Defensive medicine in dermatological practice – Dermatopathology as a mirror of structural challenges

Defensive medicine refers to diagnostic or therapeutic actions taken primarily to reduce legal liability rather than to benefit the patient. In dermatopathology, defensive practices manifest in frequent immunohistochemical testing, overly cautious report phrasing, and reliance on multidisciplinary tumor boards. Underlying causes include diagnostic uncertainty, guideline ambiguity, legal pressures, and financial incentives. These behaviors can lead to overtreatment and rising healthcare costs without improving diagnostic accuracy. This manuscript advocates for a balanced, evidence-based diagnostic approach, emphasizing appropriate indications, improved clinicopathologic correlation, and the need for further subspecializing. Dermatopathology is presented as a paradigmatic discipline that highlights both the challenges and potential of defensive diagnostic behavior. Enhancing legal understanding, promoting structured decision-making, and strengthening diagnostic confidence may help to reduce unnecessary testing and support high-quality, patient-centered care.