Dermatopathology Services Improve Patient Care
Special to the
Journal by Elizabeth Plocharczyk, MD
Diseases of the skin are among the most
common medical problems people experience. These include a wide range of
conditions from rashes, psoriasis, and infections to skin cancers and melanoma.
Physicians treat the most common skin diseases and often arrive at a diagnosis
without additional help. However, when the skin does not behave as expected or
cancer is suspected, the services of a dermatopathologist
can be helpful in arriving at the correct diagnosis and treatment plan.
When microscopic examination is required to
diagnose skin disease, the doctor takes a small skin sample in the office and
sends it to a medical laboratory for microscopic examination. As the associate
director of Laboratories for the Cayuga Health System and a dermatopathologist,
these biopsies typically come to me for examination.
Dermatopathology is a subspecialty
within the fields of pathology and dermatology. Dermatopathologists
are trained to correlate what a particular condition looks like on the skinÕs
surface with how it looks under the microscope and diagnose skin diseases and
services are available in the community now?
Pathologists and dermatopathologists
often use special stains called immunohistochemical
stains when they examine tissue samples under the microscope. The Laboratory at
Cayuga Medical Center has immunohistochemical staining
capabilities that help diagnose skin diseases.
Additionally we now have direct immunofluorescence
microscopy, which is a special set of techniques dermatopathologists
use to identify autoimmune diseases. Many blistering skin diseases and
connective tissue diseases have very specific patterns that can be detected when
tissues are stained with different antibodies. Previously these samples had to
be sent out of town; however, we now have the advantage of being able to render
a swift, accurate diagnosis with this new local capability.
I also perform certain types of biopsies
for inpatients and outpatients to determine if the medication a patient has
been prescribed is the cause of a skin rash. It is often helpful for me to see
the patient and put the clinical history together with my findings from the
microscopic examination of their skin sample. This can be done very
expediently, which is convenient for patients and their physicians.
you collaborate with general and plastic surgeons in the treatment of skin
cancer and melanoma?
One of the ways in which IÕm able to help
patients undergoing surgery for skin cancer is to coordinate with the surgeon
during the procedure to clear the margins of the cancer. This means that immediately
after the cancerous lesion has been surgically removed, the surgeon brings it
to me in the laboratory from the operating room (OR). We map out all of the
margins at the edge of the tissue and examine them while the patient is still in
the operating room. If the margins show any signs of tumor, the surgeon returns
to the OR to remove more tissue from precisely the correct place. We are able
to do this using an exacting technique that takes 20-30 minutes.
The recurrence rate for cancer is miniscule
with this process. Patients typically have smaller scars and there is a much
lower rate of repeat surgeries. This service is typically available only at
larger medical centers; in the past patients have traveled out of town for this
Melanoma tissues samples are handled
differently but the approach to identifying clean margins is similar. These
samples must be processed overnight, however we map the tissue in a similar way
to be sure the surgeon has removed all of the melanoma. We handle these cases
very quickly and have answers for the doctor within 24 hours.
We see a few thousand cases of skin cancer
a year in this community. Melanoma
is common here and it can be deadly if not caught early. If a physician sees an
unusual skin lesion and refers it to our lab, that doctor will get a call from
me directly with unexpected or unusual findings. I am always available to
discuss cases with health-care providers and this personal touch enhances
Dr. Plocharczyk is associate director of Laboratories at Cayuga
Medical Center. She is board certified by the American Board of Dermatology, the
American Board of Pathology in Dermatopathology, and
the American Board of Pathology in Anatomic and Clinical Pathology.