The skin biopsy is one of the most commonly performed procedures in dermatology.Performing Skin Biopsies: Maximizing Accuracy; Minimizing Risk < Back Performing Skin Biopsies: Maximizing Accuracy; Minimizing Risk Clay Cockerell, MD, JD, MBA | Kaseleigh McCarley, CMA Feb 10, 2023 The skin biopsy is one of the most commonly performed procedures in dermatology. Skin samples are usually taken for routine microscopy, and immunofluorescence microscopy is generally required when the possibility of an immunologic disorder exists. Rarely, electron microscopy may be performed when unusual diseases of connective tissue or unusual neoplasms are evaluated. This article will cover the four biopsy techniques that are most commonly employed: shave, punch, incision, and excision. Other specimens lend themselves to enucleation, such as cysts and benign neoplasms situated in the subcutis. Although the actual technique of skin biopsy is relatively straightforward, there are a number of important principles that must be adhered to in order to avoid potential problems, some of which may be serious. Although the vast majority of dermatologic disorders are not life-threatening, there are many pitfalls that may bedevil the unsuspecting clinician who is not aware of them. Standards & Principles Provide complete, accurate information to the dermatopathologist. A biopsy specimen submitted without appropriate clinical information may yield equivocal, confusing and often, useless results. Dermatology is a specialty that requires clinicopathologic correlation to be practiced well. Inability to correlate clinical findings with histologic ones very commonly leads to misdiagnosis and inappropriate treatment, often with harm to the patient. It is essential that those performing skin biopsies know the fundamental lesions of cutaneous pathology and how to describe them accurately and skillfully. Furthermore, the clinician must have an understanding of the disease process in question. Skin disorders are not static but are dynamic processes, and a knowledge of the disease progression and chronology is essential. For example, a biopsy taken from a lesion just in its inception or, conversely, at its end, is likely to appear completely different than those that are fully developed. The most characteristic, typical skin lesion of a given process should be sampled in a fashion that provides an intact and representative specimen to the dermatopathologist. Submit specimens only to those competent in the interpretation of cutaneous pathology. Dermatopathology is a complex specialty with morphology and terminology as fundamental elements. Those fully trained in dermatopathology have spent one or more years in specialty training focusing on the subtleties of dermatology and cutaneous pathology. Those who practice this on a daily basis are highly qualified and usually better able to able to make accurate diagnoses of skin disorders from skin biopsies. It cannot be emphasized too strongly that clinicopathologic correlation forms the cornerstone of the practice of dermatology even when dealing with seemingly banal processes such as basal cell carcinoma and nevi. It obviously assumes even more importance when the patient presents with an unusual inflammatory skin disorder or a pigmented lesion such as a possible melanoma. If no description can be made or a differential diagnosis cannot be rendered, it may be best to refer the patient for a second opinion. Incorrectly performed biopsies such as those performed using faulty technique or sampling a non-representative lesion may lead to an erroneous histologic diagnosis. For example, a superficial shave biopsy of discoid lupus erythematosus may be misinterpreted as squamous cell carcinoma with disastrous results. Conversely, a punch biopsy of malignant melanoma may fail to sample a diagnostic area resulting in failure to diagnose a serious, potentially lethal malignancy. Inflammatory skin disorders should not be biopsied using the shave technique but by punch or incision. Inflammatory dermatoses are evaluated on the basis of the pattern of the inflammation in the specimen so that evaluation of the superficial, as well as the depth of the skin, needs assessment. Superficial specimens do not permit such evaluation and are therefore prone to misinterpretation. Punch and incision specimens should extend into the subcutaneous fat. Panniculitides and alopecias, which are generally more complicated disorders, should be referred to experts in virtually all cases and must be sampled by either broad, deep punch technique or deep incision. Pigmented lesions suspicious of being melanoma should be sampled by excision whenever possible. Superficial shave and punch specimens of pigmented lesions are fraught with difficulty and are prone to medicolegal liability. Therefore, when dealing with lesions such as this, it is essential that appropriate specimens be taken. Punches are not recommended unless all of the lesion can be excised with the punch or the lesion is of such a size that complete primary excision is not feasible. In the latter case, either an incisional biopsy including the area of greatest concern or a broad punch biopsy can be performed. In any biopsy of a pigmented lesion, it is essential that the specimen that is taken be representative of the entire neoplasm in question. Ulcers should be biopsied in a way that samples the ulcerated area as well as an edge. Ulcers may develop due to many different pathologic processes in the skin ranging from neoplasms to vascular diseases. The border of the ulcer usually represents the most active portion of the process and thus, may have histologic features that differ significantly from what may be seen in the center, which may be only granulation tissue. Accurate diagnosis of ulcers is often difficult, so ancillary procedures such as cultures and immunoperoxidase stains may be required. Either broad, deep punch or incisional biopsy is required. A bulla should be biopsied so as to include a portion of the blister as well as the skin just adjacent to its edge. Vesicles, which are tiny blisters in the skin, can often be completely punched out, which is the preferable method, although bullae cannot be sampled as such because of their larger size. Punches taken through the center of a larger blister will cause the epidermis to shear away and possibly be lost. As the epidermis is often an important element in the accurate diagnosis of blistering diseases, it is essential that the specimen be taken to preserve it. Immunofluorescence studies are to be performed; it is important that the differential diagnosis is known and that the specimen be taken in an appropriate manner as certain blistering diseases should be sampled away from the blister, while others, such as pemphigus, are best sampled from the blister edge. If an infectious process is suspected, send part of the biopsy for culture and inform the dermatopathologist so that appropriate special stains will be performed. All annular and expanding lesions should be sampled from the leading edge. As the central portion of annular lesions often shows no pathologic changes, it is essential that all such lesions be sampled from the active margin. Reserve shave biopsies for pedunculated or sessile lesions. The shave is generally a technique used to sample a specimen either for confirmation such as clinically obvious nevi or keratoses or for cosmesis such as removal of acrochordons or warts. It generally does not sample the dermis, so inflammatory processes, and deeply seated neoplastic disorders may be missed when sampled in this fashion. Furthermore, many serious neoplastic disorders may have seemingly innocuous appearances, so over-reliance on this technique puts the clinician at increased risk of failure to diagnose a serious process. Punch biopsies smaller than 3 mm often do not provide enough material to make a diagnosis. Inflammatory skin disorders are almost always widespread so that the punch biopsy, even when broad, represents only a small portion of the entire process. Punches smaller than 3mm in diameter often do not contain diagnostic findings. It is often helpful if several biopsies taken from lesions at different stages of evolution and from different body sites are submitted. Suppose the dermatopathologist reports that no pathologic changes were found, and you are certain that pathologic changes were present in the biopsy specimen, ask that deeper sections be cut. In some cases, the lesion may have been small so that the initial sections into the block may not have sampled diagnostic areas. Most malpractice claims in dermatology are due to failure to diagnose. Poorly performed biopsies, specimens submitted with insufficient or misleading clinical information, and histologic interpretation by those without expertise in dermatopathology are the prime sources of medicolegal liability. It is essential that those performing dermatology be familiar with the standards of care in their communities and practice appropriately. Maintain a low threshold for the performance of skin biopsies in immunosuppressed patients when appropriate. Skin disorders may serve as signs of underlying serious infectious and neoplastic conditions and may have unusual and innocuous appearances. Skin biopsies may be the only way to establish a definitive diagnosis. Do not put specimens from multiple sites in one bottle. In some cases, malignant neoplasms may simulate benign conditions so that if multiple specimens are placed in one bottle and one is found to be malignant, the results may be disastrous. Ideally, there should be one specimen per bottle, each properly labeled with regard to the site from which the biopsy specimen was taken. Handle the tissue specimen with care. Make sure that once the biopsy specimen has been removed that it actually enters the formalin bottle. Shave specimens have a tendency to adhere to the scalpel or razor blade, while punch specimens can sometimes remain in the punch barrel. The formalin should be inspected to see that the specimen is floating in the formalin itself as if specimens adhere to the bottle, they may be crushed in the lid. The specimen should be placed in the formalin promptly to avoid dehydration and autolysis. Avoid spearing or crushing the specimen as crush artifact often renders histologic findings uninterpretable. Biopsy Techniques Shave Biopsy Equipment: Bandage Antibiotic ointment Specimen transport medium (formalin) Cautery Cotton tipped swabs No. 15 scalpel blade or surgical razor blade Gauze pads 3cc syringe with 30g needle containing 1% xylocaine with epinephrine Alcohol swabs Personal protective equipment (PPE) Technique: Obtain consent. Don PPE. Clean lesion and field with alcohol. Infiltrate anesthesia intradermally. Cut lesion at the base using a sawing motion. Place specimen in formalin bottle to be submitted for pathologic examination. Stop bleeding using Monsel’s solution or 20% aluminum chloride solution. Apply antibiotic ointment and bandage. Punch Biopsy Equipment: Personal protective equipment (PPE) Alcohol swabs Anesthesia Gauze pads Biopsy punch (3, 4, or 6 mm) Sharp pointed scissors Small toothed forceps Needle holder Monofilament nylon suture with a reverse cutting needle Specimen transport medium (formalin) Antibiotic ointment Bandage Technique: Obtain consent. Don PPE. Clean lesion and field with alcohol. Infiltrate anesthesia as above. Choose a punch that encompasses the desired lesion. With one hand, stretch skin perpendicular to natural skin tension (skin fold) lines. With the other hand, twist the punch to and fro between the fingers while slowly pushing it into the skin. Push to the hub, except in areas with little subcutaneous fat, such as the dorsal of the hands, eyelids, and external ears. Pull the punch straight out. Press the skin circumferentially around the wound site. The punch specimen should be expressed from the defect. If necessary, use a blunt instrument to remove it from the wound site. Avoid using toothed forceps as they can crush the specimen. Snip the specimen free with scissors at the base, taking care to include some fat in the lower portion of the specimen. Suture closed using a simple interrupted, horizontal mattress, or figure-of-eight stitches, in such a way as to align the incision line parallel to the skin tension lines. Apply pressure to obtain hemostasis. Dress with antibiotic ointment and a bandage. The patient is instructed to keep the area covered but clean it gently daily with water and apply antibiotic ointment before bandaging. Remove sutures at the next scheduled appointment. Excisional and Incisional Biopsy Equipment: Similar to that for punch biopsy plus a No. 15 scalpel blade on a handle. Once anesthesia is obtained, the procedure is performed under sterile conditions. Blunt-tipped undermining scissors are used instead of sharp-tipped scissors to loosen the tissue before closure. Technique: Obtain consent. Don PPE. Clean field with alcohol. Infiltrate with anesthesia as above. Apply betadine or similar preoperative scrub and don sterile gloves. Make an elliptical incision around the lesion into the superficial dermis. The ratio of length to width should be about 3: 1. If an incisional biopsy is to be performed, make an elliptical incision into the lesion itself, making certain that the most abnormal areas of the lesion are included in the specimen. Repeat incising perpendicular to the skin surface until the subcutaneous fat is seen at the base, and the ellipse sits like an island in the center of the wound. Lift one point of the ellipse with the forceps and carefully dissect the base of the specimen free with scissors, taking care to include some subcutaneous fat with the specimen. Venous oozing is usually controlled by applying gentle pressure. Small arterial bleeders may be ligated with an absorbable suture. Close the wound with simple interrupted nylon sutures or with horizontal or vertical mattress sutures. Gaping wounds will have a better cosmetic result if buried sutures are used to approximate the deeper layers with absorbable suture material such as Vicryl. This is followed by superficial interrupted or running sutures using Nylon. Apply antibiotic ointment and bandage. Dressing changes and suture removal as above. PAS Stain for Onychomycosis The performance of the potassium hydroxide preparation is considered fundamental in the diagnosis of dermatophyte infection. When dealing with onychomycosis, this is a somewhat more onerous procedure as the nail must be clipped to the proximal-most portion of involvement, and scrapings must be taken of the subungual debris. The material may need to be left on the slide for up to 20 minutes before examination, which may not be possible or practical. To expedite the diagnosis of fungal infections of the nail, a simple procedure can be done using the dermatopathology laboratory to confirm the presence of hyphae in the nail plate. This technique can be used because there are stains that allow the fungus to be identified in tissue. Equipment: Heavy-duty nail clippers Transport medium (formalin or clean Ziploc bag) Gauze pads Technique: Clean area with antiseptic solution or alcohol swab. Identify dystrophic nail plate. Gently slide the edge of the nail clipper under the dystrophic nail plate. Place gauze on the surface of the affected nail (prevents nail plate from flying across the room). Apply steady firm pressure with nail clippers until the nail plate is cut. Place the nail in a laboratory transport medium. Inform laboratory to perform PAS stain for fungus on the nail plate. ABOUT CLAY J. COCKERELL, MD, JD, MBA Dr. Clay J. Cockerell is a world-renowned specialist in treating and diagnosing skin disorders and has diagnosed over three million biopsies. An internationally recognized pioneer in his field and double board-certified in dermatology and dermatopathology, Dr. Cockerell has been practicing medicine since 1986. He is currently the Founder & President of Cockerell Dermatopathology and the Program Director of the Health Education Services dermatology residency program sponsored by the Lake Granbury Medical Center. Also, Dr. Cockerell sees patients a few days per month to assist with resident training and to keep his clinicopathological skills sharp. Dr. Cockerell has held numerous leadership positions within several highly regarded medical associations. Most notably, he served as the President, Secretary & Treasurer and a member of the Board of Directors of the American Academy of Dermatology, President of the Texas Dermatological Society, and President of the Dallas Dermatological Society. Also, Dr. Cockerell holds leadership roles as Founder and President of Cockerell Dermatopathology and a former AmeriPath Board of Directors member. Dr. Cockerell and his wife, Brenda, had a lifelong dream of producing wine and, in 2005, purchased a vineyard in Calistoga, California. They now produce wine under the Coquerel Family Wine Estates label. Dr. Cockerel and Brenda have two children, Charles and Lillian, and they have been married for forty-six years. In addition, Dr. Cockerell and Brenda enjoy traveling, golf, and winter sports. ABOUT COCKERELL DERMATOPATHOLOGY The Cockerell Dermatopathology story begins with Dr. Clay J. Cockerell's vision to establish a practice whose mission is to treat each specimen as if it came from one of own family members. Family! At Cockerell Dermatopathology, every employee is driven by a relentless pursuit of diagnostic excellence. We specialize in evaluating dermatologic disorders, tackling cases ranging from the routine to the most challenging. Our practice continuously invests in cutting-edge technologies to best serve each referring clinician and their patients. These innovations result in higher-quality diagnostic slides, quicker turnaround times for routine cases, and seamless deployment of EMR interfaces. From an educational perspective, Cockerell Dermatopathology is more than a dermatopathology practice. We host numerous in-person and internet-based education events and boast a state-of-the-art 14-headed microscope for dermatology resident training sessions. Our services extend beyond borders, serving hundreds of clinicians in Texas, throughout the United States, and globally. With a highly accessible team of board-certified dermatopathologists and a dedicated support staff, our vision is simple yet profound. Family, we treat every specimen as if it were from one of our own family members. Previous Next

Practical Symposium | Summer Sharpen Your Dermatology, Clinicopathologic & Business Skills. Join us August 20-23, 2026, in Vail, CO Future Dates PS Home 2027 Practical Symposium | Summer July or August TBA, 2027 Beaver Creek, CO

Dermpath On Demand is an online educational website for all things dermatopathology. Join Dr. Clay Cockerell in the library 24/7/365 to view eSlides and case review videos. Board Reviews DOD Home Who could benefit by participating? Residents | Dermatology & Pathology Fellows | Dermatopathology & MOHS Practicing physicians preparing for their recertification exam Medical students with interest in dermatology or pathology Cost: Thanks to the generous support of our industry partners, there is no cost to attend an in-person or virtual board review. Thank you, industry partners! Be sure to check out their services (websites.) Without their support, these board reviews would not be a reality. Included: Access to all board review e-slides. Access to the exams with a comprehensive answer key. Access to Dr. Cockerell's in-person or virtual case reviews. Cockerell 100 | Dermpath Board Review eSlides, Exam, Answer Key & Case Review Visit our Educational Library to view the 2025 Cockerell 100 content. Date: Saturday, June TBA, 2026 Virtual Times: 365/24/7: eSliding Reading. e-Slides will be provided one week before the event. To mimic the Applied exam, allow no more than 2 minutes per slide. 12:00 PM CDT: Business Lecture by Clay Cockerell, MD, MBA, JD 1:00 PM CDT: Case Review by Clay Cockerell, MD, MBA, JD via Zoom. Host: Clay J Cockerell, MD, MBA, JD Digital Board Review eSlides, Exam, Answer Key & Video Case Review Self-Paced Cases

HONE PA+NP Symposium Sharpen Your Clinical Skills Join us in Dallas, TX | September 12, 2026 Hone Home 2025 Industry Partners Dr. Clay Cockerell, the faculty, and attendees, gratefully acknowledge the following industry partners who are dedicated to supporting the Hone PA+NP Symposium. It's this continued support that allows conferences like ours to continue providing world-class educational content during these challenging post-pandemic times. Thank You! Industry Brochure

Your Academy is a series of in-person symposiums and online educational events that is focused on core and emerging dermatology and dermatopathology topics. Your Academy's goal is to improve everyone's clinicopathologic correlation communications which ultimately allows treating physicians and clinicians to formulate the best possible treatment plan for each of their patients. Accessibility Statement Measures to Support Accessibility Cockerell Educational Foundation (CEF) takes the following measures to ensure accessibility: Include accessibility throughout our internal policies. Include people with disabilities in our design personas. Conformance Status The Web Content Accessibility Guidelines (WCAG) defines requirements for designers and developers to improve accessibility for people with disabilities. It defines three levels of conformance: Level A, Level AA, and Level AAA. CEF's websites are partially conformant with WCAG 2.1 level AA. Partially conformant means that some parts of the content do not fully conform to the accessibility standard. Feedback We welcome your feedback on the accessibility of CEF's websites. Please let us know if you encounter accessibility barriers: E-mail: info@dermatology.academy (no .com) Postal Address: 2110 Research Row, Suite 100, Dallas, TX 75235 We try to respond to feedback within 3 business days. Compatibility with Browsers and Assistive Technology CEF's websites are designed to be compatible with the following browser's assistive technologies: Google Chrome Microsoft Edge Apple Safari Technical Specifications Accessibility relies on the following technologies to work with the particular combination of web browser and any assistive technologies or plugins installed on your computer: HTML WAI-ARIA CSS JavaScript SMIL WIX These technologies are relied upon for conformance with the accessibility standards used. Assessment Approach Cockerell Educational Foundation assessed the accessibility by the following approaches: Self-evaluation Outside consultant Date This statement was revised on June 1, 2024.

Practical Symposium | Winter Learn, Shred, Learn! January 29 - February 1, 2026 The Hythe | Vail, CO Registration Fees LEARN | SHRED | LEARN PS Winter Home Early Bird Physician PA | NP Resident | Fellow | Student Office Staff Guest of Attendee $500 $450 $200 $300 $250 After 10/31 $700 $650 $250 $350 $300 Register Today! The Practical Symposium | Winter registration fee includes access to all conference components, including educational sessions, the exhibit hall, and meals/social events listed on the agenda. Registration fees do not include lift tickets or ski rentals. Cancellations received on or before November 30, 2026, are subject to a $100 administrative fee. Cancellations received after November 30, 2026, are non-refundable. Attendee Brochure

Labatory improvement reduce turnaround time.Continuous Specimen Flow Changes Night Shifts to Day Shifts While Reducing Turn-Around-Time < Back Continuous Specimen Flow Changes Night Shifts to Day Shifts While Reducing Turn-Around-Time Clay Cockerell, MD, JD, MDA | Mary deBram-Hart, BS, HT | Erico Von Bueren, PhD, MD, MOR | Brenda Wander | Mark Fussner, BS, CT | Claudio Scancich | Craig Reed | Brand McCarley Jul 26, 2022 Labatory improvement reduce turnaround time. To reduce average TAT from 36-42 hours to 24-26 hours, the laboratory was restructured to include, relocation and a new floor plan for linear specimen workflow with a larger workspace. Conventional tissue processors were replaced with continuous flow, rapid tissue processors, cassette batch sizes reduced to an maximum of 32, and fully automated embedding was introduced. Personnel was rescheduled to decrease family unfriendly working hours (3pm-5am) and total hours, while increasing laboratory efficiency. MATERIALS & METHODS Customized WinSURGE® (Computer Trust Corp) Scanning Records using customized tools in Microsoft ® Excel ® 2013. Floorplans analyzing pathway crossings. Analysis of scheduled personnel shifts, family unfriendly (3pm-5am) schedules, and overtime. Analysis of cassette number reduction by increasing the number of spatially separated cross sectioned ellipse/s in Tissue-Tek® Paraform® Sectionable Cassette Systems (Sakura Finetek, Torrance, CA). Specimens were processed on Tissue-Tek VIP® 5, Tissue-Tek Xpress® x120, and embedded on Tissue-Tek AutoTEC® (Sakura Finetek, Torrance, CA). RESULTS The Paraform Sectionable Cassette System allows multiple cross sectioned ellipse/s in one cassette, locking their orientation from grossing to microtomy. Using Paraform Cassettes resulted in less cassettes grossed, processed, embedded, sectioned, and less slides stained and reviewed. Daily volumes decreased from 1,600 to 1,358 (-13%), reducing costs and increasing profitability. OLD vs. NEW LABORATORY SETUP The new laboratory set-up reduced overall daily working time for the entire Team from 215.5 hrs. to 136 hrs. (-79.5 hrs./-37%) while reducing the daily family unfriendly time (3pm to 5am) by 61% from 119.5 hrs. to 44 hrs./ 75%. The highest reduction of working and family unfriendly time was achieved in Embedding: -52 hrs./-100%, followed by Microtomy and Grossing. The Grossing and Microtomy Teams assist loading and unloading the Tissue-Tek Xpress x120 and Tissue-Tek AutoTEC, allowing task variety. The 4 stacked graphs on the left show the effect on working hours, the 4 stacked graphs on the right show the effect on family unfriendly hours. Noticeably, cumulative overtime was reduced from an average daily total of 16 hours to 0 hours. Overall, all Teams highly appreciated these changes and do not want to return to the previous set-up. CONCLUSIONS Specimens are oriented at grossing eliminating misorientation with manual embedding. Excisions can have multiple cross sectioned ellipse/s and are correctly oriented at grossing using Paraform Sectionable Cassette System reducing the total number of cassettes generated. Only 2% of the daily volume needs manual embedding due to specialty circumstances. Utilization of the Tissue-Tek Xpress x120 and Tissue-Tek AutoTEC allows 80% of specimens to be ready for microtomy within 7 hours after arrival into the laboratory. Continuous flow, rapid tissue processing means no more large batches, bottlenecks, or waiting time. The Tissue-Tek AutoTEC allowed 6 Histotechnicians to change their hours from night shift to day shift, allowing them to work more employee/family friendly shifts. Better hours and less blocks meant staff are able to perform additional duties allowing variety during the work day.  Designing a laboratory in a new building with a Lean workflow floor plan eliminated retraced steps and excessive walking time. Clients, Pathologists, and employees are happier. ABOUT CLAY J. COCKERELL, MD, JD, MBA Dr. Clay J. Cockerell is a world-renowned specialist in treating and diagnosing skin disorders and has diagnosed over three million biopsies. An internationally recognized pioneer in his field and double board-certified in dermatology and dermatopathology, Dr. Cockerell has been practicing medicine since 1986. He is currently the Founder & President of Cockerell Dermatopathology and the Program Director of the Health Education Services dermatology residency program sponsored by the Lake Granbury Medical Center. Also, Dr. Cockerell sees patients a few days per month to assist with resident training and to keep his clinicopathological skills sharp. Dr. Cockerell has held numerous leadership positions within several highly regarded medical associations. Most notably, he served as the President, Secretary & Treasurer and a member of the Board of Directors of the American Academy of Dermatology, President of the Texas Dermatological Society, and President of the Dallas Dermatological Society. Also, Dr. Cockerell holds leadership roles as Founder and President of Cockerell Dermatopathology and a former AmeriPath Board of Directors member. Dr. Cockerell and his wife, Brenda, had a lifelong dream of producing wine and, in 2005, purchased a vineyard in Calistoga, California. They now produce wine under the Coquerel Family Wine Estates label. Dr. Cockerel and Brenda have two children, Charles and Lillian, and they have been married for forty-six years. In addition, Dr. Cockerell and Brenda enjoy traveling, golf, and winter sports. ABOUT COCKERELL DERMATOPATHOLOGY The Cockerell Dermatopathology story begins with Dr. Clay J. Cockerell's vision to establish a practice whose mission is to treat each specimen as if it came from one of own family members. Family! At Cockerell Dermatopathology, every employee is driven by a relentless pursuit of diagnostic excellence. We specialize in evaluating dermatologic disorders, tackling cases ranging from the routine to the most challenging. Our practice continuously invests in cutting-edge technologies to best serve each referring clinician and their patients. These innovations result in higher-quality diagnostic slides, quicker turnaround times for routine cases, and seamless deployment of EMR interfaces. From an educational perspective, Cockerell Dermatopathology is more than a dermatopathology practice. We host numerous in-person and internet-based education events and boast a state-of-the-art 14-headed microscope for dermatology resident training sessions. Our services extend beyond borders, serving hundreds of clinicians in Texas, throughout the United States, and globally. With a highly accessible team of board-certified dermatopathologists and a dedicated support staff, our vision is simple yet profound. Family, we treat every specimen as if it were from one of our own family members. Previous Next

HONE PA+NP Symposium Sharpen Your Clinical Skills Join us in Dallas, TX | September 12, 2026 Hone Home Hotel & Travel Symposium Location This year's symposium will be held at Cockerell Dermatopathology in the 6th floor conference center. AKA The Derm Loft! Cockerell Dermatopathology 2110 Research Row 6th Floor | The Derm Loft Dallas, TX 75235 There is plenty of free parking around the building. Nearby Hotels There are numerous hotels in the nearby area which are 5-10 minutes from Cockerell Dermatopathology (meeting location.) Marriott Double Tree Element ALoft Embassy Suites Holiday Inn Express and... Many More Airport Options Dallas Love Field (DAL) Dallas, TX DFW International Airport (DFW) Irving, TX

Douglas Gray, MSOR, MBA < Back Douglas Gray, MSOR, MBA Faculty Douglas A. Gray is an entrepreneur, practitioner, leader, educator, and author with 30+ years of experience in Data & Analytics, IT/Software, E-Commerce, and Consulting. Mr. Gray has worked for Fortune 1-250, start-up, and early-stage companies in industries including retail, airlines, travel distribution, financial services, healthcare insurance, consulting, and commercial software. Mr. Gray is currently a Director, Data Science at Walmart Global Tech – US Omni Retail Tech where he leads teams that increase efficiency, cost effectiveness, and profit performance leveraging data and advanced analytics methods and solutions focused on End-to-End Fulfillment. His teams deliver economic impact and business value in the 9-figure range annually. He has been a member of two INFORMS Prize winning organizations: Walmart (2023) and American Airlines (1990). Previously, Mr. Gray served as Director, Enterprise Data & Analytics at Southwest Airlines. Through the data and analytics solutions delivered, Doug’s organization at Southwest Airlines generated $100M in annual operating cost reduction, and $100M in annual revenue augmentation. As a result, the team was recognized with the following awards: Teradata EPIC Award, FICO Decision Management Innovation Award, Alteryx Best Business ROI Award (2), Drexel LeBow Analytics50 Award (2), and AGIFORS Operations Best Innovation Award. Mr. Gray was a founding team member at award-winning American Airlines Decision Technologies (AADT) (now part of CAE, Inc.), which pioneered numerous innovations driving substantial economic impact in the use of Analytics in the airline industry, solving commercial and operational problems across the enterprise. At Sabre, he served as the founding CTO of Travelocity.com , the world’s first real-time, Internet-based travel reservation system. Mr. Gray served as Acting Director of Analytics at Blue Cross Blue Shield of Kansas City where he led the development of an Analytics Platform, i.e., a data warehouse, an operational dashboard, and a portfolio of analytical scoring models for measuring patient propensity for health conditions, behaviors, and outcomes. BCBSKC evolved the platform into a commercial Analytics-as-a-Service enterprise (CobaltTalon) serving other BCBS entities that was later sold to HealthLumen. Through his own company, Blueprint Technology Advisors, LLC, d.b.a., Optima Analytics, Mr. Gray advises executive leadership teams on best practices of applying Technology & Analytics to corporate strategy and Digital Transformation, and implementing Technology & Analytics organizations and capabilities. Mr. Gray has taught executive education seminars in Analytics since 2009. As an Adjunct Professor at SMU, Mr. Gray taught Business Analytics in the Cox School of Business EMBA Program 2016-20, through which his students’ real-world Case Analysis Projects routinely delivery 6-7-8-figure ($M) tangible, measurable business value and economic impact benefits. Mr. Gray serves as the primary instructor for Business Analytics in SMU’s MS in Data Science program. In 2025, Mr. Gray will offer an elective course, AI Strategy, in SMU’s EMBA Program. Mr. Gray teaches Analytics & AI Strategy for SMU Continuing and Professional Education and SMU Cox Leadership Academy. He currently serves on SMU’s Future of Work Advisory Council. PS Home

Practical Symposium | Winter Learn, Shred, Learn! January 29 - February 1, 2026 The Hythe | Vail, CO Who Should Attend? LEARN | SHRED | LEARN PS Winter Home The Practical Symposium | Winter is designed for: Dermatologists Mohs Surgeons Dermatopathologists Pathologists Dermatology Physician Associates/Assistants Dermatology Nurse Pra ctitioners Plastic Surgeons that Treat Skin Disorders Family Practitioners that Treat Skin Disorders Podiatrists that Treat Skin Disorders Dermatology and Mohs Fellows Dermatopathology Fellows Dermatology Residents Pathology Residents Register Today! Attendee Brochure Top Reasons to Learn | Shred | Learn Earn CME | Presented by World-Renowned Luminaries Virtually all of the major topics of dermatology and dermatopathology will be covered in this 3 day comprehensive seminar. Learn the essentials of clinicopathologic correlation, the cornerstone of dermatology and dermatopathology. Earn approximately 12 CME credit hours. Sessions on Fillers, Superficial Radiation Therapy, Molecular Diagnosis, Pediatric Dermatology, Therapeutics, and more... Creative sessions and updates on these essential topics are included to provide a more intensive didactic education. The Vail Valley Vail is the world's best winter playground. Practical Symposium Goals Achieve your educational goals with the ability to earn CME credits/hours. Comprehensive agenda topics covering a broad spectrum of dermatology and clinicopathologic correlation topics through engaging lectures. Advance your knowledge base by interacting in live demonstrations featuring emerging dermatologic technologies. Access to specialty and industry luminaries to strengthen your clinical and diagnostic skill sets. Expand your professional and social networks by mingling with colleagues, key opinion leaders, and industry executives. Prepare for the board or recertification exam through intense self-assessment and review sessions. Educational Objectives Translate the current trends and future innovations associated with clinical dermatology and dermatopathology. Demonstrate an improved knowledge base of the various treatment options and the use of multiple modalities in treating specific dermatologic disorders. Recall the basic principles for the treatment of dermatologic disorders, including biologics, combination therapy, and evolving treatment options. Implement learned skills about the clinical and histopathologic features, management, and treatment of common skin cancers and non-cancerous skin disorders. Evaluate new diagnostic and treatment algorithms for pigmented neoplasms (including melanoma), carcinomas, and inflammatory conditions. Assess the use of physical therapies in treating skin lesions, including cryotherapy, radiation therapy, photodynamic therapy, and light therapy. We would be honored to have you join us in Vail. We know that you will come away learning an incredible amount and have a great time in the process.

Business 201 Symposium Online lectures designed for residents, attending physicians and medical students. Business 201 Home Industry Partners Dr. Clay Cockerell, the faculty, and attendees, gratefully acknowledge the following industry partners who are dedicated to supporting the Business 201 Symposium. It's this continued support that allows conferences like ours to continue providing world-class educational content. Thank You!

Practical Symposium | Summer Sharpen Your Dermatology, Clinicopathologic & Business Skills. Join us August 20-23, 2026, in Vail, CO Symposium Links Clay's Message Who Should Attend Agenda Faculty Fees Hotel | Travel Industry Partners Social Media Submit Poster | Abstract Future Dates & Locations Attendee Brochure CME Document Center PS26 Register Industry Links Partnership Opportunities Past Industry Partners PRACTICALLY SPEAKING “The Practical Symposium was excellent and impacted how I will work up and treat my patients. As a practicing dermatologist, the clinicopathologic correlation was outstanding.”