister for DIF can give you a false negative. .mcq-block { padding: 1rem 1.25rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin: 0 0 0.75rem; } .mcq-form label { display: block; margin: 0.4rem 0; cursor: pointer; } .mcq-form input { margin-right: 0.5rem; } .mcq-feedback { display: none; margin-top: 0.9rem; padding-top: 0.75rem; border-top: 1px solid #e3e3e3; } .mcq-result { margin: 0 0 0.4rem; font-weight: 600; } .mcq-result.is-correct { color: #137a4a; } .mcq-result.is-incorrect { color: #b3261e; } .mcq-rationale { margin: 0; } Question: A patient has tender, deep red nodules on the lower legs, and panniculitis is on your list. Which biopsy is most likely to give you an answer? Deep shave of the most prominent nodule A 4-mm punch taken to the mid-dermis Lesional and perilesional punches for histology and DIF A biopsy goes down into the fat, such as a double punch at the same spot Rationale: Panniculitis lives in the fat, so if your biopsy doesn’t reach it, you’ll miss the diagnosis. A shave or a punch that stops in the dermis won’t get there. The video shows a double (“cake topper”) punch to get deeper, and many dermatopathologists prefer a deep wedge biopsy for these cases.

Choosing how to sample a pigmented lesion is far from a one-size-fits-all decision. In this presentation, John R. Griffin, MD, MA, FAAD, reviews how lesion size, anatomic site, and clinical concern should shape the biopsy plan, from removing smaller suspicious lesions in their entirety to using multiple punch samples for larger lesions and selecting a punch approach for acral pigmentation. He also walks through the added complexity of longitudinal melanonychia, where the width and location of the band help determine whether a matrix punch, matrix shave, or lateral longitudinal excision is most appropriate. The session closes with an important reminder that melanoma diagnosis depends on the full architectural, epidermal, dermal, and cytologic picture, sometimes supported by immunohistochemistry or molecular testing, because individual histologic features may also appear in benign nevi.

Where, when, and how a biopsy is taken can determine how much the specimen is able to reveal. In this case-based presentation, John R. Griffin, MD, MA, FAAD, walks through the practical decisions that shape biopsy yield, including choosing the appropriate technique, targeting the most informative area of a lesion, and using the correct transport medium. He applies those principles across common but easily mishandled scenarios, from selecting fresh lesional skin in suspected small-vessel vasculitis and obtaining the right specimen for direct immunofluorescence in blistering disease to distinguishing biopsy approaches for scarring, nonscarring, and patchy alopecia. Along the way, he highlights the seemingly small choices that can introduce artifact, miss the active disease process, or leave the pathologist without the tissue needed to answer the clinical question. .mcq-block { padding: 1rem 1.25rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin: 0 0 0.75rem; } .mcq-form label { display: block; margin: 0.4rem 0; cursor: pointer; } .mcq-form input { margin-right: 0.5rem; } .mcq-feedback { display: none; margin-top: 0.9rem; padding-top: 0.75rem; border-top: 1px solid #e3e3e3; } .mcq-result { margin: 0 0 0.4rem; font-weight: 600; } .mcq-result.is-correct { color: #137a4a; } .mcq-result.is-incorrect { color: #b3261e; } .mcq-rationale { margin: 0; } Question: A patient has suspected scarring alopecia with a smooth center and perifollicular erythema at the margin. Which biopsy approach is most likely to yield a diagnosis? Shave biopsy from the center 4-mm punch biopsy from the center 4-mm punch biopsy from the active margin Shave biopsy from normal scalp Rationale: The fully scarred center may show only end-stage change. Sampling the active margin, where follicles remain, is more likely to capture the underlying inflammatory process.

A useful biopsy begins well before the specimen reaches the microscope. In this practical overview, John R. Griffin, MD, MA, FAAD, explains how close clinicopathologic correlation can sharpen diagnostic accuracy, from providing a focused history and clinical photographs to selecting the right lesion, site, and biopsy technique. Using common inflammatory reaction patterns and challenging examples such as mycosis fungoides, vesiculobullous disease, vasculopathy, and panniculitis, he shows why histology often narrows the possibilities rather than delivering an answer in isolation. The central message is straightforward: better communication between clinician and dermatopathologist leads to a more meaningful biopsy report and a clearer path forward for the patient.

Hair loss can’t be evaluated well from the scalp alone. In this hair and scalp exam video, Garland James, PA-C, walks through a practical approach to evaluating hair loss in clinic, from taking a focused history and asking about styling practices to looking for signs of inflammatory and noninflammatory alopecia. She also emphasizes the parts of the exam that can easily be missed: asking permission before touching the hair, photographing the scalp for comparison, recognizing when biopsy may be needed, and building a treatment plan with the patient instead of around them. Use the accompanying Hair and Scalp Exam: A Practical Clinical Guide for PAs and NPs as a quick reference for assessing hair practices, tension patterns, density and distribution, dermoscopic clues, and care considerations in textured hair. Question: In the video, James emphasizes that the clinical history can help guide the hair loss exam. Which of the following is most relevant to ask before examining the scalp? Whether the patient prefers prescription or over-the-counter treatment Current and recent hair care practices, including protective styles and duration of wear Whether the patient has used cosmetic hair coloring in the past 10 years Whether the patient is willing to stop all styling during treatment Rationale: Rationale: Hair practices can help explain the pattern of hair loss and should be discussed before the exam. The accompanying guide also notes that hair practices often explain the pattern and recommends asking about recent styling changes, current routine, symptoms, and prior treatments. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; } Question: During the exam, which finding would most strongly support considering biopsy for possible inflammatory or scarring alopecia? Diffuse shedding without scalp symptoms Mixed hair shaft diameters consistent with miniaturization Perifollicular erythema or scaling with concern for scarring disease Mild dandruff without tenderness or visible inflammation Rationale: In the video, James notes that if the exam raises concern for an inflammatory component that could lead to scarring, biopsy should be strongly considered. She also cautions that biopsy location matters; avoid areas that are already fully scarred and sample near active inflammation when possible. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

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Download the Psoriasis Epidemiology Screening Tool (PEST) to use in your practice:A Practical Screening Tool for Psoriatic Arthritis Psoriatic arthritis is common, disabling, and still widely underdiagnosed. For patients with psoriasis, missing it can mean irreversible joint damage and loss of function. For PAs and NPs, it represents both a challenge and a unique opportunity. In this video, Henry Yu, PA-C walks through how he uses the Psoriasis Epidemiology Screening Tool (PEST) as part of routine psoriasis care. Not as a rheumatology workup, but as a focused, efficient screening approach that fits seamlessly into busy days in the clinic. Simple by design, the PEST exam is a brief five-question questionnaire paired with a targeted physical exam. But when used intentionally, and documented clearly, it becomes a powerful bridge from observation to strategic action. (Henry Yu likes to use the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) app to administer the PEST exam) Why the PEST Exam Matters As Yu explains, managing psoriasis without understanding a patient’s PsA status is incomplete care. Psoriatic arthritis can be present regardless of skin severity, and many patients see their dermatology provider more consistently than any other clinician. Used correctly, the PEST exam helps clinicians: Identify patients at higher risk for PsA earlierDistinguish inflammatory joint symptoms from common misdiagnoses like plantar fasciitisPrompt timely referral or treatment escalationInitiate therapies that protect both skin and joints before permanent damage occurs What the Exam Includes Five yes/no questions that address joint swelling, arthritis history, nail changes, heel pain, and dactylitis. A score of three or more signals the need to move forward with further evaluation.A focused, systematic physical assessment of:MCP, PIP, and DIP jointsFingernails (pitting, onycholysis)Toes and signs of dactylitisAchilles insertion points and plantar fascia He emphasizes specific documentation not just for accuracy, but because clear documentation forces a treatment decision and supports a shift toward dual-action systemic therapy when indicated. The full PEST exam takes less than five minutes. But, as Yu notes, it can change the entire trajectory of a patient’s life, allowing dermatology clinicians to intercept psoriatic arthritis years earlier than might otherwise occur. Editorial note: A substantial proportion of patients with psoriasis have undiagnosed psoriatic arthritis; meta-analysis suggests approximately 15% of psoriasis patients may have unrecognized PsA, with reported prevalence across studies ranging widely and, in some cohorts, approaching 30% or higher, depending on diagnostic criteria and screening methods.¹,² Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: a systematic review and meta-analysis. J Am Acad Dermatol. 2015;73(2):242-248.Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-265.e19.

What do PASI, EASI, SALT, and ACR actually do for us in everyday practice? Here, Jill Cowan, NP, breaks down the role of validated scoring tools—not as numbers to memorize but as frameworks that help us communicate treatment expectations, evaluate response, and bring clinical trial results into meaningful patient discussions. This teaser leads into our upcoming full breakdown on applying scoring tools at the point of care. Question: Which of the following best describes the purpose of using validated clinical trial scales such as SALT, PASI, EASI, or ACR in dermatology practice? They are primarily designed to simplify documentation for insurance paperwork. They standardize how disease severity and treatment response are measured, enabling consistent, objective interpretation of clinical and research findings. They eliminate the need for clinical assessment by replacing it with numerical scoring. They are only useful in clinical trials and should not inform patient counseling in practice. Rationale: Jill explains that validated scoring tools provide standardized, reliable, and responsive measures of disease severity and treatment response, enabling reproducible evaluation and helping clinicians translate trial results into clear, meaningful expectations for patients. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

Nail disease isn’t cosmetic; it’s a clinical signal. NP Nasslynne Lenz discusses how standardized nail scoring can improve consistency in documentation and communication, and how certain nail findings may serve as early clues of psoriatic arthritis. She also highlights how nail assessment can support when to consider PEST screening or rheumatology collaboration. Watch for a briefing on what to look for during nail checks, and why nail evaluation belongs in every psoriasis visit. Question: When evaluating nail involvement in a patient with psoriasis, which of the following best explains why using a standardized nail scoring tool (such as N-NAIL) can meaningfully influence clinical decision-making? It allows clinicians to automatically determine whether the patient meets diagnostic criteria for psoriatic arthritis. It ensures insurance approval for systemic therapies in patients with mild psoriasis. It replaces the need for clinical examination by providing a numeric score that can be tracked over time. It creates a consistent and validated way to capture the extent of nail disease, which may help identify patients at higher risk for psoriatic arthritis and guide when to escalate evaluation or collaborate with rheumatology. Rationale: Nasslynne notes that standardized nail tools bring consistency and clarity to how nail disease is documented, improving communication across clinicians and helping surface clues that may indicate underlying or emerging psoriatic arthritis, even before joint symptoms are obvious. The scoring does not diagnose PsA on its own, but it does support earlier recognition and informed referral or co-management. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

If you’ve ever felt buried in acronyms (PASI, DLQI, ACR… and now PEST?), you’re not alone. In this teaser, Henry Yu, PA-C, reflects on the quiet clues we sometimes overlook and why speaking a shared language across specialties matters. This is the start of a full-circle look at psoriasis, psoriatic arthritis, and the tools that help us catch what’s easy to miss