The Biopsy That Falls Through the Cracks: How Dermatology Practices Close the Loop on Pathology Results

Dermatology biopsy tracking sounds like back-office work, but it's one of the biggest patient-safety levers a practice has. A busy dermatology practice can send dozens of specimens to the lab every week. Most come back benign, someone signs off, and the patient never thinks about it again. But every so often, a result comes back that matters — atypical, severely dysplastic, or melanoma — and it lands in a queue nobody is watching. That's the biopsy that falls through the cracks.

In fact, it rarely happens because someone was careless. Instead, it happens because the process depends on memory: a paper biopsy log, a sticky note, a staff member who usually checks the fax tray. When that person is out sick, or the lab sends the report to the wrong provider, the loop stays open. As a result, dermatology biopsy tracking is less a clinical problem than a workflow problem.

Why gaps in dermatology biopsy tracking are a real risk

The stakes are well documented. A January 2026 review in the Journal of Clinical and Aesthetic Dermatology noted that melanoma remains the leading cause of litigation in dermatology. Moreover, it named failure to follow up on positive findings and failure to notify patients of pathology results as major contributors to legal action. Notably, the same review found that most claims stem from miscommunication, documentation gaps, and system failures — not gross negligence.

Outside dermatology, the problem is just as familiar. A widely cited study in Archives of Internal Medicine found that primary care practices either failed to inform patients of abnormal test results, or failed to document doing so, in about 7 percent of cases. In other words, roughly one in fourteen abnormal results never visibly reached the patient.

Patients now see pathology results first

There's a newer wrinkle, too. Under the 21st Century Cures Act information-blocking rules, many results now release to patient portals right away. Consequently, patients often read their pathology report before anyone at the practice has called them.

Research published in JAMA Oncology in 2023 (via Healio) tracked this shift at one large academic center. Across all test types, the share of results patients viewed before their ordering clinician rose from 37 percent in 2017 to 75 percent in 2022. For pathology reports specifically, it reached 58 percent. So, a patient reading "melanoma in situ" alone at 10 p.m. is now a realistic scenario — unless your dermatology biopsy tracking workflow gets ahead of it.

What closed-loop dermatology biopsy tracking looks like

Practices that handle dermatology biopsy tracking well tend to follow the same basic pattern. In fact, CMS even sets a 7-day quality target for skin cancer pathology reports to reach the biopsying clinician. Each step has a clear owner, and the EHR — not a spreadsheet — keeps track of where every specimen stands.

Where your EHR fits into dermatology biopsy tracking

None of these steps is complicated on its own. However, doing all five reliably for every specimen, every week, is exactly the kind of work that slips when it lives on paper. That's why dermatology biopsy tracking belongs inside the EHR itself.

A dermatology biopsy tracking checklist

• Pull a report of every specimen sent in the last 90 days, and confirm each one has a signed result
• Assign one named owner for the pending-results list, plus a backup for when they're out
• Set a turnaround threshold, and call the lab on anything that passes it
• Decide how malignant results reach the patient before the portal does — and write it down
• Document every contact attempt, including patients who decline recommended treatment
• Close a specimen only after the follow-up procedure is complete, not when the report is signed

Ultimately, good dermatology biopsy tracking isn't about working harder. Instead, it's about making sure the system remembers every specimen, even on the day your team doesn't.