{'fraction_non_alphanumeric': 0.02363919129082426, 'fraction_numerical': 0.005909797822706065, 'mean_word_length': 5.976138828633406, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A call to action: dermatopathology in the age of molecular testing—education in molecular diagnostics, genomics and personalized medicine

To the Editor, The incorporation of molecular data into clinical decision making is increasing across medical specialties.1 It is rapidly becoming the standard of care for many diseases – with the goals of streamlining therapeutic intervention, improving patient outcomes and delivering more cost-effective healthcare.1 Utilization rates of molecular testing are forecasted to more than double over the next 5 years – increasing by ∼18% per annum, compared with only ∼5% for other laboratory-based tests.1 A revolution in medicine is truly underway. A number of surveys and studies have addressed physicians’ attitudes and experiences concerning clinical molecular testing, specifically if, why, when and how providers order such assays.2– 4 Importantly, dermatologists have shown earlier adoption of pharmacogenomic testing compared with other physician specialties.2 (Pharmacogenomics is defined as the use of genetic assays to determine the optimal pharmaceutical therapy for a given individual patient, with the goal of maximizing drug efficacy and reducing the risk of potential adverse drug responses). Laboratory professionals describe being ‘enthusiastic’ about the value of clinical molecular testing (for cancer); although, many feel ‘ill equipped as individual stakeholders, or as a coordinated system of referral and interpretation’.3 A number of factors are reported to influence the uptake of molecular testing in the clinical setting. These include physician education and training, in addition to perceptions concerning patient confidentiality, insurance discrimination and ethical issues.4 Most physicians describe their understanding of genetics and clinical guidelines as limited (e.g. ‘very/somewhat poor’ in one study4), and this knowledge gap becomes apparent when their molecular test ordering practices are scrutinized. According to a recent report from a major reference laboratory, physicians ordering incorrect assays accounted for 68% of all errors in genetic test requisitions.5 Dermatopathologists (and pathologists who routinely sign out skin samples) must acquire a greater understanding of molecular diagnostic and advanced genomic (i.e. next generation sequencing) technologies, in order to provide guidance to dermatologists and other clinicians regarding clinical utility, costeffectiveness and, importantly, proper test selection and result interpretation.1 This developing role for dermatopathologists will require a broad working knowledge of available tests, including their design, advantages, limitations and evolving applications.1 We must become familiar with the ways in which molecular tests can aid in diagnosis, outcome prediction, selection of therapy and monitoring of therapeutic response for a range of skin disorders.1 This imperative represents an important opportunity for dermatopathologists to contribute and emerge as leaders in the development of personalized medicine in the field of dermatology. Therefore, instruction in molecular pathology and genomics must become integral to dermatopathology fellowship training