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Letters to the Editor

Kaleidoscope of a Dermatopathologist

Batrani, Meenakshi MD

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The American Journal of Dermatopathology: December 2019 - Volume 41 - Issue 12 - p 955
doi: 10.1097/DAD.0000000000001410
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Disclaimer: This is purely a work of fiction born out my livid frustration and vivid imagination. Any resemblance of the characters to real pathologists or dermatologists is not merely coincidental.

To the Editor:

Do you know me, who am I? I remain incognito, veiled behind, an archaic “microscope.” But, I have a “famous friend,” endowed with the latest trend—a swanky, in vogue, “dermoscope!”

Skin biopsies, I have reported many. For the first time, I am telling my agony. You may like or dislike it, I don't care, I have decided to share. My dear friend, don't be offended, that's not intended!

Ah, these granulomas, my greatest dilemmas. I scratch my head, until I go to bed. Is it leprosy, tuberculosis, sarcoidosis, fungus, or leishmaniasis? I keep searching, with a bleak hope, all the bug stains, to find that single red grain. My eyes do ache, but never complain. Spent my entire day, all in vain. How do I report? Is this the last resort? Caught up in this granulomatous mashup, I tell to myself, not to give up. Get back to scout. This time with polarscope, on the mount. Amid the blinding darkness, shines a ray of light, ending my plight. Just like, in the middle of the gloomy night, a glowing play of fireflies, stars twinkling on a moonless sky. The meteorites of mercury glittering bright, on my very own slide.1 Voila! I should have known from the start “a foreign body.” Must have been an integral part of somebody, the ruins of a broken heart, in not so distant past. Inscribed passionately, for that someone special who drifted apart!

It reminds me of the beloved friend of mine. Our story won't be so tragic, for together, we shall recreate magic. Our lives, “microscope” and “dermoscope” are as inseparable as Siamese twins, conjoint at the spine!

I confess, my most intimate love–hate affair, to my best friend, who warns, I better not dare to make this diagnosis, that's mycosis fungoides!

Holier than Thou! If you never meant it, why on each requisition slip you tend to scribble it? Yours' “just casually” I have taken “quite seriously.” I am not entitled to the liberty you have. It's not filling up a biopsy form, a “written report” is bound by certain norm!

Last but not the least, its beauty and the beast. Ugly duckling, is the calling, it's an excision of, a melanocytic lesion. I cannot make a decision. Is it a nevus or a melanoma? Save me from this mental trauma, else, I pass out into coma. The slide will be scrutinized, report criticized, the so called experts from all corners of the world. Missing a melanoma, I might be defamed or sued for a claim. Overcalling it, is less of a harm. Will everyone be up in arms? Ah! This is a nightmare. Stressed and distressed, as, I was getting crumbled, my technician mumbled “this patient has an old path number.” My oh-so busy friend, forgot to write, there was a prior procedure on the site. I take a sigh of relief. God forbid, to my disbelief, I am saved. It's a recurrence of a nevus,2 which was previously erased!

I call up my friend, sill gasping in pain. Why you always complain, he replies in disdain. Doesn't have a moment to spare, while, I kept wailing in despair!

My esteemed friend, you are allowed to thunder, but remember, you are not immune to blunder. If you don't get the result you seek. Can't you pick up a phone to speak? Can we keep our egos at stake? Just for the patient's sake!

There are times I am as clueless as you are. As if, delaying the result is my deliberate intension, I try out every single permutation and combination. What for? Only to get ridiculed for not being able to arrive at a conclusion!

You take the fame, I bear the burden of blame. Why not play a fair game? You have all the right, to hog the limelight, let it not dazzle the insight. Working relentlessly, does need motivation. You have the patient's recognition. Don't I deserve your little appreciation? Regardless, I am not the one to sob, I am in love with my rewardless job!

You still don't know, who am I? Asked to exemplify, I tend to glorify!

Sherlock Holmes, personified, unfolding the mystery, in disguise. Each case a monster, I need to conquer. Every day is a struggle to survive. It's nothing short of a “Life of Pi”!


The author sincerely thanks all true friends starring as “my friend” in this “skin” flick.


1. Seok J, Choi SY, Kwon TR, et al. Tattoo granuloma restricted to red dyes. Ann Dermatol. 2017;29:824–826.
2. Blum A, Hofmann-Wellenhof R, Marghoob AA, et al. Recurrent melanocytic nevi and melanomas in dermoscopy: results of a multicenter study of the International Dermoscopy Society. JAMA Dermatol. 2014;150:138–145.
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