Dermatopathology

NAME OF SPECIALTY

Dermatopathology

CPT CODES

To be assigned by pathology:

  • Level IV:Surgical Pathology, gross and microscopic examination; depending on the case complexity
    • 88302
    • 88304
    • 88305
    • 88307
    • 88309
  • Special Stains for microorganisms (if needed), each stain
    • 88312
    • 88313
  • Immunohistochemistry (including tissue immunoperoxidase), each stain
    • 88342

PRINCIPLE

Dermatopathology, basically is a subspecialty of dermatology and to a lesser extent of surgical pathology that focuses on the study of cutaneous diseases at a microscopic level.  It also encompasses analyses of the potential causes of skin diseases at a cellular level. Dermatopathologists work in close association with dermatologists.  In fact, most of them are trained primarily in dermatology themselves.1

Dermatologists are able to recognize most skin diseases based on their appearances, anatomic distributions, and behavior.  Sometimes, however, those criteria do not allow a conclusive diagnosis to be made, and a skin biopsy is taken to be examined under the microscope.  That process reveals the histology of the disease and results in a specific diagnostic interpretation.  In some cases, additional specialized testing needs to be performed on biopsies, including immunofluorescence, immunohistochemistry, electron microscopy, flow cytometry, and molecular-pathologic analysis.1

One of the greatest challenges of dermatopathology is its scope.  More than 1500 different disorders of the skin exist, including cutaneous eruptions (“rashes”) and neoplasms.  Therefore, dermatopathologists must maintain a broad base of knowledge in clinical dermatology, and be familiar with several other specialty areas in medicine.3

METHODOLOGY

Gross and microscopic examination with hematoxylin and eosin (H&E) stain.  Special stains and special studies (IHC, ISH, etc.) if needed.

REQUEST FORM

Complete a <Dermatopathology Requisition>.

The following information must be completed on each requisition.

  1. Patient’s Name
  2. Patient’s Date of Birth
  3. Social Security Number (if available)
  4. Date and time of collection
  5. Specimen source and tissue type
  6. Requesting Physician name and contact phone number
  7. Thorough clinical history if available
  8. All insurance information must be included to ensure proper billing.

RESULT(S)

Interpretive reporting of skin biopsies and consultation in the diagnosing  benign and malignant dermatologic diseases.

COLLECTION

Skin biopsies must be submitted in 10% buffered formalin. If immunobullous disease is suspected, submit half of the tissue in Michel’s fixative for a direct immunofluorescence study.  See Immunofluorescence: Direct, Skin in this directory for specimen requirements.

CAUSE(S) FOR REJECTION

Frozen specimens

Specimens not in appropriate fixative