How Dermatology PAs Can Master Rapid Diagnostic Recognition

Shanna Miranti, PA-C, a physician assistant at Riverchase Dermatology, took the stage at the 2026 SDPA Summer Meeting in Colorado to deliver a Kodachromes lecture centered on one of the most practiced yet least formally taught skills in dermatology: reading a rash or lesion quickly and getting it right.1

“The goal of any Kodachromes lecture is to try to improve a provider's diagnostic accuracy, speed, and acuity," Miranti said. “We want dermatology PAs to be just as good as the derm residents at visually diagnosing something quickly and accurately."

A Framework for Narrowing the Differential

Miranti described using the Fitzpatrick skin atlas algorithm as a mental organizing structure, guiding clinicians to first determine whether they are looking at a solitary lesion or multiple lesions and, if multiple, whether the distribution is localized or generalized. She argued that the initial categorization alone meaningfully narrows the differential before a provider ever reaches for a dermoscope.

The approach reflects a broader philosophy: pattern recognition is a trainable skill, not an innate talent. Research supports that even 30 minutes a day spent reviewing image-based diagnostic exercises can help clinicians build their own internal visual algorithm, according to Miranti.

Pediatric Dermatoses: A Gap in Coverage

Pediatric dermatology emerged as a focal point of the session. Miranti noted that providers who rarely see children in practice can be caught off guard by presentations unique to pediatric skin, including a greater prevalence of infectious causes and reactions that do not manifest the same way in adults. The workforce picture makes this gap more consequential: as of July 2024, only 371 board-certified pediatric dermatologists practiced across the entire United States, with 8 states having none at all.2

"It really is up to dermatology APPs to pick up the slack [and]… help those very overworked, very overwhelmed pediatric dermatologists,” Miranti said. “We can be an extension of their care.”

Even clinicians who do not see pediatric patients in their own practice benefit from familiarity with pediatric dermatoses since patients with children will often bring questions about their kids to whoever is available, Miranti added.

Balancing Speed with Diagnostic Discipline

Miranti said that visual acuity guides a provider toward the most likely diagnosis, but the differential should remain provisional until confirmed. Dermoscopy and biopsy remain essential tools for honing a differential and arriving at the most accurate diagnosis and, therefore, the right treatment.

The session also generated substantial discussion around conditions with overlapping presentations. Macular amyloidosis drew questions from attendees about how to distinguish it from notalgia paresthetica, 2 entities that share enough surface similarity to trip up less experienced clinicians. For Miranti, the answer was familiar: pattern recognition deepens with repetition, and once a provider has biopsied a condition multiple times and seen it resolve, the visual memory becomes durable.

"When we see it, we know it; we don't even need to biopsy it anymore," she said. "But this is definitely a skill that any provider can learn."

On AI as a Diagnostic Tool

Miranti offered a measured read on artificial intelligence in dermatology. AI platforms are improving at pattern recognition, and dermatology APPs are paying attention. But the technology cannot yet perform dermoscopy, obtain tissue, or initiate treatment. The more immediate concern she raised was not professional displacement but patient misinformation: people arriving at appointments having already diagnosed themselves using AI image search tools, sometimes incorrectly.

"Hopefully they seek out medical help," Miranti said, "and hopefully there is a very astute dermatology PA or nurse practitioner who can help them."

Editor's note: Reported disclosures for Miranti include Incyte Corporation, Dermavant Sciences, Ortho Dermatologics, Verrica Pharmaceuticals, Galderma Laboratories, SUN PHARMACEUTICAL INDUSTRIES, ParaPRO, and more.

References

1. Miranti S. Kodachromes: A Visual Journey Through Dermatologic Diagnosis. Session presented at SDPA Summer 2026; June 10–14.

2. Lee S, Aigbekaen I, Huang J. Geographic Maldistribution of Pediatric Dermatologists in Relation to Pediatric and Family Medicine Residency Programs. Acad Pediatr. 2025;25(6):102835. doi:10.1016/j.acap.2025.102835