Why shouldn’t general pathologists analyze skin biopsies?

There are 2 paths to dermatopathology, one of which is dermatologists who subspecialize. When I have lesions of particular interest, I send my dermatopathologists dermoscopic photographs, because these are meaningful to them. The thought would not cross my mind to send clinical/dermoscopic photographs to general pathologists.

Furthermore, dermatologists may have sufficient knowledge of the pathology to review slides themselves and make judgments. Family physicians are not likely to have the background to review slides themselves and are going to be fully reliant on the pathologist and the report. My suggestion is to get the best expert advice when there can be substantial, clinically important disagreement among the best of the best.

Clinically, the issue often is not benign/malignant, but “What is it?” A dermatopathologist is better equipped to assist in an expanded “skin” differential diagnosis, in my experience.

I try to avoid skin biopsies when not necessary. When they are necessary, it is because I need assistance. I consider my dermatopathologists full-fledged consultants in my skin practice. For the same price, in the same time frame, I can have the expertise of a dermatopathologist for my skin biopsies. Why should I not avail myself of that? If I were to daily deal with kidney, liver, thyroid, brain, bone, lung, adrenal, pancreas, gut, etc, I would become friendly with my knowledgeable and well-trained general pathologist.

Gary N. Fox, MD
Defiance Clinic, Defiance, OH
foxgary@yahoo.com