Dermatopathology (PGY 3 and 4)
During the second and third year of the dermatology training program residents will have the opportunity to spend 6 months on the dermatopathology service. They will gain experience at the UF Department of Dermatology Dermatopathology division, Gainesville VA Medical Center and in conferences and lectures. The resident is expected to:
- become proficient at recognizing inflammatory and neoplasic processes under the microscope;
- correlate the microscopic appearances with the anatomy, physiology and pathogenesis of skin disorders;
- learn the various histologic stains and how and when to use them;
- gain experience in immunopathology (immunoperoxidase and immunofluorescence);
- learn to correlate clinical aspects of skin disorders with their microscopic appearances;
- develop greater sophistication in recognizing atypical and uncommon skin disease.
The major objective for residents rotating in Dermatopathology is to gain familiarity and a basic level of competence in the histologic diagnosis of neoplasms, inflammatory conditions, and infectious conditions of the skin. In addition, we hope to provide an exposure to some of the less common entities in Dermatopathology as well as an appreciation for the complexities and diagnostic dilemmas occasionally encountered in this field.
For the pathology resident and Dermatopathology fellow, an additional major objective during the rotation should be to familiarize oneself with the clinical aspects of dermatologic diseases as much as possible. this can be achieved by reading some of the many fine textbooks and clinical atlases, some of which will be present in the Dermatopathology Laboratory. The attending physician may suggest others. Additional clinical experience can be obtained by arranging to spend some time in the Dermatology Clinic with one of our dermatology attendings. Attendance at Dermatology Grand Rounds is also strongly encouraged (noon to 2:00 p.m. each Friday) since patients are presented at this conference followed by a discussion by residents and attending members, frequently with a discussion of histopathologic findings.
For dermatology residents rotating in Dermatopathology, the rotation should complement your training in clinical dermatology and allow you to appreciate the usefulness as well as the limitations of skin biopsies. It suggested that dermatology residents familiarize themselves with the “behind the scenes aspect of pathology” such as tissue preparation, cutting, staining, and basic immunoperoxidase and immunofluorescence techniques. Spending time with the histotechnicians in the lab can greatly enhance the experience.
Dermatopathology signouts begin at approximately 8:30 a.m. each day. Slides may be available before then, and you are welcome to begin reviewing these on your own as soon as they are available and rendering a tentative diagnosis. If the attending physician is delayed, please begin reviewing available slides on your own. In general however, signouts will be done as a group since this facilitates our getting reports out as quickly as possible. Our turn around time in the UF Dermatopathology division is generally quite rapid (one day).
Dermatopathology signout takes place in the main signout room at Springhill building. The Dermatopathologists responsible for signouts in this laboratory are Dr. Vladimir Vincek, Dr. Ann Church, and Tania Gonzalez-Santiago, M.D.
The time required for signing out cases varies depending on the number of cases received, their complexity, and the attending physician. Generally, we are finished with the majority of the work somewhere between 11:00 and 3:30 p.m. In addition to looking up information as we go along in the laboratory, we occasionally will need to obtain additional reference material from the library or other sources and there is ample time for this after signouts. Of course, you are encouraged to read about the entities we encounter each day on your own time.
There is abundant glass slide teaching material available for your review in the Dermatopathology signout room. These slides are arranged according to Lever chapters, and this is really an outstanding collection. Although you are free to work through these slides at your own pace, please be aware that the slides are cherished and well guarded. Please take good care of them and put them back where you found them when you are finished. A microscope is generally available for your use on the premises.
We encourage participation in case reports or small research projects, depending on the interest of the resident. There is generally ample time during the rotation to accomplish something that can result in presentations at meetings and publications. You need to identify a project early in the rotation however in order for this to be possible.
Recommended textbooks for this rotation include Histopathology of the Skin by Lever and Schaumburg-Lever, Pathology of the Skin by Philip McKee, and Pathology of the Skin by Farmer and Hood. Excellent clinical atlases include one by Anthony DuVivier. A good basic clinical textbook of dermatology is Principles and Practices of Dermatology by Sams and Lynch.