Dermatopathology Fellowship

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University of Michigan

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Dermatopathology Core Curriculum

 

1. Dermatopathology Service:

The mainstay of our educational training program is dermatopathology sign-out where slides from patient biopsies or excisions are reviewed and diagnoses rendered. The majority of slides are available the afternoon before sign-out the next morning, so fellows have the opportunity to preview them and develop differential diagnoses or specific diagnoses. Individual cases are discussed among the faculty, dermatopathology fellows, pathology and dermatology residents, and medical students at sign-out and, therefore, there is considerable real-time teaching and opportunity for questions during this activity. The fellow can expect daily feedback on a case-by-case basis, as needed. A formal evaluation of the fellow’s performance and progress will be performed at periodic intervals and at semiannual and final annual reviews.

  • Attend daily dermatopathology sign-out in the morning (9:30-12:00) over the entire year.
  • Previewing and generating specific diagnoses or an appropriate differential diagnosis on all slides that are available the day before sign-out.
  • The fellow is encouraged to request histochemical stains based on the clinical differential diagnosis and morphologic changes in the biopsy to expedite a given case.
  • Preview direct immunofluorescence cases daily.
  • In a structured and scheduled manner, assume graded responsibility by dictating other case types (transfer cases, extramural consults, etc.) during the last 6 months of the fellowship.
  • Attend Multidisciplinary Cutaneous Oncology Tumor Boards to integrate pathology findings into the management of melanomas, Merkel cell carcinomas, non-melanoma skin cancers, and cutaneous lymphomas.
  • Attend all Diagnostic Conferences (every Thursday morning, 8:00-10:00) in the Department of Dermatology to learn the importance of clinicopathologic correlation in improving patient care.
  • Participate in the teaching of dermatopathology to pathology house officers rotating on the dermatopathology service.
  • Give weekly slide seminars to dermatology residents, which are organized by chapters according to Bolognia’s Dermatology.
  • Participate in a minimum of two journal club presentations, which will reinforce the principles of self-directed learning and evidence-based practice.
  • Participate in one QA/QI project over the year.

2. Dermatology Clinics (Pathology-trained fellows):

Fellows previously trained in pathology are expected to rotate through various dermatology clinics (general dermatology, CTCL clinic, immunobullous clinic, cutaneous surgery/Mohs clinic) at Michigan Medicine to gain experience with clinicopathologic correlation. The fellow will be in the dermatology clinics in the afternoons, for a duration of eight months. The fellows will see a minimum of 500 patients by shadowing a dermatology faculty member.

  • Attend the dermatology clinics daily in the afternoon as an observer, and see a minimum of 500 patients, over a period of 8 months.
  • Understand the appropriate settings for biopsies and excisions of skin lesions and the most appropriate site to biopsy for a given lesion and clinical differential diagnosis.
  • Attend the Mohs clinic to gain an understanding of Mohs surgery and to see frozen sections of skin.
  • Attend other cutaneous surgery clinics and have the opportunity to perform biopsies and/or excisions, which is highly encouraged.
  • Learn to correlate the clinical lesion with the histopathology when a biopsy or excision is performed.

3. Anatomic Pathology (Dermatology-trained Fellows):

A fellow who has completed a dermatology residency will rotate on some anatomic pathology rotations, during the first 8 months of the fellowship program in order to get exposure to areas of pathology that overlap with dermatopathology. The fellow will continue to participate in daily dermatopathology sign-out, but the time will depend on when each of the anatomic pathology sign-outs occurs. The fellows will participate in the gross description and dictation of skin pathology specimens. If desired by the fellow, he/she will also participate in autopsies that have relevance to dermatopathology and attend autopsy conference, surgical pathology consensus conference, and AP grand rounds. The fellow will have an opportunity to spend additional elective time in areas of surgical pathology related to the practice of dermatopathology. An example of this would be to spend a month on the consultation service with our soft tissue pathologist.

  • Rotate on various pathology services including “Room 1”, Head & Neck, Soft Tissue, GU, GI, GYN, Breast, Hematopathology that have some overlap with dermatopathology.
  • Review the dermatopathology section of the grossing manual to become familiar with the types of specimens to be grossed and the methods used.
  • Learn how to perform gross description and dictation of pathology specimens with particular attention to skin specimens. Assistance is available from the dermatopathology faculty and pathologist’s assistants.
  • Become familiar with how to process specimens for ancillary testing, such as specimens for electron microscopy, direct immunofluorescence, molecular studies, etc.
  • Elective time may also be spent in laboratories in Clinical Pathology, such as Microbiology, Immunopathology, and Molecular Diagnostics, which perform ancillary tests on patients with skin diseases to gain an understanding of how the tests are performed and the limitations of the tests.

4. Dermatopathology Molecular Diagnostic Laboratory Service:

The fellows have the opportunity during the year to review cases on the Dermatopathology Molecular Diagnostic Laboratory (DPML) service. DPML is focused on developing and offering new diagnostic and prognostic assays for melanocytic neoplasms and other solid tumors. Currently, the laboratory offers two related tests intended to help discriminate between benign and malignant melanocytic tumors--one based on FISH testing and one based on SNP/CGH array. In addition, the DPML also performs SNP array on other solid neoplasms. The fellows are encouraged to attend sign-out sessions in the DPML service with Dr.  Paul Harms, and schedule time to rotate in the laboratory. Teaching is provided during sign-out sessions and through a yearly series of lectures dedicated to molecular dermatopathology (usually scheduled together with the Molecular Genetic Pathology fellows). At the end of the rotation the fellows are expected to:

  • Recognize the categories of melanocytic lesions for which an accurate histologic diagnosis is difficult.
  • Determine appropriate ancillary molecular studies that may help establish a correct diagnosis.
  • Become familiar with the indications and limitations of ancillary molecular studies.
  • Become familiar with the interpretation of SNP-microarray and FISH studies.

  

5. Research:

Each fellow is required to do at least one research project with a faculty mentor. The goal is for each fellow to gain a thorough understanding of the process involved in conducting research. The fellow is expected to present at least one research project at a scientific meeting and write the study up for publication. To assist the fellow in accomplishing this goal, the dermatopathology fellowship program allots each fellow 3 hours a week of academic protected time to work solely on scholarly activities.