Digital Dermatopathology Is Moving Beyond Slide Scanning: What Laboratories Need for a Complete Workflow

A review published online August 26, 2026, in the Journal of Cutaneous Pathology offers a practical message for laboratories considering digital dermatopathology: purchasing a scanner is only one part of the transition. The Mayo Clinic authors describe a complete digital workflow built around case organization, image management, laboratory integration, validation, quality assurance, financial planning and regulatory review.

From a Scanner Project to a Connected System

The review is Part II of a three-part “Digital Dermatopathology Playbook.” Part I, published July 24, addressed technical infrastructure such as scanners, software, image compression, DICOM standards, storage and network capacity. Part II moves downstream and examines how images travel from storage to sign-out.

At the center is the image management system, or IMS. The authors describe it as the platform that organizes cases, links images with the laboratory information system, supports workflow automation and creates a foundation for advanced diagnostic tools. That framing matters because a digital slide without reliable case identity, status and access controls is not yet a dependable clinical workflow.

Workflow Design Must Match the Laboratory

The paper compares inline and retrospective scanning models. Inline scanning places digitization inside the active production sequence, while retrospective scanning occurs after the conventional glass-slide workflow. Each approach changes staffing, timing, storage and failure-recovery needs. The review does not identify one universal model; it emphasizes implementation choices, efficiency and fit with the laboratory’s operating environment.

For histology teams, digital readiness therefore begins before the scanner. Tissue processing, section completeness, staining, coverslipping, labeling and slide cleanliness all influence the image entering the system. A digital platform can expose these variables at scale, but it cannot repair a fold, missing margin, weak nuclear detail or incorrect identifier already present on the glass slide.

Validation and Quality Assurance Come Before Scale

The authors highlight standardized validation to confirm diagnostic concordance. CAP’s active whole-slide-imaging guideline similarly says laboratories should validate WSI for its intended clinical use before diagnostic deployment. CAP’s update reaffirms a minimum validation set of 60 cases and recommends greater than 95% concordance between whole-slide imaging and light microscopy, while recognizing the variability that also exists between glass-slide interpretations.

Regulatory scope must also be checked system by system. The FDA product classification for whole-slide imaging systems describes an aid for pathologists reviewing FFPE surgical pathology slides and states that the classification is not intended for frozen tissue, cytology or non-FFPE hematopathology specimens. That distinction is especially important for Mohs laboratories: an indication or validation established for routine FFPE dermatopathology should not be assumed to cover frozen Mohs sections.

Why This Matters for Mohs Practices

Digital pathology could support consultation, teaching, archiving, quality review and future computational tools, but the review is not a Mohs-specific validation study. Practices evaluating digital use for Mohs should define the exact purpose first: education, remote consultation, quality assurance, documentation or primary interpretation. The intended use determines the required validation, equipment, staffing, oversight and regulatory review.

Histotechnologists have a central role because image quality remains dependent on the physical slide. A practical validation plan should capture scan failures, focus problems, incomplete tissue, stain variation, rescans, recuts, turnaround time and mismatches among specimen, block, slide and digital case. Escalation procedures must also identify who resolves technical uncertainty before an image reaches interpretation.

Economics, Governance and Limitations

The review also addresses cost structures, return on investment and sustainable funding. Those issues extend beyond the scanner price to storage, interfaces, cybersecurity, monitors, service contracts, validation time, training and ongoing quality control. A system can be technically impressive and still be operationally unsustainable if these recurring requirements are not planned.

This publication is a professional review, not a clinical trial or comparative outcome study. It does not prove that digitization reduces errors, turnaround time or total cost in every laboratory. Its value is as an implementation framework that helps teams ask the right questions before clinical deployment.

Three Key Takeaways

• Digital dermatopathology requires an integrated workflow; a scanner alone is not a complete clinical system.
• Validation must match the intended use, specimen type, configuration and local laboratory environment.
• For Mohs frozen sections, laboratories should not extrapolate automatically from FFPE indications or validations.

Educational disclaimer: This article provides professional education and general information. It does not establish a clinical protocol, endorse a product, replace regulatory review or substitute for the judgment of the laboratory director, pathologist or Mohs surgeon.

Mohs Workflow - Three Practical Tips

• Define the digital use before validating it. Education, QC, consultation and primary interpretation have different requirements; document the intended purpose and confirm that frozen-section use is within the system’s scope.
• Protect the complete margin before scanning. Check epidermal and deep margin representation, folds, chatter, contamination, stain quality and coverslip condition; a scanner cannot recover tissue or detail missing from the glass slide.
• Maintain one traceable chain. Confirm that patient-safe case identifiers, stage, piece, map, block, slide and digital image remain linked, and document rescans, recuts, focus failures and any manual reassignment.

Histopathology Workflow - Three Practical Tips

• Standardize the pre-scan checkpoint. Use a documented acceptance check for section quality, H&E or special-stain performance, coverslip cleanliness, label legibility and tissue placement before the slide enters the scanner.
• Record levels and recuts sequentially. Preserve the original block-to-slide relationship and ensure that every additional level, recut or stain appears in the correct digital case without overwriting earlier records.
• Escalate discordance rather than interpreting it. Out-of-focus regions, missing tissue, image artifacts or disagreement between the glass slide and digital case should be documented and referred to the responsible pathologist, laboratory director or supervisor.

Direct Sources

Sokumbi O, Velusamy B, Peters MS, Comfere NI. Part II: Digital Dermatopathology Playbook: Navigating Operational Workflow From Storage to Sign-Out. Journal of Cutaneous Pathology. Published online August 26, 2026. — https://pubmed.ncbi.nlm.nih.gov/42643128/

Wiley version of record and DOI: 10.1111/cup.70196. — https://doi.org/10.1111/cup.70196

Sokumbi O, Velusamy B, Peters MS, Comfere NI. Part I: Digital Dermatopathology Playbook: Technical Infrastructure for Transition From Glass to Digital. Published online July 24, 2026. — https://pubmed.ncbi.nlm.nih.gov/42495872/

College of American Pathologists. Validating Whole Slide Imaging for Diagnostic Purposes in Pathology. Active guideline; 2021 update published in 2022. — https://www.cap.org/cap-guidelines/validating-whole-slide-imaging-for-diagnostic-purposes-in-pathology/

U.S. Food and Drug Administration. Technical Performance Assessment of Digital Pathology Whole Slide Imaging Devices. Final guidance, April 2016. — https://www.fda.gov/regulatory-information/search-fda-guidance-documents/technical-performance-assessment-digital-pathology-whole-slide-imaging-devices

U.S. Food and Drug Administration. Product classification: whole slide imaging system. — https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?ID=PSY‍