What Is a Dermatopathologist?

Medically Reviewed by Sabrina Felson, MD on July 15, 2023
3 min read

Dermatopathologists are doctors who use microscopes to look at samples of skin, hair, and nails to diagnose diseases. Their specialty, dermatopathology, is a combination of "dermatology," the study of the skin, and "pathology," the study of disease.

For every medical specialty, there is a pathologist working in the field, helping diagnose diseases and give input on patient care. In the field of dermatology, this is the dermatopathologist. 

Dermatopathologists use light microscopes, electron microscopes, and fluorescence microscopes to look at tissue samples. These include things like cellular scrapings, tissue sections, and skin lesion smears. Dermatopathologists diagnose disorders of the immune system, infectious diseases, degenerative diseases, tumors, and more.

To become a dermatopathologist, a doctor must be either a dermatologist or a pathologist first. 

Like all doctors, those who want to be dermatopathologists must have a 4-year undergraduate degree before entering medical school. They then must finish:

  • 4 years of medical school
  • A 1-year internship
  • A 3-year residency in either dermatology or pathology 
  • 1 year of training in the subspecialty of dermatopathology

Doctors can take exams to become board certified in their specialty (dermatology or pathology) and their subspecialty (dermatopathology). Those who are board certified must take part in regular professional development to keep their certification past the first 10 years.

Dermatopathologists don't treat medical conditions directly. Instead, they offer valuable information to the doctors who send them samples for analysis. The conditions that dermatopathologists may diagnose include:   

Basal cell carcinoma. About 80% of skin cancers are basal cell carcinomas, which grow on parts of the skin that get a lot of sunlight. These cancers rarely metastasize, or spread from one part of the body to another, but they can get large enough to damage nearby tissue and even grow into bone. Dermatologists usually diagnose basal cell carcinomas just by looking at them, but they can send tissue to a lab to confirm the diagnosis. 

Melanoma. Only 1% of skin cancer cases are melanoma, but it’s one of the most aggressive types of cancer and can spread throughout the body. Melanomas are identified by biopsy. Lab examination of the tissue gives other important information about the cancer, such as how quickly the cells are dividing. Doctors use this information to guide treatment. 

Psoriasis. People with psoriasis have patches of skin that are red, itchy, and scaly. Experts believe that psoriasis is an immune system disorder that can affect your overall health. Psoriatic arthritis, for example, can cause permanent joint damage. A biopsy can confirm a diagnosis of psoriasis, determine which type of psoriasis you have, and guide treatment decisions. 

Alopecia areata . Alopecia means hair loss. When it happens in patches, it may be because of an autoimmune disorder called alopecia areata. The physician may make a diagnosis, but a dermatopathologist can confirm it by looking for a nest of immune cells around hair follicles.

You won’t see a dermatopathologist in person. Instead, you’ll probably see a dermatologist if you have skin conditions such as:

  • A change in the way a mole looks
  • Stubborn acne
  • Hives or rashes
  • Scars from blemishes, cuts, or scrapes
  • Skin irritation
  • Ingrown nails or fungus
  • Hair loss

Your insurance company or managed care program may call for samples to be sent to a specific lab that may or may not have a dermatopathologist on staff. If you have skin tissue removed, you can ask your doctor to send it to a dermatopathologist. 

A misdiagnosis can lead to the wrong treatment and may have other serious effects. For example, a misdiagnosis of melanoma could keep you from being able to buy affordable life insurance. You may want a second opinion for a diagnosis of melanoma if a dermatopathologist did not make the original diagnosis.