Learning Dermatopathology in the Digital Age

As in the study of clinical dermatology, establishing a strong fund of knowledge regarding dermatopathology requires visual exposure to countless representative cases. In the not-so-distant past, textbooks relied on grayscale representations to illustrate these diagnoses, but residents today enjoy full-color images; however, textbooks lack the plasticity of digital media, which allow for more immersive interaction with the content. With technological advances in whole-slide imaging, teaching cases can be saved and shared, and rare diagnoses can be studied by individuals who are far removed from the original specimen.¹ Even more exciting is that many of the applications (apps) that facilitate digital learning of dermatopathology are available free of charge. In this article, I will review some of the available apps, focusing on their usability, content, and utility as a learning resource for dermatologists at all stages of training. They are discussed in the order of their utility to students of dermatopathology. I have no financial ties to any of the products reviewed, and my recommendations reflect my opinions and observations after real-world use.

Winner: Clearpath

The Clearpath app (https://www.dermpathlab.com/clearpath/) is a fantastic representation of well-executed digital pathology software. Initially released for $50.00 in 2013, the app has since become free while maintaining a steady stream of updates and expanded content. The app is incredibly intuitive and easy to use, made possible by its modern user interface and versatile search function (Figure). For those just beginning to learn dermatopathology, the glossary contains well-written definitions as well as images, which have highlighting that can be toggled on and off to show an area of interest; for instance, if you cannot wrap your mind around the concept of a “grenz zone,” the app can highlight and focus your attention on the respective area in a related image. The app’s library contains more than 250 diagnoses; by clicking on a diagnosis, you are first shown several images displaying features of the pathology identified with highlighting. Then you can study a digital slide as if your tablet was a microscope stage, panning and zooming as you choose. When you are comfortable with the slides, the integrated quiz mode allows for board review with up to 25 answer choices per slide. Although Clearpath’s image-intensive program does require a wireless connection, it also offers the ability to download slides for offline review.

^{User interface of Clearpath app with definition of key features of mucinous eccrine carcinoma. Photograph courtesy of Clearpath by the Dermatopathology Laboratory of Central States.}

The app has few notable shortcomings related mostly to compatibility, as it is only available for download from the Apple App Store for iPad. Additionally, in comparison to other programs, there is a relative paucity of pathology images to look at, though new diagnoses frequently are added. Regardless, for those with iPads, it is the most refined introduction to a digital dermatopathology product, and a must-have download.

Runner-up: myDermPath

In my February 2014 column,² I interviewed Dirk M. Elston, MD, and we briefly discussed the myDermPath app (https://mydermpath.com/), which had just recently been made available for free. The myDermPath app excels in the sheer volume of diagnoses it presents—more than 1000 in all—including more unusual pathologic entities. Physicians looking for images of barnyard pox or inflammatory myofibroblastic tumor, for example, do not need to go any further. The pathologic images presented are accompanied by coherent descriptions of clinical features and usually are supplemented with clinical photographs. Furthermore, the app includes a video primer on normal histology narrated by Dr. Elston, a step-by-step algorithm for arriving at a diagnosis, and detailed descriptions of immunofluorescence studies and stains. These additional features make myDermPath a more comprehensive application and a more useful reference source. Its universal compatibility on a range of digital devices makes access to myDermPath convenient for users on any platform (ie, iOS, Android, Web).

The app’s most notable limitation is that, at the time of this writing, it feels somewhat less polished, especially compared to the Clearpath app. This antiquated feel also is evident in the app’s apparent instability on my smartphone, as it frequently stops responding while I am navigating through the menus or looking at histology and often makes it cumbersome to use. This stability issue is not evident on the Web-based version. The app also does not fully support the larger screen sizes of some of the newer smartphones, and therefore the display includes wasted dead space. These faults aside, the volume of material presented and the app’s comprehensive content still make myDermPath a useful addition to your digital dermatopathology repertoire.