Small tissue biopsies are often difficult to visualize and can be easily lost or mishandled. The authors hypothesized that full epidermal surface coloration of small skin lesions with a sterile skin marker (gentian violet ink) before performing shave biopsy would make small gross specimens easier to identify without impacting microscopic appearance. Live evaluation of 4 inked and 4 noninked gross (2-3 mm) specimens in covered and uncovered formalin-containing jars by 50 consecutive health care personnel demonstrated that inked specimens were significantly (P < 0.001) easier to visualize than noninked specimens. Additionally, a blinded dermatopathologist evaluated 25 inked and 25 noninked specimens microscopically. Utilization of this inking process did not interfere with histopathologic assessment or impede diagnosis. This pilot study describes an easily implementable quality improvement measure that may decrease the rate of loss and mishandling of specimens.

Hemosiderotic dermatofibromas (HDFs) are a rare variant of the relatively common dermatofibroma (DF). HDFs can clinically mimic melanoma as well as other melanocytic lesions and are diagnosed with histopathological examination. Histopathologic diagnosis is not straightforward as there are many DF variants and the features of several variants can often be found in one lesion. These lesions may represent a stage in development from common DF to aneurysmal dermatofibroma (ADF). This possible progression is important to recognize, as ADFs tend to exhibit increased tendency for local recurrence and can also be confused with malignant lesions. We present a case of a 65-year-old presenting with a rare HDF having unique clinical and dermatoscopic findings. Our case underscores the importance of recognizing this rare entity and stresses the importance of remaining mindful of the possible progression to ADF, an entity with increased propensity for recurrence.