Dermatopathology

Goals and Objectives

During the rotation in dermatopathology, the residents and fellows are expected to acquire the following core competencies: 

Patient Care

Dermatopathology is a subspecialty of both pathology and dermatology in which adequate clinical information is essential to a valid tissue diagnosis. Communication with the submitting clinician is a critical part of a dermatopathology service, and improves patient care overall. The trainee will learn how:

• To assess adequacy of clinical information submitted with skin biopsy specimens, to obtain additional information from the submitting clinician when appropriate.
• To convey information to the clinician about patient management when appropriate (i.e. re-excision of severely dysplastic nevi, follow-up for rebiopsy if first biopsy is subdiagnostic).
• To get up to date management recommendations for cutaneous melanoma and lymphoma in order to help educate clinicians about their cases when needed.

Medical Knowledge

• The trainee will learn how to develop acumen with biopsy diagnosis and surgical staging each of the common types of skin lesions, including infections and inflammatory lesions, neoplasms of the epidermis and its appendages, and melanocytic neoplasms.
• To learn the clinical correlates of the histopathology for skin lesions.
• To learn the common pitfalls in diagnostic dermatopathology which should require consultation with a specialist.
• To evaluate the need for special immunologic or molecular studies for cases in which a diagnosis may depend on laboratory techniques other than routine histology.

Practice-Based Learning and Improvement

The trainee will learn how:

• To locate, appraise and assimilate evidence from scientific studies related to skin disease.
• To assess dermatologic databases on line for clinical information about the clinical and pathologic aspects of skin disease.
• To teach basic histology of the skin to students and other health care personnel.

Interpersonal and Communication Skills

The trainee will learn how:

• To maintain an ethically sound relationship with submitting clinicians, realizing that information must always pass from dermatopathologists to patient through the clinician.
• To develop dictation and report generating skills.

Professionalism

The trainee will learn how:

• To maintain ethical principles with respect to patient confidentiality and informed consent.
• To understand age, gender, and ethnic differences in the manifestation of skin disease.

Systems-Based Practice

The trainee will learn how:

• To function in different types of medical practice and delivery systems that differ from each other (i.e. hospital versus private practice).
• To practice cost effectiveness that does not compromise patient care.

Duration

Dedicated training in dermatopathology is given in four one week blocks, distributed throughout the Resident's anatomic pathology years. Surgical Pathology fellows can also participate in dermatopathology electives.

A biweekly lecture series presented by dermatopathologists in the Department of Dermatology throughout most of the academic year is offered for reinforcement of didactic material. This includes digital images, kodachromes (knowns and unknowns) and unknown glass slides. Review sessions are scheduled every quarter.

Duties and Responsibilities of Residents by Year

First Year of AP Training

In the first year of AP training, the Resident is expected to attend regularly the didactic lectures in dermatopathology presented by the Department of Dermatology.

First-year Residents are scheduled for 2-week rotations in Dermatopathology signout, and when possible, as on days assigned to the autopsy service when no cases are to be performed.

Second and Third Years of AP Training

In the subsequent years of AP training, the Resident is scheduled for two weeks of concentrated training in dermatopathology. During this time, the Resident is required to participate in the daily morning signout of dermatopathology cases.

Residents supplement practical education in dermatopathology obtained at signout with independent readings, and review of digital copies of the lectures assigned by the dermatopathologists. These resources are located in the Dermatopathology area and in the Department of Pathology.

Residents are encouraged to take advantage of teaching glass slide collections that illustrate a broad spectrum of neoplastic and inflammatory diseases. These collections (one in the Pathology residents' room and the other in the Dermatopathology Laboratory contain more than 1,000 glass slides of common and unusual skin pathology. They are constantly updated and increased by the Dermatopathology faculty, who provide teaching slides regularly for the collection.

The weeks' cases of dermatopathology specimens are held in a baking oven until Monday, when they are filed. The Resident is encouraged to look through these on Friday afternoon to fine tune diagnostic skills.

During the Dermatopathology rotation, Residents must participate in the Multidisciplinary Cutaneous Lymphoma Conference and the Multidisciplinary Melanoma Conference by reviewing the glass slides ahead of time, then attending the formal presentations.

The Pathology Resident on dermatopathology rotation is encouraged to attend the weekly Dermatology Grand Rounds in which live patients are examined, their pathology reviewed and management discussed in a conference that follows the viewing. These are usually patients with difficult diagnosis or treatment issues. The Dermatology Resident and Pathology Resident on the dermatopathology elective will each present the histopathology of the cases.

Residents are strongly encouraged to spend at least one afternoon in the dermatopathology laboratory, learning the special techniques used for grossing, orientation and processing of small skin biopsies.

As available, Residents are encouraged to attend one of the dermatology clinics in order to see first hand the gross pathology of skin lesions as well as to become familiar with methods used for biopsies and excisions of skin lesions.

Supervision and Evaluation