100+ Free ABD Dermatopathology Practice Questions

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Question 1

Score: 0/0

A biopsy from a photodistributed eruption shows a vacuolar interface dermatitis with scattered necrotic keratinocytes, a superficial perivascular lymphocytic infiltrate, increased dermal mucin highlighted by colloidal iron, and follicular plugging. Which diagnosis is most likely?

Lichen planus

Discoid lupus erythematosus

Erythema multiforme

Acute graft-versus-host disease

to track

2026 Statistics

Key Facts: ABD Dermatopathology Exam

270

Total MCQ Items

160 Written/Practical + 110 Virtual Microscopy

~7.5 hrs

Total Exam Time

3h 13m W/P + 4h 9m VM

500

Scaled Pass Score

Modified Angoff (criterion-referenced)

$2,100

2026 Exam Fee

Includes $200 admin fee

12 mo

Required Fellowship

ACGME dermpath fellowship

10 yr

Certification Validity

Time-limited; CC/MOC required

The ABD/ABPath Dermatopathology exam is a 1-day computer-based test of 270 single-best-answer MCQs split into a Written/Practical section (160 items, 3h 13m) and a Virtual Microscopy section (110 items, 4h 9m) — no glass slides. Scaled pass score is 500 (modified-Angoff). The 2026 fee is $2,100 including a $200 nonrefundable administrative fee; exam window is September 8-28, 2026. Eligibility requires primary ABD or ABPath certification plus a 12-month ACGME dermpath fellowship.

Sample ABD Dermatopathology Practice Questions

Try these sample questions to test your ABD Dermatopathology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A biopsy from a photodistributed eruption shows a vacuolar interface dermatitis with scattered necrotic keratinocytes, a superficial perivascular lymphocytic infiltrate, increased dermal mucin highlighted by colloidal iron, and follicular plugging. Which diagnosis is most likely?

A.Lichen planus

B.Discoid lupus erythematosus

C.Erythema multiforme

D.Acute graft-versus-host disease

Explanation: Follicular plugging, a vacuolar interface pattern with a superficial and deep perivascular/periadnexal infiltrate, and increased dermal mucin are classic for discoid LE. Lichen planus shows a lichenoid (band-like) interface with wedge-shaped hypergranulosis and saw-toothed rete, not a vacuolar pattern with mucin.

2A biopsy from the oral buccal mucosa shows a dense band-like lymphocytic infiltrate hugging the basal layer, wedge-shaped hypergranulosis, saw-toothed rete ridges, and scattered Civatte bodies. Which diagnosis best fits?

A.Lichen planus

B.Lupus erythematosus

C.Dermatomyositis

D.Pemphigus vulgaris

Explanation: Classic lichen planus features are a lichenoid (band-like) infiltrate at the dermo-epidermal junction, wedge-shaped hypergranulosis, saw-toothed rete, and Civatte (colloid/apoptotic) bodies. DIF shows shaggy fibrinogen at the BMZ.

3Which histologic feature is LEAST likely to be seen in fully developed chronic plaque psoriasis?

A.Confluent parakeratosis with Munro microabscesses

B.Regular elongation of rete ridges with thinning over dermal papillae

C.Absent or markedly diminished granular layer

D.Prominent papillary dermal eosinophilia

Explanation: Psoriasis is defined by parakeratosis with Munro microabscesses, Kogoj spongiform pustules in the upper spinous layer, elongated rete with thin suprapapillary plates, loss of the granular layer, and dilated papillary capillaries. Eosinophils are typically absent — their presence should prompt consideration of drug-induced psoriasiform eruption or other mimics.

4Kogoj spongiform pustules are most characteristic of which dermatosis?

A.Atopic dermatitis

B.Psoriasis

C.Pemphigus foliaceus

D.Bullous pemphigoid

Explanation: Kogoj spongiform pustules are collections of neutrophils in the upper spinous layer surrounded by attenuated, reticulated keratinocytes — a defining feature of psoriasis (and its variants such as pustular psoriasis and reactive arthritis).

5A spongiotic dermatitis biopsy shows intraepidermal vesicles containing Langerhans cell microabscesses (eosinophilic spongiosis with Langerhans cells). Which condition should be considered?

A.Allergic contact dermatitis

B.Atopic dermatitis

C.Nummular dermatitis

D.Psoriasis

Explanation: Langerhans cell microabscesses (clusters of Langerhans cells within spongiotic vesicles) are most characteristic of allergic contact dermatitis. All three are spongiotic — the question specifies the ACD-specific pattern.

6A biopsy shows a subcorneal blister filled with acantholytic cells and few neutrophils. DIF shows intercellular IgG throughout the epidermis. Which diagnosis fits best?

A.Pemphigus vulgaris

B.Pemphigus foliaceus

C.Bullous impetigo

D.Subcorneal pustular dermatosis (Sneddon-Wilkinson)

Explanation: Pemphigus foliaceus produces a subcorneal/superficial acantholytic blister with intercellular IgG on DIF (Dsg1 target). PV is suprabasal acantholysis with intercellular IgG targeting Dsg3 (and Dsg1 in mucocutaneous). Bullous impetigo has no DIF positivity. Sneddon-Wilkinson is DIF-negative.

7Which direct immunofluorescence (DIF) pattern best describes pemphigus vulgaris?

A.Linear IgG and C3 along the basement membrane

B.Granular IgA at the tips of dermal papillae

C.Intercellular (chicken-wire) IgG throughout the epidermis with suprabasal accentuation

D.Shaggy fibrinogen along the basement membrane

Explanation: Pemphigus vulgaris shows intercellular chicken-wire IgG (and often C3) between keratinocytes, typically with suprabasal accentuation. The H&E correlate is suprabasal acantholysis with 'tombstone' basal cells.

8On salt-split skin DIF, a subepidermal autoimmune blistering disease shows linear IgG on the DERMAL (floor) side. Which disorder does this finding favor?

A.Bullous pemphigoid

B.Epidermolysis bullosa acquisita

C.Linear IgA bullous dermatosis

D.Dermatitis herpetiformis

Explanation: EBA autoantibodies target type VII collagen in the sublamina densa, so on salt-split skin they localize to the DERMAL (floor) side. Bullous pemphigoid autoantibodies (BP180/230) are above the lamina densa and localize to the EPIDERMAL (roof) side.

9A biopsy from the extensor elbow shows neutrophilic microabscesses at the tips of dermal papillae with a subepidermal split. DIF shows granular IgA at the tips of dermal papillae. Which is the best diagnosis?

A.Dermatitis herpetiformis

B.Linear IgA bullous dermatosis

C.Bullous pemphigoid

D.Bullous lupus erythematosus

Explanation: DH is characterized by neutrophilic microabscesses at the tips of dermal papillae and granular IgA deposition at those papillary tips on DIF — a highly specific combination. Patients almost universally have gluten-sensitive enteropathy.

10Which finding most strongly favors sarcoidosis over tuberculous granulomatous dermatitis?

A.Presence of caseating necrosis

B.Well-formed 'naked' granulomas with minimal surrounding lymphocytes

C.Positive Fite stain for acid-fast bacilli

D.Giant cells containing Schaumann bodies only

Explanation: Sarcoid granulomas are classically 'naked' — compact noncaseating epithelioid granulomas with only a sparse lymphocytic rim. TB granulomas caseate and are usually richly surrounded by lymphocytes. Schaumann and asteroid bodies occur in both.

About the ABD Dermatopathology Exam

The Dermatopathology subspecialty certification is jointly sponsored by the American Board of Dermatology (ABD) and the American Board of Pathology (ABPath), with ABPath as Sponsoring Board and ABD as Administrative Board. The 1-day computer-based exam includes 160 Written/Practical items and 110 Virtual Microscopy items (270 total) and tests expert-level diagnostic dermatopathology. Candidates must hold primary certification in AP/CP, AP, or Dermatology plus a 12-month ACGME-accredited dermpath fellowship.

Questions

270 scored questions

Time Limit

1-day computer-based (3h 13m Written/Practical + 4h 9m Virtual Microscopy)

Passing Score

Scaled score of 500 (criterion-referenced via modified Angoff)

Exam Fee

$2,100 (includes $200 nonrefundable administrative fee) (ABD + ABPath (jointly sponsored) / Pearson VUE)

ABD Dermatopathology Exam Content Outline

~25%

Inflammatory Dermatoses

Interface (vacuolar/lichenoid — LE, LP, DM, GVHD, EM), psoriasiform (psoriasis pattern features + Munro/Kogoj), spongiotic (AD/ACD/id), vesiculobullous with DIF (pemphigus, BP, DH, EBA), granulomatous (sarcoid, TB, GA, NXG, rheumatoid nodule)

~20%

Melanocytic Lesions

Nevus vs melanoma (pagetoid spread, architectural disorder, cytologic atypia, HMB45 gradient, SOX10), spitzoid spectrum (Spitz vs atypical Spitz tumor vs spitzoid melanoma), dysplastic nevus, BAP1-deficient tumors, deep penetrating nevus, blue nevus variants

~12%

Keratinocytic Tumors

BCC subtypes (nodular, superficial, morpheaform, infiltrative, pigmented, fibroepithelioma of Pinkus), SCC spectrum (AK to Bowen to invasive with PNI), keratoacanthoma, verrucous carcinoma

~10%

Melanoma Variants

Lentigo maligna, nodular, acral lentiginous, desmoplastic/neurotropic, amelanotic — Breslow depth, mitotic rate, ulceration, staging

~10%

Skin Adnexal Tumors

Trichoepithelioma vs BCC, syringoma, eccrine poroma, cylindroma (Brooke-Spiegler), SCAP, hidradenoma, pilomatricoma, sebaceous neoplasms (Muir-Torre)

~8%

Cutaneous Lymphomas

Mycosis fungoides (patch/plaque/tumor), Sézary, CD30+ LPDs (LyP types A-E vs primary cutaneous ALCL), CD4+ small/medium TCL, subcutaneous panniculitis-like TCL, PTCL NOS, cutaneous B-cell lymphomas

~7%

Vascular & Mesenchymal Tumors

Kaposi stages, angiosarcoma, infantile hemangioma (GLUT1+) vs vascular malformations, dermatofibroma vs DFSP (CD34/Factor XIIIa), leiomyoma, atypical fibroxanthoma

~5%

Infections

Leishmaniasis (parasitized histiocytes), leprosy (Fite), syphilis (plasma cells), deep fungi (PAS/GMS), mycobacteria, viral (HSV/HPV/molluscum)

~3%

Deposits, Metabolic, IHC Panels

Amyloid (Congo red), mucin (colloidal iron), calcium (Von Kossa), iron (Prussian blue); core IHC — S100, SOX10, Melan-A, HMB45, BerEP4 (BCC+ / SCC−), CK20 (Merkel dot-like), TTF1 (negative in primary skin)

How to Pass the ABD Dermatopathology Exam

What You Need to Know

Passing score: Scaled score of 500 (criterion-referenced via modified Angoff)
Exam length: 270 questions
Time limit: 1-day computer-based (3h 13m Written/Practical + 4h 9m Virtual Microscopy)
Exam fee: $2,100 (includes $200 nonrefundable administrative fee)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABD Dermatopathology Study Tips from Top Performers

1Master the big 5 inflammatory patterns cold — interface (vacuolar vs lichenoid DDx: LE, LP, DM, GVHD, EM), psoriasiform (know all 6 psoriasis features — parakeratosis, Munro microabscesses, Kogoj spongiform pustules, elongated rete, thin suprapapillary plates, absent granular layer), spongiotic, vesiculobullous, and granulomatous are the backbone of the exam

2For vesiculobullous disease, memorize level of split + DIF pattern: subcorneal (IgA pemphigus), intraepidermal (pemphigus vulgaris — DIF tombstone/chicken-wire IgG), subepidermal (BP linear IgG/C3 at BMZ, DH granular IgA in papillae, EBA salt-split dermal side)

3Build a melanocytic algorithm: pagetoid spread above basal layer, architectural disorder (asymmetry, poor circumscription, confluence), cytologic atypia, loss of HMB45 gradient toward base, and dermal mitoses favor melanoma over nevus

4Spend real time on the Virtual Microscopy section — the VM section is longer (4h 9m / 110 questions) than the Written/Practical section and tests whole-slide pattern recognition under a time pressure you only build with repetition

5Commit the core IHC panel to memory: S100/SOX10 (melanocytes, nerves), Melan-A and HMB45 (melanocytic — HMB45 gradient is key), BerEP4 (BCC positive, SCC negative), CK20 (Merkel cell — dot-like paranuclear), TTF1 (negative in primary skin — positive suggests metastasis), CD34 (DFSP positive, dermatofibroma negative)

6Know your special stains: PAS/GMS for fungi, Fite for leprosy/atypical mycobacteria, Congo red with apple-green birefringence for amyloid, Prussian blue for iron, Von Kossa for calcium, colloidal iron for mucin

Frequently Asked Questions

What is the ABD Dermatopathology subspecialty certification?

Dermatopathology subspecialty certification is jointly sponsored by the American Board of Dermatology (ABD) and the American Board of Pathology (ABPath). ABPath serves as the Sponsoring Board and ABD serves as the Administrative Board. Candidates from either primary pathway (dermatology or pathology) sit for the same exam and, if successful, earn a subspecialty certificate recognized by both ABMS boards.

Who is eligible to take the ABD Dermatopathology exam?

Candidates must hold primary certification in good standing in (a) ABPath AP/CP or AP, or (b) ABD Dermatology. They must also have completed 12 months of full-time training in an ACGME-accredited dermatopathology fellowship program with program-director attestation. A valid unrestricted medical license and an M.D., D.O., or equivalent are required.

What is the format of the dermatopathology boards?

The exam is a 1-day computer-based examination administered at Pearson VUE. It comprises 270 one-best-answer multiple-choice questions split into a Written/Practical section of 160 items (3 hours 13 minutes) and a Virtual Microscopy (VM) section of 110 items (4 hours 9 minutes). No glass slides are used — all images are digital whole-slide or photomicrograph images.

How much does the 2026 ABD Dermatopathology exam cost?

The 2026 examination fee is $2,100, which includes a $200 nonrefundable administrative fee. Candidates who cancel by June 15 forfeit a $500 cancellation fee; cancellations after June 15 forfeit the full fee. Retakes within the 7-year qualification window require full re-registration and payment of the $2,100 fee.

When is the 2026 dermpath exam offered?

The 2026 Dermatopathology Subspecialty Certification Exam is offered September 8-28, 2026, at Pearson VUE centers. The application/registration window is February 16 – May 15, 2026 (11:59 PM EST). Accommodation requests are due April 15, and scheduling opens in August 2026.

What is the passing score?

ABPath uses criterion-referenced scoring with a scaled passing score of 500. The cut-score is set in advance by a committee of subject-matter experts using the modified Angoff method, which asks raters to estimate minimally-qualified-candidate performance on each item. A candidate's result depends only on performance relative to the cut-score, not on other candidates.

What topics are on the dermpath exam?

Content covers diagnostic dermatopathology across the full spectrum: inflammatory dermatoses (interface, psoriasiform, spongiotic, vesiculobullous with DIF, granulomatous), melanocytic lesions (nevus vs melanoma, spitzoid spectrum), BCC/SCC and keratinocytic tumors, adnexal tumors, melanoma variants, cutaneous lymphomas (MF/Sézary/LyP/ALCL), vascular and mesenchymal tumors, infections with special stains, deposits, and ancillary immunohistochemistry.

How long is dermatopathology certification valid?

Dermatopathology certificates are time-limited to 10 years. Diplomates maintain certification through each primary board's Continuing Certification (CC/MOC) program and must meet dermpath-specific requirements to keep the subspecialty certificate active.