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According to the Accreditation Council for Graduate Medical Education, dermatopathology is the subspecialty of dermatology and pathology that is concerned with the study and diagnosis of diseases of the skin and adjacent mucous membranes, cutaneous appendages, hair, nails, and subcutaneous tissues by histological, histochemical, immunological, ultrastructural, molecular, and microbiological techniques.
Dermatopathology is unique in its emphasis on clinicopathologic and histopathologic correlations, requiring a close working relationship with dermatologists for accurate diagnoses. An ability to analyze photographs of clinical lesions along with a broad knowledge of both neoplastic and inflammatory medical dermatology can be important as well. This subspecialty is known for its challenging yet rewarding nature, and importance is placed on the ability to condense various inputs into a single diagnosis.
Frequently Asked Questions
Challenges include the relatively limited number of academic jobs, the competition between dermatology-trained and pathology-trained professionals, the frustration of (sometimes) running into open positions that seem “regionally protected,” or just breaking into a saturated job market. Additionally, finding a dermatopathology-only position can be challenging, and partnership tracks are becoming less common due to consolidation. On the other hand, dermatopathologists tend to hold off retiring for longer than in other specialties, possibly because it is not typically patient-facing and not physically taxing.
Typically, dermatopathology requires a one-year fellowship, comprising both dermatopathology and clinical dermatology experiences. There are, however, a smaller number of fellowship programs that also have a second year of research.
For the most part, the answer is no. Dermatopathologists do not typically have on-call times, or they are extremely rare. For instance, if a person signs out general pathology and dermatopathology, they may be on-call for donor organ frozen sections and other intraoperative frozen sections for margins, skin specimens, etc.
Dermatopathology positions may be part- or full-time, and the case volume varies depending on the institution or the practitioner, ranging anywhere from 35 to 300 cases per day for full-time positions. Ancillary tests commonly involve special stains, immunohistochemical stains, direct immunofluorescence, FISH and molecular tests, and occasionally tests for T-cell gene rearrangement/clonality. A subspecialty-only practitioner, however, may only see 120–150 biopsies a day.
As you might imagine, dermatopathology primarily interacts with dermatologists. However, dermatopathologists also collaborate with other medical professionals such as oncologists, family medicine physicians, nurse practitioners, physician assistants, hematopathologists, and soft tissue pathologists. Dermatopathologists may also collaborate with surgical oncologists, ophthalmic/oculoplastic and otolaryngologic surgeons, and general surgeons in some cases, as well as plastic surgeons and other specialists depending on the specific nature of a case.
Dermatopathology pairs well with a variety of other pathology subspecialties, including surgical pathology, soft tissue pathology, hematopathology, and molecular pathology. Anatomic pathology can also be useful for general pathology and immunohistochemistry techniques, as well as the recognition of cutaneous metastases. Infectious disease pathology may be beneficial in niche areas with high exposure and in many medical dermatology/dermatopathology cases. In some cases, bone pathology may also be relevant.
Unless you are a dermatology-trained dermatopathologist, you will not typically interact directly with patients. In general, dermatopathologists only interact with patients during fellowship training.
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