Dermatopathology

Dermatopathology is a medical subspecialty at the intersection of dermatology and pathology that focuses on the diagnosis of skin, hair, and nail diseases through microscopic examination of tissue. Dermatopathologists interpret biopsy specimens, such as punch, shave, or excisional specimens, to identify inflammatory, infectious, dysplastic, and neoplastic processes, and they often provide ancillary testing to refine diagnoses.

Practice involves integrating clinical information with histopathologic features. Common biopsy indications include suspected skin cancers (basal cell carcinoma, squamous cell carcinoma, melanoma), inflammatory dermatoses (eczema, psoriasis, dermatitis), vascular disorders, and infectious conditions. Specimen handling, fixation, and accurate orientation are essential to preserve architectural detail.

Histopathology remains central; immunohistochemistry helps classify tumors and distinguish mimics; special stains detect organisms; direct immunofluorescence and indirect immunofluorescence assist in autoimmune blistering diseases; molecular tests such as PCR or FISH are used for select lesions; electron microscopy is rare but historically used.

Training: Dermatopathology is typically pursued after training in both dermatology and pathology, with a fellowship in dermatopathology. In many centers, dermatopathologists work in academic or hospital settings and collaborate with dermatologists to guide management.

Clinically, dermatopathology provides essential diagnoses that drive treatment and prognosis; however, sampling error, overlapping features, and interobserver variability can complicate interpretation; continuous clinical-pathologic correlation is emphasized.