Head & Neck Pathology

There are a limited number of head & neck pathology fellowships, meaning there are very few fellowship-trained head & neck pathologists on the job market. For non-fellowship-trained pathologists there can be a steep learning curve on the job due to the high complexity of cases and overlapping differential diagnoses. Head & neck pathologists often need to practice in academic settings to maintain a sufficient case volume of somewhat more rare tumors. The complexity of the case volume in private practice will be lower, comprising mainly biopsies and benign thyroids. Regional fluctuations can also affect job opportunities in both private and academic settings, and the challenging nature of head & neck cases deters general pathologists from handling such cases, further underscoring the demand for specialized expertise in this field. However, despite these challenges, there is a notable demand for these specialists.

Usually one year. It’s a non-ACGME accredited fellowship, so although having a fellowship is highly advantageous, it’s not mandatory to practice and it is not boarded. Some fellowships may be dedicated subspecialty programs, while others may be part of a focused surgical pathology fellowship.

Head & neck pathologists may have on-call responsibilities similar to other surgical pathology fields. This could involve usual surgical pathology call duties, institutional frozen section coverage, or specific on-call responsibilities related to frozen sections. The extent of on-call time may vary based on individual practice settings and institutional requirements.

As compared to other subspecialties, head & neck pathology typically involves lighter caseloads, but increased complexity of cases. This is due to head & neck tumors representing only a small percentage of overall cancers. The case volume varies depending on the institution and practice structure; the top range is 4,000–5,000 cases per year in large academic tertiary care settings, with much lower volumes in smaller hospitals. While the absolute number of cases may be lower, many cases are large resections with a main specimen, multiple margins (often evaluated at frozen section), and neck dissections (ranging from sentinel lymph node procedures to radical neck dissections comprising multiple neck lymph node levels).

Knowledge of unique immunoprofiles and molecular profiles is crucial for accurate diagnosis. Ancillary tests play a significant role in diagnosis, and may include immunohistochemical stains (such as p16), cytogenetics, molecular pathology, in-situ hybridization, extended molecular NGS panels, and predictive marker testing such as PD-L1 immunohistochemistry.

It interacts closely with a wide range of medical specialties due to the complexity and anatomical diversity of the area. These include otolaryngologists, head & neck oncologic surgeons, endocrinologists, dermatologists and Mohs surgeons, general dentists, oral maxillofacial surgeons, radiologists, radiation oncologists, and medical oncologists.

In many institutions, head & neck pathologists also manage endocrine pathology, making them integral members of both head & neck tumor boards and thyroid/parathyroid/neuroendocrine tumor boards.

The main organization is the North American Society of Head and Neck Pathology (NASHNP) which sponsors the journal Head and Neck Pathology. There is also the specifically-focused Endocrine Pathology Society, which sponsors the journal Endocrine Pathology.

It pairs well with a variety of other pathology subspecialties, including thoracic, molecular, bone & soft tissue, oral/maxillofacial, dermatopathology, cytopathology, neuropathology, and many others. These pairings allow for comprehensive assessment and diagnosis of conditions affecting the head and neck region, ensuring a thorough understanding of diverse pathologies and their implications.