The Church Spire Sign in Dermatopathology

Raagini Suresh, B.S.

Keywords: church spire sign, dermatology, dermatopathology, pathology, biopsy

Abstract: Dermatopathologists often use key phrases to describe histopathological findings. This piece takes a look at the origin of the phrase “church spire sign,” and explains the symbolic meaning behind the addition of spires to church buildings.

Dermatology is an extremely visual field. While the physical exam is often a key component of establishing a diagnosis, histopathology can be used to provide a microscopic look at clinical findings. Most dermatologists are well versed in performing biopsies to better characterize their patients’ skin lesions, often sending biopsy specimens to dermatopathologists for interpretation.

The language dermatopathologists use in their reports includes key phrases that, if properly understood, are effective tools for communication. One example of a key phrase used in dermatopathology is the church spire sign, used to describe epidermal changes of hyperkeratosis, acanthosis, and papillomatosis. The church spire sign can be seen in multiple lesions, including hyperkeratotic seborrheic keratosis, acrokeratosis verruciformis of Hopf, verruca vulgaris, epidermodysplasia verruciformis, verruca plana, actinic keratosis, arsenic keratosis, tar keratosis, acanthosis nigricans, epidermal nevus, confluent and reticulate papillomatosis of Gougerot-Carteaud, hyperkeratosis lenticularis, and verrucous carcinoma1.

The church spire sign of dermatopathology actually does look like real-life church spires! Figure 1 shows a side-by-side comparison of an architectural church spire and the church spire sign seen in the biopsy from a seborrheic keratosis.2

So what exactly are church spires? In architecture, the word “spire” means a “steeply pointed pyramidal or conical termination to a tower.” Spires were included on churches for symbolic reasons – the spire proclaimed a martial power of religion, with the spear-like tip of the spire giving the impression of strength. Additionally, since spires projected towards the heavens, they were considered symbols of piety. Finally, since spires were added for aesthetic reasons and played no role in structural integrity, they were seen as symbols of wealth and prestige.

There is a difference in meaning between the word “spire” and “steeple.” While the word steeple describes the turret of a church in any form, the word spire is specifically used for steeples that have rising tapers to the top.

Church spires can be seen on many of the tallest church buildings around the world. Ulm Minster, the tallest church in the world, is located in Germany. The architectural marvel is 530 feet tall, with one of its three spires contributing a sizeable 490 feet. The more you know!

Figure 1
Side-by-side comparison of an architectural church spire and the church spire sign seen in the biopsy of a seborrheic keratosis


  1. Weedon D, Geoffrey S. An approach to the interpretation of skin biopsies. Skin pathology: 2nd ed. Weedon D, Geoffrey S, Editors. China: Churchill Livingstone; 2004. p.12.
  2. Madke B, Doshi B, Khopkar U, Dongre A. Appearances in dermatopathology: The diagnostic and the deceptive. International Journal of Dermatology, Venereology, and Leprology. 2013;79(3):338-348.

Author bio: Raagini Suresh is a second year medical student at the University of California, San Francisco who is interested in pursuing a career in dermatology. Email:

Acknowledgements: Dr. Leonard Hoenig reviewed the manuscript. He is affiliated with Memorial Hospital West and practices Internal Medicine in Pembroke Pines, Florida.

I have no disclosures to report.

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