Instructions & Guide to Services
4320 Forest Park Ave., Suite 212
St. Louis, MO 63108
Table of Contents
Table of Contents ................................................................................................ i
Welcome ................................................................................................................. 1
Service Commitment ....................................................................................... 2
Turnaround Times ...................................................................................... 2
How To Get Started ........................................................................................... 2
Service Trial ................................................................................................... 2
New Client Registration ............................................................................ 2
Orders and Results ........................................................................................... 3
Ordering .......................................................................................................... 3
Results .............................................................................................................. 3
Preparing and Sending Specimens .......................................................... 3
Labeling ........................................................................................................... 3
Surgical Specimens – Formalin .............................................................. 4
Surgical Specimens – Michel’s ................................................................ 4
ELISA Specimens – Serum ........................................................................ 4
Consultations (Slides and/or Blocks) .................................................. 4
Supplies ........................................................................................................... 4
Transportation of Tissue .......................................................................... 4
Available Physician Communication Technology ........................... 4
Secure Web-based Ordering and Report Delivery (Lab
Connect) .......................................................................................................... 5
Contact Us .............................................................................................................. 5
General Phone Number ............................................................................. 5
General Email ................................................................................................ 5
Facsimile ......................................................................................................... 5
Address ............................................................................................................ 6
Special Procedures ........................................................................................... 6
Direct Immunofluorescence (DIF) ........................................................ 6
Molecular Testing ........................................................................................ 7
ELISA Testing ................................................................................................ 7
Stains ........................................................................................................................ 9
Questions or Concerns?............................................................................... 10
Welcome
T
his instruction manual is intended to help you utilize our services and to assist your staff
in preparing and sending tissue. We value your time and have designed our internal
processes to provide an efficient and accurate diagnostic service with convenient
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options for requisitioning, ordering supplies and viewing reports. In addition, our
dermatopathologists are available to discuss cases at your convenience. This guide will assist
you and your staff in accessing the range of services we offer.
Service Commitment
Our intent: To provide rapid turnaround time and high diagnostic precision to help physicians
make the best treatment decisions for their patients.
Turnaround Times
Off-Campus
Routine Specimen
Routine Specimen
Complicated Specimen*
Complicated Specimen*
Rush Specimen
Pickup Time
Mid-day
End of day
Mid-day
End-of-day
Before 12:00 PM
Rush Specimen
Between 12:00 and 5:00 PM
Turnaround Time§
48 hrs
48 hrs
72 hrs
72 hrs
Preliminary report: 6 hrs**;
Final report: within 24 hrs
Preliminary report: within 24 hrs;
Final report: within 48 hrs
From receipt of specimen at our Center
* Complicated specimens require longer processing times due to immunohistochemistry, special stains and/or in situ hybridization studies
**May be longer for larger specimens or for specimens requiring special stains or immunohistochemistry
§
How To Get Started
Service Trial
If you are interested in trying our service, there is no need to set up an account. Simply
complete a requisition form (available on our web site, dermpath.wustl.edu) and send us your
specimen(s). If you are happy with the service, we encourage you to become a client.
New Client Registration
To become a client, simply complete the registration and proxy approval forms that are
available online. Our customer service representative will contact you with any questions and
to confirm the information provided. We will send you supplies, including requisition forms,
specimen jars and labels. Just click on the “Forms” tab on our web site.
Benefits of Becoming a Client
 Convenient supply ordering on our website or through our customer service
representative
 Access to our secure portal for ordering pathology and viewing reports (Lab Connect)
 Access to our secure live consultation service (Live Slide View)
 Scheduled routine courier service
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Orders and Results
Ordering
Once you are set up as a client and we have established your pickup times and routine, you can
order pathology by printing and filling out the requisition form and sending your specimen via
courier. Alternatively, you can complete the order online through our secure portal (Lab
Connect), print the requisition(s) and send your specimen(s) via courier or FedEx. The choice of
method is yours.
For consultations, complete a consult request form (available on our web site) and send us the
slides and/or blocks along with the initial pathology report. We will issue a report that will be
sent to you as well as to the pathologist who initially diagnosed the case. We will return your
slides and/or blocks within 30 days of receipt.
Results
Your dermatopathology results will be provided to you in the manner you choose during
registration. You will be able to adjust this method at any time should your needs change.
 Web-based results via our secure portal, Lab Connect
 Facsimile to your office
 Paper results returned via the courier’s next pickup
 Reports delivered to your EMR system (available for most EMR systems, pending
consultation with our information technology team)
 USPS (if FedEx is used to send the specimen)
 Slides and/or blocks will be returned to you within 30 days (for consultations)
Preparing and Sending Specimens
Our Washington University Dermatopathology Center has established a uniform
policy for accepting or rejecting specimens that enhances patient safety and care,
protects the quality of specimens, eliminates risk to all healthcare staff, and
complies with accreditation standards.
Labeling
Our labels have pre-defined spaces for patient information. The primary concern is to ensure
patient safety, so correct labeling of specimen containers is required. In order to process
patient tissue without delay, we require that two patient identifiers are provided on the
specimen label:
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Patient name (first and last) – MANDATORY; and one of the following:
Patient date of birth OR
Patient medical record number OR
Patient SSN
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In addition to the patient demographics above, to assist in further enhancing patient safety and
care, we ask that you also include on the container’s label:
 Biopsy date
 Anatomical site
 Provider name
Surgical Specimens – Formalin
Routine biopsy specimens are typically submitted in buffered neutral formalin. Containers
should be large enough so that the specimen is free-floating in the jar. Place into the blue
biohazard bag along with the requisition form. If using FedEx®, use the clinical pak bag and
choose overnight shipping.
Surgical Specimens – Michel’s
Specimens being sent for immunofluorescence should be placed in a container of Michel’s
solution (please use the green labels). If the container will be held at the office after hours, it
should be refrigerated. Place into the green biohazard bag along with the requisition form (if
you are also submitting a routine biopsy specimen in addition to a DIF specimen, please place
both in the green biohazard bag; there is no need to separate them). If using FedEx®, use the
clinical pak bag and choose overnight shipping.
ELISA Specimens – Serum
Please see page 7 for detailed instructions on submission. Red-top tubes for ELISA testing
should be placed in the yellow biohazard bag along with the requisition form.
Consultations (Slides and/or Blocks)
Place slides in a slide container, wrap in bubble wrap or other protective wrapping and send
with the consultation request form and previous pathology report. If shipping blocks, please
include ice packs when temperature may place the specimen viability at risk. If using FedEx®,
use the clinical pak bag and choose overnight shipping.
Supplies
When you need additional supplies, either call our customer service representative at (314)
362-5757 or complete our online supply form request. It can be faxed or emailed to
dermpath@wustl.edu. We will send a new shipment of supplies within 1 business day.
Transportation of Tissue
We provide free pickup service by courier (for practices within 30 miles of our center) or will
provide complimentary FedEx®/UPS® shipping. After establishing your practice as a client, we
will work with you to determine the best pickup mechanism.
Available Physician Communication Technology
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Our Dermatopathology Center has the ability to communicate results with referring physicians
using several methods. No special equipment is needed at your office other than an internet
connection. We can help set up options for you and your staff.
Secure Web-based Ordering and Report Delivery (Lab Connect)
We offer an online service to help manage your pathology processing from ordering through
viewing final results. You may use the process in its entirety or simply to view reports.
Features of Lab Connect include:
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Order submission directly to the Dermatopathology Center (a requisition will be created
and must be printed and submitted with the specimen)
Delivery of reports to your Lab Connect inbox for review, printing, or downloading to
your EMR system
Integration with many existing EMR systems for both ordering and reporting (pending
assessment by our information technology team)
To access Lab Connect, contact us at (314) 362-5757 or visit our web site at
dermpath.wustl.edu . Our team will set up an online account for you and will arrange a demo of
our streamlined system. You may request additional logins and customize permissions and
preferences for your staff members.
Contact Us
We hold your time and need for patient care coordination at the highest value. We have several
methods of communication so that you and your office staff can reach us quickly.
General Phone Number
Your call will be answered within three rings. We will address your questions or connect you to
the appropriate person immediately. Call 314-362-5757
Physician-to-Physician Access
Our dermatopathologists are readily available to answer your questions or to
discuss specific cases with you. You will be able to email questions, photographs,
or special requests to our dermatopathologists. When you need immediate
assistance with a case, simply call us to be connected with the
dermatopathologist who reviewed your case. Call 314-362-5757
General Email
You may send questions, requests, replies, or clinical photos related to a specific case to our
general email address; our laboratory manager will handle your email.
Email
dermpath@wustl.edu.
Facsimile
Our fax is always available and is handled during our working hours. Fax 314-362-5701
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Address
 Shipping/physical: Washington University Dermatopathology Center, 4320 Forest Park
Ave., Suite 212, St. Louis, MO 63108
 Mailing: Washington University Dermatopathology Center, 660 S. Euclid Ave., Box 8118,
St. Louis, MO 63110
Special Procedures
As part of our patient care and teaching mission to provide superior interpretation of skin, hair,
and nail specimens, we provide diagnostic services that integrate the full range of
immunological and molecular testing. Besides a comprehensive array of routine histology and
immunohistochemistry, we also offer other unique processes that can enhance your diagnosis
and treatment choice.
Direct Immunofluorescence (DIF)
Immunofluorescence testing is key to the diagnosis and classification of immunologic disorders,
and in helping you to provide superior care to your patients. DIF processing can help diagnose:
blistering diseases, connective tissue diseases, and vasculitis.
Please use the following guidelines when performing a biopsy for direct immunofluorescence.
BLISTERING DISORDERS
Pemphigus and pemphigoid groups (including linear IgA bullous dermatosis and epidermolysis
bullosa acquisita):
 Biopsy the edge of a blister or perilesional erythematous skin
 Do not biopsy the center of a blister, denuded skin or an ulcer
 Label as "perilesional"
Dermatitis herpetiformis:
 Biopsy perilesional skin (normal-appearing), at least 0.5 cm away from a blister
 Do not biopsy active blisters
 Label as "perilesional"
Porphyria and pseudoporphyria:
 Biopsy involved skin (preferably, the edge of a new blister)
 Do not biopsy denuded skin or old lesions
 Label as "lesional"
COLLAGEN VASCULAR DISEASES
Lupus erythematosus (discoid and systemic) and dermatomyositis:
 Biopsy the erythematous or active border of a lesion
 Do not biopsy old lesions (>3 months), ulcers or facial lesions, if possible
 Label as "lesional"
For the lupus band test, in addition to a lesional biopsy, please perform a second biopsy on
nonexposed, nonlesional skin, preferably on the buttocks or thigh. Label as "nonexposed,
nonlesional."
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VASCULITIS
Biopsy the active border of a new lesion, ideally one that is less than 48 hours old
Do not biopsy ulcers or old lesions; if possible, avoid the distal lower extremities
Label as "lesional"
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Molecular Testing
Molecular testing has become an essential tool in the evaluation of borderline
lymphoid and melanocytic lesions. Integration of morphological,
immunophenotypic and molecular information guides the dermatopathologist in
differentiating between benign and malignant lesions. Turnaround time is
typically 1-4 weeks depending upon the test; we recommend contacting us
before ordering a molecular test.
We offer:
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Clonality testing (gene rearrangment studies) for cutaneous T- and B-cell lymphomas
Detection of mutational status for melanoma (BRAF V600E, KIT)
ELISA Testing
ELISA (enzyme-linked immunoabsorbent assay) is a rapid immunochemical test that allows for
detection of specific autoantibodies in the blood. Currently, we offer ELISA testing to aid in the
diagnosis and to follow disease activity for bullous disorders:
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Desmoglein 1, 3 (pemphigus foliaceus, pemphigus vulgaris)
Bullous pemphigoid antigens 1, 2 (bullous pemphigoid, herpes gestationis)
Supplies needed:
 6ml red top blood collection tube containing no coagulants, or preservatives
 Proper size needle between 19 and 23 gauges
Procedure:
1. Blood should be collected fasting or at least one hour after meals.
2. Aseptically collect 5-8 mls of blood by approved venipuncture procedures.
3. Allow the blood to clot at room temperature (20° - 25° C) and separate serum as soon as
possible. Wait-time for clotting should be 10 to 30 minutes.
4. Centrifuge at 3000-3500rpm (800 x g) for 10 min. at 20° - 25° C.
5. Specimen should be stored refrigerated (2°-8° C).
6. If specimen is collected after the evening courier run, it should be placed in the
refrigerator for the morning run. To avoid this please contact us prior to 3:00 pm.
7. When sending an ELISA specimen, please mark it as such on the specimen requisition
and immediately call (314) 362-5757 for a courier.
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Specimen Collection Sites
If phlebotomy service is not available at your office to collect the needed specimen, please utilize
the following specimen collections sites:
Barnes-Jewish West County Pathology Lab
12624 Olive Blvd.
Creve Couer, MO 63141
Center for Advanced Medicine
4921 Parkview Place, 5 B
St. Louis MO, 63110
Instructions for Barnes-Jewish West County Lab:
The Washington University Dermatopathology Center requisition form needs to accompany
patients to the laboratory specimen collection. Patients can enter the hospital through the main
entrance and let the receptionist know they are there for lab work. After patients register, the
phlebotomist will be paged and blood draws will occur in the order of patient arrival. For
specimen submission requirements ONLY, contact the Barnes-Jewish laboratory at (314) 9968691.
Instructions for the Center for Advanced Medicine (CAM):
Both the Washington University Dermatopathology Center requisition and the BJH
Venipuncture requisition need to accompany patients to the laboratory for specimen collection.
Patients can enter the CAM through the main entrance and take elevators to the 5th floor to the
laboratory in room 5B. They will then submit both requisition forms for services. The BJH
laboratory will collect the samples and forward them to our lab for processing and test results.
For questions regarding specimen submission, please contact Washington University
Dermatopathogy Center customer service at (314) 362-5757.
The ELISA tests will be run every Friday morning at 10 am. We request that any specimens
collected for ELISA be collected and sent to the lab every Wednesday or Thursday of each
week in a yellow biohazard bag. It is important that the Dermatopathology Center be
notified upon collection, as these specimens are sensitive and have a maximum 48 hour
refrigeration hold time. If a specimen is collected on a day other than Wednesday or
Thursday, then contact the lab immediately because those specimens need to be frozen in
the laboratory under controlled conditions, until the next processing day.
Specimen Adequacy:
These conditions may cause aberrant test results:
1. Lipemic blood
2. Hemolysis – ruptured blood cells
3. Icterus – Jaundice
4. Microbial growth
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Lipemic Blood
 Please verify when the patient had his or her last meal
 Collect at least one hour after meals
Hemolysis
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Allow alcohol to completely dry when prepping the venipuncture site
The tourniquet should never be left on the patient's arm more than one minute.
Leaving the tourniquet on too long can result in hemolysis
Avoid pulling the plunger back to quickly if you are collecting blood with a needle
and a syringe. Forcing blood out too quickly can result in hemolysis
Vials without clot activators (like the ones for this test) should not be inverted,
just allow them to sit in a vertical position for the allotted time to clot before
centrifugation
Icterus
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Jaundice – liver disease
Drug induced, etc.
Do not collect specimen as it will invalidate test, and the laboratory will have to
reject the specimen for testing
The lab will ask for a redraw when the patient's condition has cleared up
Microbial Growth
 Positive blood culture for microbial infection
 Sepsis
 Do not collect specimen as it will invalidate the test and the laboratory will have
to reject the specimen for testing
 The lab will ask for a redraw when the patient's condition has cleared up
If you have any questions about this test or specimen preparation, contact us at (314) 3625757.
Stains
In addition to routine hematoxylin and eosin (H&E) staining,
to help differentiate disease within tissue, we often employ the use of
other stains.
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Over 20 special stains and 70 immunohistochemical stains performed in-house to more
efficiently provide you with results
If we do not have a stain available, we will send the specimen to an outside reference
laboratory and notify you.
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Questions or Concerns?
Feel free to contact us with any questions, concerns, or general feedback. We are dedicated to
providing you with the best service possible and welcome any comments. Thank you.
(314) 362-5757
dermpath@wustl.edu
dermpath.wustl.edu
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