Dermatology M&A Multiples Report 2026: Valuation Benchmarks by Size and Segment

Publication date: July 2026
Coverage window: 2019 through Q2 2026 transaction data, with detail on the 2023 through 2026 rebase.
Geography: United States dermatology practice transactions, from single-provider owner-operator practices through PE-backed platform scale.
Framing: This report is a market benchmark. It is not advice, not appraisal, and not investment, legal, tax, or financial advice. Every observed range is conditional on payer mix, provider mix, cosmetic revenue share, MOHS surgical volume, geography, and lease posture. Every range should be tested against the specific practice under review.

Dermatology is one of the deepest single-specialty M&A datasets in outpatient physician services outside of ophthalmology and dental. The depth exists because private equity has been buying dermatology practices continuously since 2012, because Provident Healthcare Partners publishes a quarterly dermatology M&A update, because GF Data collects lower middle market healthcare transaction data quarterly, and because more than fifteen PE-backed dermatology platforms have filed public press releases documenting hundreds of individual practice acquisitions. That density is what allows a size-band spine to be drawn with reasonable confidence.

This report walks the multiple stack from sub $500K SDE single-provider practices through $10M plus adjusted EBITDA PE-backed platforms, breaks out MOHS and surgical dermatology as a distinct sub-segment, quantifies the cosmetic revenue share premium, and separates medical dermatology from cosmetic dermatology from mixed practices. It differentiates strictly from the existing Private Equity Dermatology 2026 tracker, which is a buyer directory and consolidator map. This report is the transaction multiple benchmark. The two are complementary and cross-linked.

Executive summary

• Single-provider dermatology practices sub $500K SDE cluster at 3.5x to 5.5x SDE in owner-operator transactions across the 2023 through Q2 2026 window, per GF Data healthcare envelope and BizComps NAICS 621111 medical practice comps. Practices with cash-pay cosmetic revenue share above 25% and MOHS credentialing lean toward the upper half of that band; medical-only Medicare-heavy solo practices cluster at the lower half. Source: GF Data healthcare quarterly LMM report Q1 2026, DealStats NAICS 621111 subset, and BizComps physician office comps 2024 through Q2 2026.
• Mature single-provider practices generating $500K to $1M SDE transact at 4.5x to 6.5x SDE. Where the same practice is reported on an adjusted EBITDA basis after full owner compensation normalization, the observed range is 5x to 7x adjusted EBITDA. Higher end when there is a documented associate provider, physician assistant staffing depth, and a cosmetic revenue mix above 20%. Source: Provident Healthcare Partners dermatology quarterly M&A report Q1 2026, Cain Watters and Associates dermatology valuation whitepaper 2025.
• Multi-provider dermatology groups with $1M to $3M adjusted EBITDA transact at 7x to 10x adjusted EBITDA when sold to PE-backed platforms as tuck-ins, per Provident dermatology quarterly Q4 2025 through Q1 2026 disclosed observations and Skytale Group dermatology M&A commentary 2025. Range is wider than the LMM healthcare average because platform tuck-in demand is uneven across regions.
• Regional multi-site groups with $3M to $10M adjusted EBITDA transact at 9x to 12x adjusted EBITDA to PE platforms and add-on acquirers, based on GF Data healthcare 2024 through Q1 2026 disclosed LMM add-on observations. This band is the most active and the most competitive. It is also the band where MOHS and surgical volume adds the most measurable turn premium.
• PE-backed platform scale dermatology groups with $10M plus adjusted EBITDA transacted at 12x to 15x adjusted EBITDA in the 2020 to 2022 peak, per Provident quarterly reports and PitchBook consolidator deal flow, rebased to 10x to 13x adjusted EBITDA in the 2023 through 2025 rate environment, and appear to have stabilized at 11x to 14x in Q1 and Q2 2026 for platforms with premium payer mix, MOHS and surgical concentration, and demonstrable de novo pipeline.
• MOHS and surgical dermatology practices command a 1x to 2x turn premium over medical dermatology at every size band. This is the most durable premium observation in the dataset. Reimbursement stability for MOHS CPT codes 17311 through 17315 has been more predictable than evaluation and management dermatology codes, and MOHS surgeons are effectively single-source procedural specialists. Source: American Society for Dermatologic Surgery benchmarks and Provident dermatology quarterly commentary.
• Cosmetic revenue share above 40% of practice revenue is empirically associated with materially higher multiples at the single-provider and multi-provider group level, though it introduces a discretionary demand recession sensitivity risk that shows up in earnout structures. Source: Skytale Group derm M&A observations 2024 through 2025 and Cain Watters practice valuation commentary.
• Deal structure has shifted meaningfully. Cash at close for LMM dermatology deals during the 2020 to 2022 peak trended toward 70% to 80% of enterprise value; since mid 2023, cash at close for platform tuck-ins has compressed to 55% to 70% with expanded seller notes, provider retention earnouts, and rollover equity into platform ranging 15% to 30%. Source: SRS Acquiom studies referenced in Provident and Skytale commentary and the broader founder earnout benchmarks by deal size 2026 synthesis.

This report is not advice, not appraisal, and not investment, legal, tax, or financial advice. Every buyer and seller should test the observations here against a specific practice, a specific buyer universe, and a specific vintage window.

Key findings (verified data points)

The following data points are drawn from the source stack described later in the methodology and source ranking sections. Each point is stated as a single verified observation. Undisclosed named deal multiples are not asserted for any specific transaction.

1. GF Data healthcare LMM, covering transactions between $10M and $500M enterprise value, reported blended healthcare services multiples of 8.9x to 10.5x TTM adjusted EBITDA across the 2023 through Q1 2026 window, with dermatology tuck-ins and platform trades running toward and above the top of that range because of specialty scarcity. GF Data quarterly reports do not publish specialty cut medians publicly, so the dermatology-specific range in this report leans on Provident dermatology quarterly and Skytale commentary triangulated against the GF Data healthcare envelope. Source: GF Data quarterly reports Q4 2024, Q1 2025, Q1 2026.
2. Provident Healthcare Partners has reported active PE-backed dermatology platform acquirers deploying at 10x to 13x adjusted EBITDA at platform scale in the 2024 through 2025 window, with premiums for MOHS and surgical concentration and mid single digit to low teens same store organic growth. Source: Provident Healthcare Partners dermatology M&A quarterly reports.
3. American Academy of Dermatology practice management survey data continues to identify the median dermatologist collections figure in the $900K to $1.5M range depending on cosmetic share, MOHS credentialing, and geography. This underpins the SDE single-provider benchmark. Source: AAD Practice Management Survey.
4. American Society for Dermatologic Surgery reports MOHS is the highest volume surgical procedure in dermatology, with more than two million MOHS procedures performed annually in the United States and reimbursement stability that has outperformed the evaluation and management fee schedule updates. Source: ASDS benchmarks.
5. Named PE-backed dermatology platforms with disclosed sponsor ownership include US Dermatology Partners (ABRY Partners), Advanced Dermatology and Cosmetic Surgery (Harvest Partners), Anne Arundel Dermatology (Ridgemont Equity Partners), Forefront Dermatology (Partners Group), West Dermatology (Wafra and Silver Oak Services Partners), Pinnacle Dermatology (Chicago Pacific Founders and Hildred Capital), Golden State Dermatology (LLR Partners), Schweiger Dermatology Group (Aldrich Capital Partners), Water’s Edge Dermatology and Riverchase (BayPine), Epiphany Dermatology (Adams Street and Comvest Partners), Skin and Cancer Institute (association through the US Dermatology Partners network), and Dermatology Physicians of Connecticut. Ownership structural facts only; no undisclosed multiples asserted for any specific transaction.
6. The Federal Reserve H.15 selected interest rates series shows the SOFR based reference environment moved from an effective floor near zero in 2021 to above 5.30% by late 2023, easing modestly through the 2024 to 2026 window. Every dermatology platform LBO closed at 2020 to 2022 vintages was underwritten to a materially different cost of capital than every platform LBO closed at 2023 to 2026 vintages, and this is the single largest driver of the multiple compression from the 12x to 15x peak to the 10x to 13x rebase. Source: Federal Reserve H.15 statistical release.
7. Provident dermatology quarterly commentary through 2025 emphasized cash at close compression, expanded seller note usage (often 10% to 20% of enterprise value), and rollover equity in the 15% to 30% range on platform tuck-ins. These structures are consistent with the broader SRS Acquiom deal structure trend documented in the founder earnout benchmarks 2026 and founder rollover equity benchmarks 2026 synthesis pages.
8. Cosmetic revenue share is the single largest variable moving multiple at the single-provider level. Practices with cash-pay cosmetic revenue above 40% (typically injectables, laser, energy based devices, and clinical skincare retail) trade at meaningful premiums to medical only comparables. Transaction structure typically includes earnouts tied to cosmetic revenue retention. Source: Skytale Group commentary 2024 to 2025 and Cain Watters valuation whitepaper.
9. Payer mix matters at every band. Practices with commercial insurance above 60% of collections and Medicare share below 30% trade at meaningfully better multiples than Medicare heavy comparables at the same collections level, because Medicare CPT rate risk and Medicare Advantage prior authorization drag reduce contribution margin quality. Source: AAD practice management commentary and Cain Watters.
10. Advanced practice provider staffing depth matters. Practices with a physician assistant or nurse practitioner ratio of 1:1 or higher to MDs generally demonstrate lower per provider revenue but higher contribution margin and more scalable growth, and PE-backed platforms treat APP staffing depth as a structural quality signal. Source: Skytale Group commentary.
11. Corporate practice of medicine (CPOM) state variation shapes deal structure but does not consistently shift multiples. CPOM strict states such as California, Texas, and New York require an MSO and PC structure with a friendly professional corporation held by a licensed physician. This is a legal structure fact, not a multiple driver, but it does affect diligence timelines and integration cost. Source: state level CPOM analysis referenced in Provident and Skytale commentary.
12. Real estate ownership generally does not sit inside the operating multiple. When a selling practice owns its clinical real estate, standard practice is to bifurcate the transaction: sell the operating practice at the operating multiple, and either lease back the real estate to the buyer or sell it separately at a market cap rate. This preserves clean operating comparability. Source: general LMM healthcare M&A practice and Provident commentary.
13. Recurring cosmetic subscription and skin cancer screening frequency programs are increasingly modeled as recurring revenue add-backs in adjusted EBITDA bridges. Their quality of earnings treatment is a QoE provider judgment (see QoE provider comparison 2026) and improves multiple when documented cleanly.
14. Reimbursement risk is real. CMS annual physician fee schedule updates, biopsy code reweighting, and periodic MOHS code review cycles all show up as diligence points. This is why the 2024 through 2026 platform multiples are lower than the 2020 through 2022 peak even for high quality practices: buyers are underwriting a broader reimbursement risk premium. Source: CMS Physician Fee Schedule.
15. R&W insurance and QoE penetration are near universal at the $3M plus adjusted EBITDA platform tuck-in band. Below $1M adjusted EBITDA, R&W is rare and QoE is often abbreviated. This affects transaction cost as a percentage of enterprise value and shows up in seller note structuring. See R&W insurance carrier comparison 2026 and QoE provider comparison 2026.

Multiples by size band (the spine)

The following five bands describe observed transaction ranges in dermatology practice M&A. Each band is stated with an explicit earnings basis. SDE and adjusted EBITDA are not blended in any single range. Every band is conditional on the drivers detailed in the drivers section.

Size band	Earnings basis	Observed range	Vintage window	Buyer universe
Sub $500K SDE	SDE	3.5x to 5.5x SDE	2023 through Q2 2026	Individual physician acquirers, small regional groups
$500K to $1M SDE	SDE or adjusted EBITDA (never blended)	4.5x to 6.5x SDE, or 5x to 7x adjusted EBITDA	2023 through Q2 2026	Regional strategics, small PE-backed platforms (rare), competitive physician buyers
$1M to $3M adjusted EBITDA	Adjusted EBITDA	7x to 10x adjusted EBITDA	2024 through Q2 2026	PE-backed dermatology platforms (tuck-in sweet spot), regional strategics
$3M to $10M adjusted EBITDA	Adjusted EBITDA	9x to 12x adjusted EBITDA	2024 through Q2 2026	PE-backed platforms, strategic dermatology consolidators, occasional hospital systems
$10M plus adjusted EBITDA (PE platform)	Adjusted EBITDA	11x to 14x (Q1 to Q2 2026, above average); 10x to 13x (2023 to 2025 average); 12x to 15x (2020 to 2022 peak)	2020 through Q2 2026	Mid and large cap PE sponsors, sponsor to sponsor exits

Sub $500K SDE (single-provider owner-operator)

Observed range: 3.5x to 5.5x SDE.

Earnings basis: Seller’s discretionary earnings. Typically calculated as pre-tax net income plus owner compensation plus interest expense plus depreciation plus amortization plus one-time non-recurring items. Adjusted to a market rate of operator replacement compensation only when the buyer is a strategic acquirer intending to hire a replacement provider.

Typical practice profile: One dermatologist, often the founder, sometimes with a part-time associate or a physician assistant. Annual collections typically $700K to $1.5M. Medical dermatology dominant with modest cosmetic revenue. Owner is the primary clinical producer. Practice depends heavily on owner presence.

Buyer universe: Individual physician buyers (SBA financed), local strategic acquirers, small regional groups. Platform acquirers do not compete at this band because integration cost exceeds accretion value.

Structure typical: Cash at close 70% to 90% of enterprise value, occasional SBA 7(a) financing (see SBA acquisition lender rankings 2026), short seller note. Rare rollover equity because there is no platform to roll into.

Multiple drivers within the band:

• Cosmetic revenue share above 25%: upward pressure.
• MOHS credentialing and documented MOHS volume: upward pressure.
• Medicare share above 60%: downward pressure.
• Owner only production without associate coverage: downward pressure.
• Real estate ownership (bifurcated out) with clean lease at market: neutral to slightly positive.
• CPOM state with clean PC and MSO structure already in place: neutral.

Source: GF Data healthcare LMM report (envelope), BizComps NAICS 621111 physician office subset 2024 to Q2 2026, DealStats NAICS 621111 subset, BizBuySell derm practice listings sold data, Provident dermatology quarterly commentary on sub LMM.

$500K to $1M SDE (mature single-provider or small group)

Observed range: 4.5x to 6.5x SDE, or where reported as adjusted EBITDA, 5x to 7x adjusted EBITDA.

Earnings basis: SDE for owner-operator practices. Adjusted EBITDA where the practice has grown large enough that owner compensation normalization is straightforward. The two are not blended: any single observed transaction is stated in one basis or the other.

Typical practice profile: One senior dermatologist, one associate provider (physician assistant, nurse practitioner, or junior MD), often two to four operatories, annual collections $1.2M to $2.5M. Meaningful cosmetic revenue mix at 20% to 40%. May have MOHS credentialing. Some documented associate provider ramp.

Buyer universe: Local and regional strategic acquirers, smaller PE-backed dermatology platforms (rare tuck-ins at the low end), competitive physician buyers with SBA plus seller note financing.

Structure typical: Cash at close 65% to 80%. Seller notes at 10% to 20% of enterprise value common. Earnouts on provider retention are common in seller financed transactions. Rollover equity emerging when a small PE-backed platform is the acquirer.

Multiple drivers within the band:

• Documented associate provider generating meaningful revenue: material upward pressure (the single most valuable driver in this band).
• Cosmetic revenue share above 30%: upward pressure.
• MOHS credentialing plus documented MOHS volume: 0.5x to 1.0x turn upward.
• Real estate ownership bifurcated cleanly: neutral to slightly positive.
• CPOM structure clean and in place: neutral to slightly positive.
• Payer mix commercial dominant: upward pressure.
• Owner retirement risk with no succession plan: downward pressure.

Source: Provident dermatology quarterly Q4 2025 and Q1 2026, Cain Watters dermatology practice valuation commentary 2025, Skytale Group commentary, BizComps and DealStats physician office subset.

$1M to $3M adjusted EBITDA (LMM multi-provider group; PE tuck-in target)

Observed range: 7x to 10x adjusted EBITDA.

Earnings basis: Adjusted EBITDA. Adjustments typically include owner compensation normalization to a market rate physician salary, non-recurring transaction and legal expenses, one-time real estate related items, and quality of earnings items around cosmetic subscription and recurring skin cancer screening panels. See QoE provider comparison 2026 for QoE provider comparison.

Typical practice profile: Two to five dermatologists, an APP layer, two to four clinical locations, integrated MOHS surgeon (or a referring MOHS relationship), cosmetic revenue meaningful and often growing, annual collections $4M to $12M.

Buyer universe: PE-backed dermatology platforms (this is the sweet spot tuck-in size for platforms), regional strategic consolidators, occasional hospital system acquirers in select markets.

Structure typical: Cash at close 55% to 75%. Seller notes commonly 5% to 15%. Rollover equity into the acquiring platform commonly 15% to 25%. Earnouts on provider retention and revenue growth typical. R&W insurance usage becoming standard above $2M adjusted EBITDA (see R&W insurance carrier comparison 2026). QoE required.

Multiple drivers within the band:

• Same store organic growth in mid single digits or better: material upward pressure.
• MOHS surgeon on staff with documented volume: 0.5x to 1.5x turn upward.
• Cosmetic revenue share above 30% with documented retention: 0.5x to 1.0x turn upward.
• APP staffing depth at or above 1:1 APP to MD: upward pressure.
• Payer mix commercial above 60%: upward pressure.
• Owner-provider dependence below 30% of clinical production: material upward pressure.
• Missed budget in prior twelve months: material downward pressure.
• Any single-provider concentration above 50%: material downward pressure.

Source: Provident Healthcare Partners dermatology quarterly M&A reports Q3 2024 through Q1 2026, Skytale Group derm M&A commentary, GF Data healthcare LMM envelope Q1 2025 and Q1 2026, Ziegler healthcare M&A commentary.

$3M to $10M adjusted EBITDA (regional multi-site group; DSO equivalent add-on)

Observed range: 9x to 12x adjusted EBITDA.

Earnings basis: Adjusted EBITDA. QoE normalized. This is the band where a proper quality of earnings report is standard practice.

Typical practice profile: Five to fifteen dermatologists, structured APP layer, three to eight clinical locations, dedicated MOHS surgeon or MOHS suite, formalized cosmetic service line often with medical spa integration, corporate administrative infrastructure, annual collections $15M to $50M.

Buyer universe: PE-backed dermatology platforms adding on, occasional hospital system integration acquirers, strategic dermatology consolidators. This is the most competitive band for tuck-ins because platforms have the most integration muscle here.

Structure typical: Cash at close 55% to 70%. Seller notes 5% to 10%. Rollover equity 20% to 30%. Earnouts on provider retention, MOHS volume growth, and cosmetic revenue retention. R&W insurance standard. QoE mandatory. Working capital peg at target level negotiated. See founder rollover equity benchmarks 2026 for rollover benchmarks and the QoE overview.

Multiple drivers within the band:

• MOHS and surgical concentration above 20% of revenue: 1x to 2x turn upward (the largest single premium at this band).
• Multi-site geographic density in one market: upward pressure.
• Same store organic growth 6% or better: material upward pressure.
• Documented de novo track record: material upward pressure.
• Cosmetic revenue share above 35% with documented retention: 0.5x to 1.0x turn upward.
• Provider concentration (any single provider above 30% of revenue): downward pressure.
• CPOM state complexity without pre-existing MSO and PC structure: modest downward pressure (diligence and integration cost).
• Any Medicare share above 45%: modest downward pressure.

Source: GF Data healthcare LMM report add-on subset Q4 2024 through Q1 2026, Provident dermatology quarterly commentary, PitchBook consolidator deal flow, Skytale Group commentary.

$10M plus adjusted EBITDA (PE-backed derm platform target)

Observed range: 11x to 14x adjusted EBITDA in Q1 and Q2 2026 for platforms with strong payer mix, MOHS and surgical concentration, and demonstrable de novo pipeline. 10x to 13x for average quality platforms in the 2023 through 2025 rebase window. 12x to 15x during the 2020 to 2022 peak.

Earnings basis: Adjusted EBITDA at platform scale. Adjustments include full corporate cost normalization, non-recurring integration and platform build expenses, and management services organization overhead consolidation. Because these are large scale transactions with sophisticated buyers and R&W insurance, QoE normalization is heavily scrutinized.

Typical platform profile: Twenty to two hundred dermatologists, structured APP layer, ten to eighty clinical locations, multiple MOHS suites, medical spa integration, corporate infrastructure, dedicated CFO and CIO, EHR platform, annual collections $80M to $500M plus.

Buyer universe: Mid and large cap private equity sponsors doing sponsor to sponsor transactions or bringing platforms to strategic exit. Documented sponsor ownership of active US dermatology platforms includes ABRY Partners, Harvest Partners, Ridgemont Equity Partners, Partners Group, Wafra, Silver Oak Services Partners, Chicago Pacific Founders, Hildred Capital, LLR Partners, Aldrich Capital Partners, BayPine, Adams Street, and Comvest Partners.

Structure typical: Sponsor to sponsor LBO structure. Cash at close typically 80% to 90% of enterprise value with senior debt and mezzanine layers, rollover equity from management team into new platform, minority secondary rollover from prior sponsor in some cases. R&W insurance standard. Multi-provider QoE, market study, quality assessment, and IT diligence.

Multiple drivers within the band:

• MOHS and surgical concentration with dedicated MOHS suites: material upward pressure.
• Documented de novo pipeline with per site payback metrics: material upward pressure.
• Same store organic growth documented in the mid single digits or better: material upward pressure.
• Diversified geography (three plus MSAs): upward pressure.
• Payer mix commercial dominant across the platform: upward pressure.
• EHR platform consolidation and clean data room: upward pressure.
• Any concentrated same state exposure with regulatory or CPOM risk: modest downward pressure.
• Any elevated debt load or cash conversion pressure at time of exit: modest downward pressure.

Source: Provident Healthcare Partners dermatology quarterly M&A reports 2020 through Q1 2026, PitchBook consolidator deal flow, Modern Healthcare and Becker’s Dermatology M&A coverage, WSJ and Bloomberg dermatology consolidation coverage of the Anne Arundel, Advanced Dermatology, and Forefront transactions.

Multiples by sub-segment

Size band is the primary axis. Sub-segment is the second axis. The two interact: a large multi-provider group with cosmetic dominance sits in a different place than a large multi-provider group that is 80% medical dermatology plus MOHS. This section breaks out sub-segment effects.

Sub-segment	Earnings basis	Typical range	Buyer universe	Notes
Single-provider practice	SDE	3.5x to 6.5x SDE across sub $500K and $500K to $1M SDE bands	Individual physician buyers, small regional groups	Cosmetic share and MOHS credentialing dominate driver stack
Multi-provider group	Adjusted EBITDA	7x to 12x depending on band	PE-backed dermatology platforms, regional strategics	APP depth, same store growth, geographic density are meaningful positive drivers
MOHS and surgical dermatology	SDE or adjusted EBITDA depending on band	Premium: 0.5x to 2x turn over medical baseline at each band	Same as underlying band	Reimbursement stability plus low national supply of MOHS surgeons
PE-backed platform	Adjusted EBITDA at consolidated platform	11x to 14x (above average 2026); 10x to 13x (2023 to 2025 average); 12x to 15x (2020 to 2022 peak)	Mid and large cap PE sponsors; sponsor to sponsor exits	MSO and PC structure; management fee flow scrutinized in QoE

Single-provider practice (SDE based)

Covered in the sub $500K and $500K to $1M SDE bands. Key notes:

• These are the SDE-based transactions.
• The buyer universe is dominated by individual physician acquirers, not PE.
• Multiple ranges are 3.5x to 5.5x SDE at the sub $500K band and 4.5x to 6.5x SDE at the $500K to $1M band.
• Cosmetic revenue share and MOHS credentialing are the strongest positive drivers.
• Owner-only production without associate coverage is the strongest negative driver.

Multi-provider group (adjusted EBITDA)

Covered in the $1M to $3M and $3M to $10M adjusted EBITDA bands. Key notes:

• Adjusted EBITDA is the earnings basis; owner compensation is normalized to market physician salary.
• Buyer universe is dominated by PE-backed platforms.
• Multiple ranges are 7x to 10x adjusted EBITDA at $1M to $3M and 9x to 12x at $3M to $10M.
• APP staffing depth, same store organic growth, and multi-site geographic density are meaningful positive drivers.
• Any single-provider concentration above 30% of revenue is a material negative driver.

MOHS and surgical dermatology (premium band)

MOHS and surgical dermatology commands a durable premium across every size band. The mechanism is fourfold:

• MOHS reimbursement stability across CPT codes 17311 through 17315 has been more predictable than the E and M dermatology code family.
• MOHS surgeons are effectively single-source procedural specialists (fellowship trained, board eligible, low national supply).
• Recurring skin cancer screening drives sustainable case flow.
• The surgical revenue line is high margin at the practice level.

Observed premium:

• Sub $500K SDE single-provider MOHS-heavy practices: often trade in the top half of the 3.5x to 5.5x SDE range, sometimes above.
• $500K to $1M SDE: 0.5x to 1.0x turn premium.
• $1M to $3M adjusted EBITDA multi-provider with MOHS surgeon on staff: 0.5x to 1.5x turn premium.
• $3M to $10M adjusted EBITDA multi-site with MOHS and surgical share above 20% of revenue: 1x to 2x turn premium.
• $10M plus platform: MOHS and surgical concentration is a headline underwriting factor and shows up in the top of the 11x to 14x band.

Source: American Society for Dermatologic Surgery benchmarks, Provident Healthcare Partners dermatology quarterly commentary emphasizing MOHS premium, Skytale Group commentary.

PE-backed platform (adjusted EBITDA; management fee structure)

Covered in the $10M plus band. Key notes:

• Adjusted EBITDA at consolidated platform scale.
• Management services organization (MSO) structure with a professional corporation (PC) holding physicians is the norm in CPOM states.
• Management fee flow from PC to MSO is the primary revenue path for the platform level enterprise; QoE and diligence scrutinize this carefully.
• Multiple ranges are 11x to 14x adjusted EBITDA in the Q1 and Q2 2026 window for above average platforms, 10x to 13x for average, and 12x to 15x in the 2020 to 2022 vintage peak.
• Sponsor to sponsor transactions dominate exits.

Medical dermatology vs cosmetic dermatology vs mixed

Medical dermatology (insurance heavy): Reliable recurring revenue from skin cancer screening, biopsy, and E and M driven care. Multiple ranges track the spine directly. Cosmetic upside is a stretch case.

Cosmetic dermatology (cash-pay heavy): Higher gross margin, higher per visit revenue, meaningful subscription program potential (injectables, energy device series), but discretionary demand introduces recession sensitivity. Practices with cash-pay cosmetic revenue share above 40% often trade at meaningful premiums to medical only comparables at the single-provider band, but earnouts tied to cosmetic revenue retention are standard.

Mixed (medical dominant with cosmetic layer): The most common practice type in the LMM. This is what most PE-backed platforms are built on. Multiple ranges track the spine directly, with upward pressure when cosmetic share is above 30% and MOHS credentialing is present.

What moves the multiple: the twelve drivers

Every observed range in this report is conditional on the following drivers. The drivers listed here are ordered by empirical significance in the dermatology M&A dataset as reported by Provident, Skytale, Cain Watters, and the GF Data healthcare envelope.

1. Payer mix

Commercial insurance dominant is preferred. Practices with commercial share above 60% of collections and Medicare share below 30% trade at meaningfully better multiples than Medicare heavy comparables at the same collections level. Two mechanisms:

• Commercial rates per code are typically higher than Medicare, driving higher per visit revenue.
• Medicare Advantage prior authorization drag and Medicare fee schedule risk create underwriting drag at the platform level.

At the platform band, buyers underwrite the payer mix at the platform consolidated level, and any concentration in a single Medicare Advantage plan above 15% shows up as a diligence flag.

2. Cosmetic revenue share (cash-pay)

Cash-pay cosmetic revenue is the single largest single-provider level premium driver. Mechanism:

• Higher gross margin than most medical dermatology revenue.
• Retail service model with recurring visits (injectables typically every three to four months, energy device series over multi month protocols).
• Product attached revenue (clinical skincare retail).

Observed effect on multiple:

• Below 15% cosmetic share: minimal effect.
• 15% to 30%: modest upward pressure.
• 30% to 50%: material upward pressure, but earnouts on cosmetic revenue retention are standard.
• Above 50%: multiple can be materially higher but the practice is effectively a cosmetic dermatology business and is underwritten differently (discretionary demand sensitivity, fewer recurring insurance covered visits).

3. MOHS and surgical procedure mix

Covered separately in the sub-segment section. Consistent 0.5x to 2x turn premium depending on band.

4. Provider concentration and owner-provider dependence

Any single-provider concentration above 30% of revenue is a diligence flag at the multi-provider band. Any single-provider concentration above 50% at any size is a material downward pressure. Owner-provider dependence (owner still producing more than 50% of practice revenue at time of sale) is a downward driver because it reads as retention risk. This is why associate provider development and structured APP staffing depth move multiples so much. See owner dependency affects valuation for the framework on owner dependency.

5. Advanced practice provider (PA and NP) staffing depth

APP staffing depth at or above 1:1 APP to MD is a positive structural quality signal. Mechanisms:

• Lower cost per visit at the practice level.
• Scalable growth without full cycle recruiting of dermatologists.
• Documented APP infrastructure signals institutional practice management.

Effect on multiple: modest but consistent upward pressure at the $1M to $3M and $3M to $10M adjusted EBITDA bands.

6. Real estate ownership (own vs lease)

Real estate is typically bifurcated: the operating practice is sold at the operating multiple, and the real estate is either sold separately at market cap rate or leased back to the buyer at market rent. Standard practice is to normalize the operating EBITDA to a market rate lease. Real estate ownership does not directly inflate the operating multiple. It does create optionality for the seller.

7. Recurring revenue (subscription and screening)

Cosmetic subscription programs (injectable retention protocols, energy device series), recurring skin cancer screening (annual full body checks), and clinical skincare product subscription create documented recurring revenue. QoE providers scrutinize this. When documented cleanly, this improves multiple at the $1M plus adjusted EBITDA bands. See quality of earnings and QoE provider comparison 2026.

8. Geographic density and demographic tailwind

Dermatology demand tracks aging demographics (skin cancer incidence rises with age) and Sun Belt geography. Sun Belt platforms with multi-market density trade at the upper half of the platform band. Northeast urban platforms with tight geographic density also trade well. Rural single-market platforms without density trade at the lower half.

9. Reimbursement risk

CMS annual physician fee schedule updates, biopsy code family reweighting, and periodic MOHS code review cycles show up in diligence. This is priced into the 2024 through 2026 rebase. Buyers underwrite a broader reimbursement risk premium than they did in the 2020 to 2022 vintage.

10. CPOM state framework

CPOM strict states require an MSO and PC structure. The legal fact is neutral to multiple, but it affects diligence timeline and integration cost. Practices already operating under a clean MSO and PC structure in a CPOM state trade with less friction than practices that must be restructured pre close.

11. Owner dependency (linked framework)

The single largest driver of downward pressure at the $1M to $10M adjusted EBITDA bands is any concentration of clinical production, referring physician relationships, or business development in a single owner-provider. When the owner is also the CEO, the CMO, and the top producing MD, buyers underwrite retention risk aggressively. This is why the highest quality dermatology platforms have moved the founder-owner to a chief medical officer role two to three years before sale and hired professional CEO and COO leadership. See owner dependency affects valuation for the framework.

12. Same store organic growth documentation

Documented same store organic growth in the mid single digits or better is a material positive driver at the $1M plus adjusted EBITDA bands. Buyers scrutinize same store trends across the trailing twelve, twenty-four, and thirty-six month windows. A clean same store growth story supports the upper half of every band above $1M adjusted EBITDA.

Trend and trajectory (Fed H.15 anchored)

The dermatology M&A dataset has a clean five-phase narrative from 2019 through Q2 2026. Every observed multiple is conditional on the vintage cost of capital environment reported in the Federal Reserve H.15 selected interest rates series.

2019 baseline

Pre-COVID. Dermatology PE consolidation was already well underway (many platforms had been active since 2012 through 2015). LMM platform multiples clustered at 10x to 12x adjusted EBITDA for tuck-ins and 11x to 13x at platform scale. Single-provider practices traded at 3.5x to 5x SDE. Cost of capital was low. Provident dermatology quarterly commentary from 2019 emphasized platform build out and add-on cadence.

2020 through 2022 peak (dermatology consolidator peak)

Zero interest rate environment. Aggressive PE deployment across specialty physician services. Dermatology was among the most active sub-sectors. LMM platform multiples ran to 12x to 15x adjusted EBITDA. Add-on multiples ran to 10x to 13x. Sponsor to sponsor exits at premium valuations were common. Documented sponsor turnover across US Dermatology Partners, Advanced Dermatology and Cosmetic Surgery, Anne Arundel Dermatology, Forefront Dermatology, and others.

Every platform LBO closed in this window was underwritten to a cost of capital that was materially lower than any platform LBO closed in the 2023 through 2026 window. The multiple premium in this vintage was not a specialty premium; it was a capital markets premium.

Source: Provident Healthcare Partners dermatology quarterly M&A reports 2020, 2021, 2022; PitchBook consolidator deal flow; Modern Healthcare and Becker’s coverage of consolidator transactions.

2023 through 2024 rebase (rate compression)

The Federal Reserve H.15 SOFR reference rose above 5.30% by late 2023 and stayed at or above 5.00% through much of 2024. Sponsor to sponsor dermatology transactions slowed materially. LMM platform multiples compressed to 10x to 13x adjusted EBITDA. Add-on multiples compressed to 8x to 11x. Deal structure shifted toward expanded seller notes, provider retention earnouts, and rollover equity into platform.

MOHS and surgical premium persisted throughout the rebase; that observation is what makes MOHS and surgical concentration the most durable driver in the dataset.

Source: Provident Healthcare Partners dermatology quarterly M&A reports 2023, 2024; GF Data healthcare LMM Q4 2023 through Q4 2024; Skytale Group commentary; Federal Reserve H.15 statistical release.

2025 through Q2 2026 stabilization

SOFR reference eased modestly through 2025 and into the first half of 2026 but remained meaningfully above the 2020 to 2022 vintage. LMM platform multiples stabilized at 11x to 14x adjusted EBITDA for above average platforms with MOHS and surgical concentration, premium payer mix, and demonstrable de novo pipeline. Add-on multiples stabilized at 9x to 12x. Single-provider practice multiples remained relatively stable through the rebase (3.5x to 6.5x SDE across the sub $1M SDE range) because the buyer universe at that band is dominated by individual physician acquirers rather than PE, so rate compression is a smaller driver.

Source: Provident Healthcare Partners dermatology quarterly M&A reports Q1 2025 through Q1 2026; GF Data healthcare LMM Q1 2025 through Q1 2026; Skytale Group commentary; Federal Reserve H.15.

Federal Reserve H.15 rate context (why the trajectory matters)

Every observed multiple in this report is conditional on the vintage rate environment. Any 2026 buyer underwriting a dermatology platform is underwriting the acquisition to a materially different cost of capital than any 2021 buyer. This is not opinion; it is documented in the Federal Reserve H.15 series.

Practically: a seller in Q3 2026 should not compare against 2021 vintage transaction gossip. The reference set that matters is 2024 through Q2 2026, and specifically the same size band and sub-segment.

Deal structure context

Dermatology M&A deal structure follows the broader LMM healthcare pattern with specialty specific adjustments. The structural components below are the ones that appear most consistently in dermatology deal documentation.

Cash at close

The percentage of enterprise value paid in cash at closing.

• 2020 to 2022 peak: 70% to 80% of enterprise value at platform tuck-in scale.
• 2023 to 2024 rebase: compression to 55% to 70% for platform tuck-ins.
• 2025 through Q2 2026: stabilization at 55% to 70% for platform tuck-ins, higher (65% to 80%) at the single-provider band because those transactions are individually financed by physician acquirers.

Seller notes

Financing provided by the seller to the buyer.

• Peak vintage: rare (5% to 10% of enterprise value or absent).
• Rebase and stabilization: expanded (5% to 20% of enterprise value common at platform tuck-in scale).

Earnouts on provider retention

Contingent purchase price paid over a two to five year post-close period based on provider retention, revenue milestones, or EBITDA milestones. Increasingly standard at platform tuck-in scale. Provider retention earnouts are the most common structure in dermatology because clinical production is highly correlated with individual dermatologists and because the buyer’s platform value depends on the seller-providers continuing to practice. See founder earnout benchmarks by deal size 2026 for cross-industry earnout benchmarks.

Rollover equity (10% to 30% into platform)

Selling providers roll a portion of their after tax proceeds into equity of the acquiring platform. Range:

• LMM tuck-in ($1M to $3M adjusted EBITDA): 15% to 25% common.
• Add-on ($3M to $10M adjusted EBITDA): 20% to 30% common.
• Platform ($10M plus adjusted EBITDA): 10% to 20% at the platform ownership level for management team; secondary sale of prior sponsor equity into new sponsor at closing.

Rollover creates alignment between seller-providers and the acquiring platform. See founder rollover equity benchmarks 2026 for cross-industry rollover benchmarks.

QoE and R&W penetration

• Below $1M adjusted EBITDA: QoE is often abbreviated and R&W insurance is rare.
• $1M to $3M adjusted EBITDA: QoE standard, R&W insurance emerging.
• $3M to $10M adjusted EBITDA: full QoE, R&W insurance standard.
• $10M plus platform: full QoE with multi-provider breakout, market study, R&W insurance standard, cybersecurity and IT diligence standard.

See quality of earnings overview, QoE provider comparison 2026, and R&W insurance carrier comparison 2026.

Provider employment agreements and non-competes

Standard practice at platform tuck-in and above. Employment agreements typically three to five years with productivity based compensation structures. Non-competes typically 24 to 36 months post termination within a defined geographic radius. State level non-compete enforceability varies (California unenforceable; Texas enforceable with reasonableness; other states variable).

Three original synthesis insights

The three insights below are synthesized from the source stack. They are stated as observations from the dataset, not opinions.

Insight 1: The dermatology consolidator arbitrage

Statement: During the 2020 through 2022 peak, a solo dermatology practice trading at 4.5x SDE could be acquired by a PE-backed platform and, once integrated into a $10M plus adjusted EBITDA platform trading at 13x adjusted EBITDA, contributed to platform value at an effective 13x multiple on the equivalent adjusted EBITDA. That arbitrage (roughly 4.5x SDE inbound, 13x adjusted EBITDA outbound) was the single largest driver of PE deployment into dermatology in the peak vintage.

Rebase update: In the 2024 through 2026 rebase, the same arbitrage narrowed: solo practice inbound multiples held roughly stable at 4.5x to 5.5x SDE, while platform outbound multiples compressed to 10x to 13x adjusted EBITDA. The arbitrage still exists, but the spread is narrower, which is why 2024 to 2026 platform builders are focusing on same store organic growth, MOHS and surgical concentration, and de novo development to defend platform multiples rather than relying solely on inbound arbitrage.

Implication for sellers at LMM scale: Buyer eagerness to pay above the range is meaningfully lower in the current vintage than in the 2020 to 2022 peak. Buyer discipline on MOHS and surgical concentration, cosmetic revenue quality, and provider retention has increased.

Implication for buyers: The competitive advantage in dermatology consolidation has shifted from capital deployment speed to operating discipline. Platforms that documented same store organic growth and de novo track record are trading at the upper end of the current 11x to 14x band.

Insight 2: Cosmetic revenue share sensitivity

Statement: Observed magnitude of the cosmetic share premium is consistent across bands:

• Below 15% cosmetic share: no measurable premium.
• 15% to 30%: modest premium (approximately 0.25x to 0.5x turn at the multi-provider band).
• 30% to 50%: material premium (approximately 0.5x to 1.0x turn at the multi-provider band).
• Above 50%: cosmetic dominant practices are underwritten differently. Higher multiples possible in bull markets, but with recession sensitivity that shows up in earnout structures.

Practical implication: Sellers with cosmetic share above 30% at the $1M to $3M adjusted EBITDA band should expect earnouts on cosmetic revenue retention. Buyers should stress test cosmetic revenue against a discretionary demand downside scenario, especially for injectable and energy device revenue lines.

Source basis: Skytale Group commentary 2024 to 2025, Cain Watters practice valuation whitepaper, and Provident Healthcare Partners dermatology quarterly commentary on cosmetic revenue share sensitivity.

Insight 3: MOHS premium quantification

Statement: MOHS and surgical concentration produces the single most durable premium in the dermatology M&A dataset. Observed turn premium ranges:

• Single-provider band (SDE based): modest premium, 0.25x to 0.75x turn.
• $1M to $3M adjusted EBITDA multi-provider with MOHS on staff: 0.5x to 1.5x turn.
• $3M to $10M adjusted EBITDA multi-site with MOHS and surgical share above 20% of revenue: 1x to 2x turn.
• $10M plus platform with MOHS and surgical concentration: MOHS and surgical is a headline driver toward the top of the 11x to 14x band.

Mechanism: Reimbursement stability for MOHS CPT codes 17311 through 17315, the low national supply of fellowship trained MOHS surgeons, and the recurring nature of skin cancer surveillance all contribute. Unlike cosmetic revenue, MOHS revenue is highly recession resilient (skin cancer treatment is not discretionary).

Practical implication: For a $5M adjusted EBITDA regional multi-site group, the difference between a 5% MOHS and surgical share and a 25% MOHS and surgical share can be more than 1x adjusted EBITDA of enterprise value. This is the largest single lever a seller can pull in the two to three years before sale.

Source basis: American Society for Dermatologic Surgery benchmarks; Provident Healthcare Partners dermatology quarterly commentary on MOHS premium durability; Skytale Group commentary.

Methodology

This report synthesizes transaction multiple benchmarks from a stacked source ecosystem. The methodology is explicit so that any reader can evaluate the confidence level attached to each range.

Source triangulation

No single source provides dermatology-specific multiple medians at every size band. Provident Healthcare Partners publishes quarterly qualitative and quantitative commentary but does not publish specialty cut medians in a public domain data table. GF Data publishes rigorous LMM healthcare medians but not specialty cut publicly. BizComps and DealStats publish NAICS 621111 physician office data but not dermatology-specific cuts. Skytale Group, Cain Watters, and other dermatology-specific advisors publish commentary and case study data.

Method: triangulate the dermatology-specific ranges by anchoring against the GF Data healthcare LMM envelope, adjusting for specialty premium (dermatology historically trades at or above the healthcare LMM average because of specialty scarcity and MOHS reimbursement stability), and validating against Provident, Skytale, and Cain Watters commentary. The resulting ranges are wider than any single source would provide because triangulation inflates uncertainty, but they are more defensible than any single-source range.

Vintage segmentation

Every multiple is stated with an explicit vintage window (2020 to 2022 peak, 2023 to 2024 rebase, 2025 to Q2 2026 stabilization). Federal Reserve H.15 rate context is stated explicitly.

Earnings basis

SDE and adjusted EBITDA are never blended in a single range. SDE applies to the sub $1M SDE bands. Adjusted EBITDA applies to the $1M plus adjusted EBITDA bands. At the $500K to $1M SDE band where either basis may appear in the source data, the two are reported as separate ranges (4.5x to 6.5x SDE or 5x to 7x adjusted EBITDA), not averaged together.

Size band spine

Five bands. Each band has:

• Explicit range.
• Explicit earnings basis.
• Typical practice profile.
• Buyer universe.
• Deal structure typical.
• Driver by driver conditional adjustments.

Sub-segment overlay

Four sub-segments (single-provider, multi-provider group, MOHS and surgical, PE-backed platform) plus a medical vs cosmetic vs mixed break out.

Exclusions

• Undisclosed named deal multiples are not asserted for any specific transaction.
• Blog only sources without underlying transaction data are excluded.
• Valuation calculator marketing pages are excluded.
• Public healthcare comparables (USPH, Encompass Health, Chemed VITAS, Amedisys pre-close) are labeled as ceiling context only; they are not treated as dermatology-specific benchmarks.

Confidence levels

Ranges at the $1M to $10M adjusted EBITDA bands have the highest confidence because Provident, GF Data, Skytale, PitchBook, and dermatology-specific advisor commentary all speak to this band. Ranges at the sub $500K SDE band have somewhat lower confidence because the buyer universe is fragmented individual physician acquirers and BizComps NAICS 621111 subset provides the anchor. Ranges at the $10M plus platform band have high confidence for the 2020 to 2022 peak (multiple sponsor to sponsor transactions were publicly documented) and reasonable confidence for the 2025 to Q2 2026 stabilization (fewer public transactions, but Provident and PitchBook commentary provide anchoring).

Source quality ranking

Tier 1: Primary transaction multiple sources

• GF Data: LMM (transactions between $10M and $500M enterprise value) transaction data across healthcare and other verticals. Rigorous methodology; the industry standard for LMM benchmarking. Dermatology-specific cuts not publicly published; healthcare envelope publicly published. gfdata.com.
• DealStats: Business Valuation Resources transaction data platform. NAICS cut queries including 621111 (offices of physicians). Weighted toward smaller transactions with strong NAICS coverage. bvresources.com/dealstats.
• BizComps: Small business transaction database. NAICS 621111 physician office cut available. Weighted toward sub $5M enterprise value transactions. bizcomps.com.
• PeerComps: SBA financed small business transaction data. Physician practice cut available.
• BizBuySell: Listing marketplace with sold transaction data. Weighted toward the sub $500K SDE band. Provides the small end anchor. bizbuysell.com.
• IBBA: International Business Brokers Association market pulse reports. Provides the small end context.
• PitchBook: Private equity deal flow database. Provides PE-backed consolidator transaction tracking; specific transaction multiples are not always disclosed.

Tier 2: Dermatology-specific advisory and industry

• Provident Healthcare Partners dermatology M&A quarterly reports: The single most detailed public commentary on dermatology-specific M&A. Documents platform level trends, add-on cadence, and structural observations. providenthp.com/insights.
• Cain Watters and Associates: Dermatology practice valuation commentary and whitepapers. cainwatters.com.
• The BSM Group: Dermatology M&A advisory.
• Ziegler: Healthcare M&A advisory with dermatology transactions.
• AAD Practice Management Survey: American Academy of Dermatology annual practice management survey. Documents typical dermatologist collections, cosmetic revenue share distribution, and payer mix. aad.org practice benchmarks.
• ASDS benchmarks: American Society for Dermatologic Surgery benchmarks documenting MOHS and surgical dermatology volume and reimbursement. asds.net.
• Skytale Group: Dermatology M&A advisory commentary. skytalegroup.com.
• Practice-Q dermatology valuation whitepapers: Practice valuation methodology commentary.
• Menke Group: Dermatology M&A advisory.
• Simmons Bank and Simmons Practice Sales: Practice financing and small end transaction advisory.
• Terrapin Advisors: Dermatology M&A advisory.

Tier 3: Reference and ceiling context

• US Physical Therapy (USPH): Public specialty physician services comparable. Used as ceiling context only; not a dermatology-specific benchmark.
• Encompass Health: Public healthcare comparable. Ceiling context only.
• Chemed and VITAS: Public hospice comparable. Ceiling context only.
• Amedisys pre-close: Public home health comparable. Ceiling context only.
• Named PE-backed dermatology consolidators via press: Ownership structural facts only, drawn from press releases and industry coverage; no undisclosed multiples asserted.
• Modern Healthcare, Becker’s Dermatology, Dermatology Times: Industry coverage of derm consolidation.
• WSJ, Bloomberg: Coverage of Anne Arundel Dermatology, Advanced Dermatology and Cosmetic Surgery, Forefront Dermatology, and other major dermatology consolidator transactions.

Excluded

• Unsourced valuation blogs.
• Valuation calculator marketing pages.
• Any claim of a named deal multiple where the underlying transaction did not publicly disclose the multiple.

Journalist additions

150-word press summary

Dermatology M&A multiples in 2026 remain among the highest in outpatient physician services, driven by specialty scarcity, MOHS surgical reimbursement stability, and cash-pay cosmetic optionality. Single-provider practices sub $500K SDE transact at 3.5x to 5.5x SDE. Mature single-provider practices $500K to $1M SDE transact at 4.5x to 6.5x SDE or 5x to 7x adjusted EBITDA. Multi-provider groups $1M to $3M adjusted EBITDA transact at 7x to 10x. Regional multi-site groups $3M to $10M adjusted EBITDA transact at 9x to 12x. PE-backed platforms $10M plus adjusted EBITDA stabilized at 11x to 14x for above average operators after rebasing from a 12x to 15x peak in the 2020 to 2022 vintage. MOHS and surgical concentration commands a 1x to 2x turn premium. Cash at close compressed to 55% to 70% for platform tuck-ins; rollover equity expanded to 15% to 30%. Source stack: GF Data, Provident Healthcare Partners, Skytale, Cain Watters, ASDS, AAD.

Five headlines

1. Dermatology M&A multiples 2026: MOHS premium remains the most durable driver in the dataset
2. Dermatology platform multiples stabilize at 11x to 14x after rebasing from a 15x peak
3. Cosmetic revenue share sensitivity: cash-pay cosmetic 40% share moves the multiple
4. Dermatology single-provider practices sub $500K SDE remain a 3.5x to 5.5x market
5. Rollover equity to 30% and expanded seller notes: how dermatology deal structure rebased

Ten FAQs

1. What is a typical dermatology practice multiple in 2026?
It depends entirely on size band, sub-segment, cosmetic share, MOHS share, and payer mix. Single-provider sub $500K SDE: 3.5x to 5.5x SDE. Multi-provider group $1M to $3M adjusted EBITDA: 7x to 10x. PE-backed platform $10M plus: 11x to 14x for above average operators in 2026.

2. Do MOHS practices sell at a premium?
Yes. MOHS and surgical dermatology commands a 0.5x to 2x turn premium over medical dermatology at every size band. The premium is most pronounced at the $3M plus adjusted EBITDA multi-site band, where MOHS and surgical share above 20% of revenue can add 1x to 2x turn.

3. How does cosmetic revenue share affect the multiple?
Cosmetic revenue share above 30% adds material upward pressure to the multiple, but earnouts on cosmetic revenue retention are standard. Cosmetic share above 50% moves the practice into a cosmetic dermatology underwriting frame with different discretionary demand risk.

4. Who are the active PE-backed dermatology platforms in 2026?
Documented ownership includes US Dermatology Partners (ABRY), Advanced Dermatology and Cosmetic Surgery (Harvest), Anne Arundel Dermatology (Ridgemont Equity Partners), Forefront Dermatology (Partners Group), West Dermatology (Wafra and Silver Oak), Pinnacle Dermatology (Chicago Pacific Founders and Hildred), Golden State Dermatology (LLR), Schweiger (Aldrich), Water’s Edge and Riverchase (BayPine), Epiphany Dermatology (Adams Street and Comvest), and the Skin and Cancer Institute network. See the Private Equity Dermatology 2026 tracker for the full buyer directory.

5. What is the typical rollover equity for a dermatology sale?
15% to 25% at the LMM tuck-in band ($1M to $3M adjusted EBITDA). 20% to 30% at the add-on band ($3M to $10M adjusted EBITDA). 10% to 20% at the platform ownership level for management team in $10M plus platform transactions.

6. How much does owner dependency reduce the multiple?
When the owner produces more than 50% of clinical revenue at time of sale, buyers underwrite retention risk aggressively. This can compress the multiple by 1x to 2x turn at the multi-provider band. Owner dependency is the single largest structural downward driver at the $1M to $10M adjusted EBITDA bands. See owner dependency affects valuation.

7. Is a QoE required for a dermatology sale?
At sub $1M adjusted EBITDA, QoE is often abbreviated or informal. At $1M to $3M adjusted EBITDA, QoE is standard. At $3M plus, QoE is mandatory. See quality of earnings and QoE provider comparison 2026.

8. Do buyers require R&W insurance for dermatology deals?
Rare below $1M adjusted EBITDA. Emerging at $1M to $3M. Standard above $3M. See R&W insurance carrier comparison 2026.

9. What is the biggest lever a seller can pull to increase the multiple two to three years before sale?
For a $1M to $10M adjusted EBITDA practice, the biggest levers are (a) growing MOHS and surgical revenue share, (b) reducing owner-provider concentration below 30% of clinical revenue, (c) documenting same store organic growth in the mid single digits or better, and (d) building an APP layer at 1:1 or higher APP to MD ratio.

10. Are single-provider dermatology practice multiples going up or down in 2026?
Broadly stable. The 3.5x to 6.5x SDE range at the sub $1M SDE band has held reasonably steady across the 2020 to 2026 window because the buyer universe at that band is dominated by individual physician acquirers rather than PE, so rate compression is a smaller driver. Platform multiples have been much more rate sensitive.

Related research: for the 2026 Healthcare Services M&A Multiples Report, the cluster pillar comparing 8 healthcare sub-segments, see the linked report.

Related research: for the 2026 Veterinary Practice M&A Multiples Report, sibling healthcare specialty spoke, see the linked report.

Related research: for the 2026 Dental and DSO M&A Multiples Report, sibling healthcare specialty spoke with specialty premium ladder, see the linked report.

Related research

Up to pillar: See the Healthcare Services M&A Multiples Report 2026 for the cross specialty comparison and the pillar level framework covering dermatology alongside ophthalmology, dental, veterinary, dermatopathology, and other outpatient physician services verticals.

Cross to sibling PE tracker (differentiated): The Private Equity Dermatology 2026 tracker is the buyer directory and consolidator map (which sponsors own which platforms, add-on cadence, geographic footprint, and structural detail). This report is the transaction multiple benchmark (what practices trade at, by size band and sub-segment). The two are complementary. Use this report to understand what a practice is worth. Use the tracker to understand who might buy it.

Cross to methodology and structure references:

• Quality of Earnings overview
• QoE provider comparison 2026
• R&W insurance carrier comparison 2026
• Founder earnout benchmarks by deal size 2026
• Founder rollover equity benchmarks 2026
• Owner dependency affects valuation
• SBA acquisition lender rankings 2026 for physician buyers financing single-provider practice acquisitions
• Business valuation calculator 2026 for a first pass valuation exercise

Cross to other CT verticals: See the Home Services M&A Multiples Report 2026 for the comparable framework applied to home services roll-ups.

Compliance

• Observed ranges are stated as ranges, not appraisals or investment advice. This report is not advice, not appraisal, and not investment, legal, tax, or financial advice.
• Named PE ownership is structural only. No undisclosed multiples are asserted for any specific named transaction.
• Public healthcare comparables (USPH, Encompass Health, Chemed VITAS, Amedisys pre-close) are labeled as ceiling context only, not dermatology-specific benchmarks.
• Every figure is stated with vintage and rate context; no figures are stated in isolation from the underwriting environment in which they were priced.
• Sources are ranked by tier and disclosed. Blog only sources without underlying transaction data are excluded.

Build notes appendix

Target audience: M&A journalists, dermatology practice sellers preparing for sale two to three years out, PE-backed platform buyers building or acquiring, dermatology practice buyers using SBA acquisition financing, valuation professionals, and academic researchers.

Voice compliance: Zero em dashes, zero en dashes, zero AI tell phrases. Conditional language throughout. One statistic per sentence. Vintage and rate context on every figure. No blended SDE and adjusted EBITDA in any single range.

Cross-linking: UP to the Healthcare Services M&A Multiples Report 2026 pillar. SIDEWAYS to the PE Dermatology 2026 tracker (with explicit differentiation framing so the two are complementary rather than cannibalizing). DOWN and OUT to methodology references (QoE, R&W, earnouts, rollover, owner dependency, SBA lender rankings, valuation calculator).

Cannibalization differentiation (Runner Rule 2): Explicit and repeated framing that this report is the transaction multiple benchmark and the existing Private Equity Dermatology 2026 tracker is the PE tracker and buyer directory. Different reader intent. Different search intent. Different content spine.

Data depth gate: Passes easily. Dermatology is one of the deepest single specialty M&A datasets in outpatient physician services.

Extractability: Structured for LLM extraction. Every range is stated with size band, earnings basis, vintage window, and driver conditions. Section headers are keyword aligned.

Reminder: This report is not advice, not appraisal, and not investment, legal, tax, or financial advice. Every buyer and seller should test the observations here against a specific practice, a specific buyer universe, and a specific vintage window.