Millions of skin cancers are diagnosed annually.Beware: Not All Labs are Created Equal < Back Beware: Not All Labs are Created Equal Clay Cockerell, MD, JD, MBA Nov 8, 2021 Millions of skin cancers are diagnosed annually. "There is a major epidemic of skin cancer in the world today. In the United States alone, millions of skin cancers will be diagnosed just this year," said Clay J. Cockerell, MD of Cockerell Dermatopathology. Furthermore, it is estimated that approximately 1 in 50 individuals born this year will develop malignant melanoma, the most dangerous and often life-threatening form of skin cancer in their lifetime. This cancer is the leading cause of death in young women in their 20's and 30's. However, skin cancers are most common in older people over the age of 50. Because of the gravity of this problem, it is vitally important that all individuals, especially those in the highest risk groups, understand how to recognize the signs of skin cancer and call it to the attention of their doctor, preferably someone with expertise in skin disorders. If there is suspicion that a spot may be skin cancer, a biopsy must be performed to make a diagnosis before treatment is undertaken. Getting an accurate diagnosis from the biopsy is critical as different treatments are used for different skin disorders, and if the lesion turns out to be benign, no treatment at all may be required. What many patients and surprisingly many doctors, especially non-dermatologists, do not understand, however, is that there is significant variation in the accuracy of different pathology labs depending on who is performing the examination of the biopsy. Many doctors try to reassure their patients that they are "sending the specimen to the lab." What you should ask your doctor is, "Which lab and who's going to be reading my biopsy"? CHANGING TIMES Years ago and still in many cases today, doctors, especially dermatologists, developed close working relationships with pathologists known as dermatopathologists, who are specially trained to interpret skin biopsies. With the ongoing evolution of health insurance companies, national laboratory companies made bids to provide laboratory services, mainly blood tests, for managed care plan patients. Because health insurance companies often look at all lab services as one, many of the specialized areas of pathology, such as dermatopathology, where an expert performs the service, were lumped into the same category as blood tests performed by a machine with no need for physician interpretation. Furthermore, there are cost pressures that discourage non-experts from seeking consultative second opinions from experts. SERIOUS CONSEQUENCES A misread specimen can have serious consequences for a patient. Failure to diagnose skin cancer, especially melanoma, can result in a disease that can be cured, turning into a deadly process. On the other hand, overdiagnosis of something benign as cancer can lead to loss of insurance or significantly increased insurance premiums, not to mention unnecessary and sometimes disfiguring surgery. In some cases, patients simply go for months, sometimes years, with no diagnosis or an erroneous one. In addition to poor patient care, inaccurate lab results can lead to legal liability and increased health care costs. DEPENDING ON EXPERT DERMATOPATHOLOGISTS The most critical key to accuracy involves the expertise of the person who is reading your biopsy. While board-certified dermatopathologists are certainly the best trained to read skin biopsies, some general pathologists with interest and experience in dermatopathology can do a good job, especially if he or she has access to consultation with a board-certified dermatopathologist. In the ultimate analysis, it's not the label of the person who evaluates the slide that matters but his or her competence, said the late A. Bernard Ackerman, M.D. As a rule, Dr. Ackerman always noted that a board-certified dermatopathologist is best equipped to render an accurate diagnosis of a skin lesion that is difficult to diagnose under the microscope, a phenomenon that is surprisingly common. CHALLENGING LESIONS Expertise becomes even more crucial in lesions that are difficult to interpret. Some subtle skin disorders, such as mycosis fungoides, a rare type of skin lymphoma, require very special expertise to make the right diagnosis. Non-cancerous skin diseases due to inflammation, such as rashes, can be diagnosed accurately only by dermatopathologists. Other challenging diagnoses are diseases that produce blisters such as bullous pemphigoid, pemphigus, and epidermolysis bullosa. WORRISOME TREND Some health insurance companies require physicians to send specimens to a specific lab that may or may not have an individual with expertise in dermatopathology. Many health insurances have instituted programs to penalize physicians who fail to utilize contracted laboratories, a practice that has received criticism from many physicians across the U.S. Many dermatologists choose to opt-out of contracts in which the biopsies are "steered" to a non-desired lab. They fear that these labs might not provide complete service for their patients and pose a malpractice risk to them. THE IMPORTANCE OF COMMUNICATION Communication is another important factor in making sure your doctor gets the "right" answer in your skin biopsy. When your doctor, especially a dermatologist, performs a biopsy, he or she is not sending out a simple blood test to a nameless lab. He or she needs to know who the pathologists are and work with them. Some specimens can present subtleties that are quite difficult to interpret. Arriving at a correct diagnosis requires a good treating physician who can relay information between the doctor performing the biopsy and the pathologist. Lines of communication have to be open both ways so that the doctor can call the pathologist to ask questions about a result, and the pathologist can call the doctor when he needs clinical clarification. Unfortunately, in many labs, it is difficult to reach any pathologist to discuss a case. Furthermore, it is often necessary for a slide to be sent back to the doctor because the patient is going for a second opinion or for additional treatment. "It is often difficult to get slides from some labs," notes Dr. Clay Cockerell. OTHER SIGNS OF QUALITY High-quality labs perform daily quality control, and most perform special studies when required, such as immunophenotyping. They also comply fully with state, federal, and other regulations. A lab having accreditation is also a sign of quality because obtaining and maintaining certifications takes time and requires the passage of rigorous inspections. RAISING COMPLAINTS As many health insurance companies attempt to "steer" biopsies to large corporate labs with which they have a contract, it is quite possible that your doctor is not happy with the quality of the lab but feels compelled to use it nonetheless, especially if there is a risk of a penalty. If you or your doctor is not happy with the quality of service from a lab, a number of different steps can be taken. Generally, the first step is a letter from your doctor and, in some cases, from the patient addressed to the health insurance company expressing complaints. In response, the health insurance company may agree that your doctor can send the specimen to the lab of his choice. Another, although less satisfactory solution, is that your doctor can insist that the lab have a board-certified dermatopathologist on staff. That's not a substitute, though, for having someone read your specimens whom your doctor knows and trusts. Finally, another option is for the patient to pay for the biopsy interpretation out of pocket. Surprisingly, however, many patients are reluctant to do so because they feel as if they need to "get their money's worth" and go with what the insurance plan will pay for, even if the expense is relatively low. Many people have no problem shelling out $100.00 or more for things such as a dinner out on the town, but when it comes to paying for an expert interpretation of a skin biopsy that could save his/her life or that of a family member, they balk. BOTTOM LINE Ask your doctor where he or she would send the biopsy if it was from one of his or her family members. Then request the same for yourself. 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

Business 201 Faculty < Back Michael Smith Regional Business Development Officer Coming soon. Business201 Home

Business 201 Faculty < Back Clay Cockerell, MD, MBA, JD President & Founder Cockerell Dermatopathology , Founder & President Health Education Services sponsored by Lake Granbury Medical Center, Program Director, Residency Program Dermpath On Demand , Co-Founder & Educational Director 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. http://www.dermpath.com Business201 Home

Business 201 Faculty < Back Edward Zabawski, DO Dermatologist Dr. Edward Zabawski is a board-certified dermatologist with a passion for treating a variety of skin, nail, and hair disorders. His formal education and training include: Duquesne University (Pittsburgh, PA) – BS, Pharmacy Ohio University College of Osteopathic Medicine (Athens, OH) – Doctor of Osteopathic Medicine Doctors Hospital of Stark County (Massillon, OH) – General and Internal Medicine Internship UNT Health Science Center (Fort Worth, TX) – Dermatology Residency A fellow of the American Academy of Dermatology (AAD) and the European Academy of Dermatology and Venereology (EADV), Dr. Zabawski’s research has been published in major dermatology articles and publications. In his spare time, Dr. Zabawski enjoys fishing, sports, cooking, and music. https://www.epiphanydermatology.com/ Business201 Home

David Hensley, MD < Back David Hensley, MD Faculty David Hensley, MD, is an experienced dermatologist at Metroplex Dermatology. He is dedicated to serving patients living in and around Arlington, Texas. A native of North Texas, Dr. Hensley graduated from the Texas Tech University Health Sciences Center in Lubbock. Dr. Hensley then served as a dermatology clinical research fellow at the University of Texas Health Science Center at Houston for two years before completing his dermatology residency at Geisinger Medical Center in Danville, Pennsylvania. In 2000, he was honored to accept the role of chief resident and served in this position for a year before returning to Texas. Dr. Hensley has practiced clinical, surgical, and cosmetic dermatology in Arlington since 2001 and regularly lectures and educates peers in his field. He started Metroplex Dermatology in early 2010 and continues to provide exceptional, personalized care to patients in the Arlington area. Hone Home

Business 201 Faculty < Back Mireya Hawthorne CEO & Principal Mireya Gonzalez Hawthorne serves the insurance and risk management needs of commercial clients in a variety of industries including retail, food service, manufacturing, public entity, financial services, healthcare, construction, property management and development. Mireya specializes in large-scale corporate risk management and solves critical risk and asset management objectives for middle market corporations. Areas of expertise include multi-state property and casualty programs, negotiating favorable terms for difficult or unique Directors and Officers Liability placements, negotiating Bonds, Products Liability coverage, helping clients turn around adverse Workers' Compensation experience, and insuring hard to place Property Schedules. She brings over 20 years of extensive insurance, risk financing, and risk management experience to MGRA. Mireya began her insurance career in San Antonio, Texas with Nationwide Insurance. A leading sales executive in personal lines and a nationally ranked producer of property and casualty insurance. Promoted to Dallas County Portfolio Manager & led the underwriting division for her district to the state Sales Conference each year. Became one of ten districts in Texas to reach Pacesetter’s (annual award) 4 consecutive years. In 1998, went to Summit Global Partners & excelled as an Account Executive/Producer. Served the insurance and risk management needs of companies such as WBK Construction Co, Hardscape Construction, Bell Sports, Monitronic’s, Broadcast.com , BroadbandNow, Trintel, ABC Pest Control, NTTA, and NV Holdings. She was recruited by Marsh USA in 2002 to develop new engagement opportunities for middle to large markets in their consulting and risk management division. She developed relationships with companies such as D.R. Horton, Carreker Financial, and Mary Kay, Inc. She managed client risks to strengthen their balance sheets, reduce expenses, and benefit their overall bottom line. Specialties: Technology Consulting firm, Franchised Food Service, Development of National Insurance Programs for Groups/Associations/Franchises, Construction, Mgmt Consulting, Service Organization, Products Liability, Executive Risk Arena-DnO, EnO, EPLI, Crime & Fiduciary https://www.mgrainc.com/ Business201 Home

Practical Symposium | Winter Learn, Shred, Learn! January 29 - February 1, 2026 The Hythe | Vail, CO 2026 Agenda [Draft] LEARN | SHRED | LEARN Attendee Brochure Register Today! PS Winter Home

View Your Academy's social media (pictures and videos) from all events. @YourAcademy101 Practical Symposium | Ski Symposium | HONE PA+NP | Dermpath On Demand | Business 201 Symposium Give Us A Like! Instagram @YourAcademy101

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.

Business 201 Faculty < Back Jeff Libby Partner Jeff Libby is more than an outstanding attorney and counselor; he is a trusted advisor. Jeff's practice focuses on commercial real estate and commercial loan transactions in which he assists clients on a local and national basis in a wide array of development, leasing, lending and construction matters. Mr. Libby works alongside developers of medical office buildings, retail shopping centers, multifamily complexes and single-family lots assisting with site acquisition, due diligence, subdivision and platting, zoning, entitlements and financing, as well as the construction of improvements, leasing, management and asset disposition. Jeff helps landlords and tenants successfully negotiate their commercial lease agreements, and counsels owners and contractors throughout the construction process. Mr. Libby also assists local community banks and national institutional lenders in processing and closing commercial loan transactions. Specialties Include: Commercial Real Estate Transactions Commercial Loan Transactions Commercial Lending Site Acquisition and Disposition Sale-Leaseback Transactions Medical Office Building Development Retail Development Mixed Use Development, Shopping Center Development Office Building Development Multifamily Development Single-Family Development Leasing (Landlord / Tenant) Medical Office Leasing Retail Leasing Shopping Center Leasing Commercial Office Leasing Industrial Leasing Warehouse Leasing Construction (Owner, Contractor, Subcontractor) Entitlements and Zoning Business Loan Transactions (Lender / Borrower) Commercial Mortgage Loans (Lender / Borrower) Title and Survey Easements Covenants, Conditions and Restictions (CCRs) Deed Restrictions Owner Associations Business Transactions Corporate Transactions https://www.libbysparks.com/ Business201 Home

Business 201 Faculty < Back Mary Nix Partner Mary Goodrich Nix is a Partner at LPHS with 25 years of experience handling complex commercial litigation. She frequently handles non-compete and trade secret litigation for publicly traded and privately held companies, including Fortune 500 , middle market companies, and startups in a variety of industries. Ms. Nix has extensive courtroom experience, including multiple jury trials, bench trials and injunction evidentiary hearings. She has arbitrated numerous cases throughout Texas and in other parts of the country. Mary is frequently called upon to assist companies when key employees move between competitors. In her work related to confidential information and trade secret protection, she advises clients in the identification of confidential information, trade secrets and other intellectual property assets and options for protection. Ms. Nix is Board Certified in Labor and Employment Law by the Texas Board of Legal Specialization. She has worked successfully with the U.S. Equal Employment Opportunity Commission (EEOC) , the U.S. Department of Labor (DOL) , the Texas Workforce Commission (TWC) and several other federal, state and local government agencies when a client is the subject of a complaint. Advocacy in this area includes responding to the complaint, negotiating where appropriate and advocating for her clients in administrative hearings. Frequent matters she handles include allegations of breach of contract, breach of fiduciary duty, tortious interference claims, Title VII claims, claims related to discrimination, harassment, retaliation and alleged violations of Americans with Disabilities Act (ADA), Fair Labor Standards Act (FLSA), Family and Medical Leave Act (FMLA), Families First Coronavirus Response Act (FFCRA), Age Discrimination in Employment Act (ADEA), Equal Pay Act (EPA) and alleged Occupational Safety and Health Act (OSHA) violations. https://www.lynnllp.com/ Business201 Home

Practical Symposium | Winter Learn, Shred, Learn! January 29 - February 1, 2026 The Hythe | Vail, CO Industry Partners LEARN | SHRED | LEARN PS Winter Home Industry Brochure Dr. Clay Cockerell, the faculty, and attendees gratefully acknowledge the following industry partners who are dedicated to supporting the Practical Symposium | Winter. It's this continued support that allows conferences like ours to continue providing world-class educational content. Thank You! Industry Brochure