An Exploratory Survey on Dermatopathology Practices Among a Subset of Indian Dermatologists

Dear Editor, Dermatopathology remains a cornerstone of dermatologic diagnosis and patient management.[1] Dermatopathology evolved largely through dermatologists’ efforts, and even today, many general pathologists have limited familiarity with its complex classifications, clinicopathological correlations, and specialized terminology.[2] Although the field has expanded significantly with the integration of immunofluorescence, immunohistochemistry, molecular diagnostics, and more recently artificial intelligence, its practice in India continues to show considerable variability.[1] Despite the availability of training programs, dermatopathology practices across the country remain inconsistent,[3] leading to variability in diagnostic accuracy—an issue recognized by both dermatologists and pathologists. The challenges faced by Indian dermatologists due to such variability have not been explored thoroughly. This cross-sectional, questionnaire-based survey aims to analyze the current trends in dermatopathology practices among Indian dermatologists and identify factors contributing to this variability. The questionnaire was developed through discussions between dermatologists and dermatopathologists, validated by a senior dermatopathologist, and pretested on seven dermatologists before finalization. Dermatologists not affiliated with medical colleges/teaching institutions were invited to participate by circulating the survey form through WhatsApp groups comprising approximately 1000 members. The self-administered survey was conducted over 8 weeks, targeting 100 participants. Data were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages. This was an exploratory, convenience-based survey, and the findings are not intended to be nationally representative. Among the 100 respondents, the majority were females (52%), and the most common age group was 25–35 years (51%). Among the 100 respondents, most were early in practice (71%, ≤10 years’ experience) and engaged in solo private practice (45%), based in urban settings (76%), with 69% lacking access to an in-house dermatopathology laboratory. Formal fellowship training was rare (2%), while 34% had no training and 49% relied on self-learning. Skin biopsy was routinely performed, commonly for autoimmune (65%), infectious (65%), and granulomatous disorders (65%), with 7% performing more than 20 biopsies monthly; 39% regularly used immunofluorescence/immunohistochemistry. While 65% of practitioners did perform biopsies from challenging sites like the scalp and mucosa, 35% practitioners continue to refer such cases to higher centers. Although dermoscopy was widely practiced, 56% felt it had not reduced biopsy rates. While 99% believed histopathology should ideally be reported by a dermatopathologist, only 42% consistently sent samples to a dermatopathologist, and dissatisfaction with general pathology reports was common (76%). Despite 92% endorsing a stronger clinician–pathologist collaboration, only 30% regularly discussed histopathology reports with reporting pathologists, and 29% reported encountering discordant findings affecting patient management. The key challenges faced by Indian dermatologists concerning dermatopathology practices included a lack of access to expert dermatopathologists (69%) and limited training in dermatopathology [61%; Chart 1]. Most dermatologists (61%) showed interest in receiving additional training in dermatopathology; 49% chose online courses, 28% favored clinical case discussions with pathologists, 17% opted for hands-on workshops, and just 5% picked conferences and seminars as their preferred mode of training. To improve dermatopathology practices, participants suggested enhancing accessibility to dermatopathology centers, ensuring a clinicopathological correlation for each case, organizing dermoscopy and dermatopathology colloquiums, making services more affordable, and strengthening dermatopathology training during postgraduate residency.Chart 1: Frequency distribution of major challenges faced by dermatologists in dermatopathology practice. IF: immunofluorescence; IHC: immunohistochemistryLike the study conducted by Comfere et al.,[4] which identified ineffective clinician–pathologist communication as a key challenge, our survey also found inadequate discussion of histopathology findings; however, unlike their setting—where biopsies were reported by certified dermatopathologists—our respondents additionally faced shortages of trained dermatopathologists and limited training opportunities. Compared to structured systems in the United States and United Kingdom, dermatopathology training in India remains heterogeneous, potentially contributing to diagnostic variability.[4,5] These preliminary observations may prompt further structured evaluation and discussion regarding dermatopathology training and interdisciplinary collaboration in India. The major limitations of this study include the small sample size, low response rate, exclusion of dermatologists affiliated with medical colleges, and reliance on self-reported cross-sectional data, limiting generalizability and long-term inference. Acknowledgment Nil. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.