Dermatology: Practical and Conceptual


Letter  |  Dermatol Pract Concept 2019;9(1):17 71

Dermatology Practical & Conceptual

Introduction

In 2013, ex vivo derm dotting was published as a technique 

to mark a dermoscopically interesting area by dotting it with 

nail polish after fixation of the specimen [1]. Although inter-

esting, this technique may have its disadvantages. First, the 

pathologist needs to know dermoscopy. Second, we already 

have shown that ex vivo and in vivo dermoscopic images 

display different features: some structures and colors are less 

clear or even lost, while others become more prominent [2]. 

This may lead to different areas of interest in vivo and ex vivo. 

Moreover, pathologists have been using the technique for 

only a few years, and they are still developing criteria for it.

Case Presentation

Dermatologists are trained dermoscopists and know the areas 

of highest interest (eg, ulceration in melanoma, changed area 

in existing nevus, blood vessel alterations, and collisional 

lesions). Hence we tried to perform derm dotting in vivo by 

placing the nail polish dot before excision and processing. 

The dot survived transportation in formalin and the different 

processing stages in the laboratory (formalin 10% fixation 

for 48 hours, paraffin embedding, cutting, and hematoxylin 

and eosin staining or immunohistochemical staining). The 

dot remained in place, which enabled us to make a pathology 

slide through it. The marked area remained easily detectable 

and visible under the microscope (Figure 1).

To fine-tune the practical aspects, we applied different 

types, sizes, and colors of nail polish to pig skin.

Applying the nail polish drop with a toothpick or a 

nail art brush was most rewarding. The thicker drops cre-

ated using the commercial brush covered bigger areas than 

intended and detached easily during processing. Smaller 

drops were easily discernable by the laboratory technician 

and under the microscope. Their quicker drying times also 

allowed us to check dermoscopically in vivo to determine 

whether the dot was accurately placed. Red, orange, blue, 

and black yielded the best visibility. Multiple colors in one 

specimen are possible for collisional lesions or multiple areas 

of interest (Figure 2).

In Vivo Derm Dotting: An Easy and Inexpensive Way 
for Clinicopathological Correlation

Sven Lanssens1, Katrien Vossaert1, Sofie De Schepper2

1 Dermatologie Maldegem, Maldegem, Belgium

2 University Hospital Ghent, Department of Dermatology, Ghent, Belgium

Key words: clinicopathological correlation, derm dotting, dermoscopy, nail polish

Citation: Lanssens S, Vossaert K, De Schepper S. In vivo derm dotting: an easy and inexpensive way for clinicopathological correlation. 
Dermatol Pract Concept. 2019;9(1):71-72. DOI: https://doi.org/10.5826/dpc.0901a17

Published: January 31, 2019

Copyright: ©2019 Lanssens et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Sven Lanssens, MD, Dermatologie Maldegem, Stationsstraat 92 9990 Maldegem, Belgium. Email: Sven.Lanssens@
gmail.com



72 Letter  |  Dermatol Pract Concept 2019;9(1):17

Conclusions

We conclude in vivo derm dotting is 

an easy and inexpensive method for 

clinicopathological correlation, and we 

believe it should be incorporated in rou-

tine dermatological practice. All tested 

commercially available nail polishes 

worked perfectly, but small drops of 

red, orange, blue, and black yielded the 

best results.

References

1. Haspeslagh M, Degryse N, De Wispelaere 

I. Routine use of ex vivo dermoscopy with 

“derm dotting” in dermatopathology. Am 

J Dermatopathol. 2013;35(8):867-869.

2. Haspeslagh M, Vossaert K, Lanssens S, 

et al. Comparison of ex vivo and in vivo 

dermoscopy in dermatopathologic evalu-

ation of skin tumors. JAMA Dermatol. 

2016;152(3):312-317.

Figure 1. Pig skin with different nail polish drops (A). Preparing for routine processing (B, 

C). View under the microscope after routine processing, with a clearly visible dot on top, 

without damaging the underlying skin (D). [Copyright: ©2019 Lanssens et al.]

Figure 2. Clinical view of lesion on the nose (A). Dermoscopic view of the same lesion, 

composed of potential collision of 4 different lesions (B). Dotting of the 4 different areas in 4 

different colors (C). Clinical view after dotting the lesion and before excision (D). [Copyright: 

©2019 Lanssens et al.]

A B

C

D

D

A B

C