Welcome to Dermatopathology - Dermatology

Welcome to Dermatopathology!!
DERMATOPATHOLOGY
Updated 6/08
The Dermatopathology Section at UCSF is the most active university-based dermpath
service on the West Coast. We aim to provide a stimulating and educational experience.
Our service handles wet tissue specimens sent directly to us both from the Dermatology
Clinic at UCSF and by outside private practitioners, as well as consultations on previously
prepared glass slides from both clinical dermatologists and pathologists. Our total
accession volume exceeds 85,000 specimens and is growing.
The full-time attending staff consists of Drs. Philip LeBoit, Tim McCalmont, and Beth
Ruben. The dermatopathology service is located at 1701 Divisadero St., Third Floor
(corner of Sutter and Divisadero), across from Mt. Zion Hospital. The academic office is in
Room 350, and is administered by Mary Kate Fitzsimon (353-7416). This office handles
academic activities. The staff of the UCSF Dermatopathology Service are in Room C101
(first floor of Mt. Zion Hospital), phone 353-7546. Wet tissue specimens and previously
prepared glass slide consultations from dermatologists and pathologists outside the
University are handled through this office. The Service office manager is Al Naklowycz, in
Room C101 (phone 353-7535).
Resident Sign-out and Conference Schedule
While on Dermatopathology Rotation
7:30 – 8:30 AM
DERMPATH
LECTURE
1701 Divisadero
Room #3100
9:00 AM - 12 PM
SIGNOUT
1701 Divisadero
Room #450
12:45 PM DAILY
CONSENSUS
CONFERENCE
All dermpath faculty
1701 Divisadero
Room #450
M T W TH F
7:30 – 8:10 AM
DERM
RESIDENT
SCOPE
SESSION
1701 Divisadero
Room #450
9:00 AM - 12 PM
SIGNOUT
1701 Divisadero
Room #450
12:45 PM DAILY
CONSENSUS
CONFERENCE
All dermpath
faculty
1701 Divisadero
Room #450
8:00 – 9:00 AM
Derm Grand
Rounds
Herbst Hall, Mt. Zion
9:00 -10:00 AM
Staff Conference
1701 Divisadero
(Pt viewing 3 rd Floor
clinic; discussion 1st
Floor Conference
Room)
10:00 AM - 12 PM
SIGNOUT
1701 Divisadero
Room #450
12:45 PM DAILY
CONSENSUS
CONFERENCE
All dermpath faculty
1701 Divisadero
Room #450
9:00 AM–12:00PM
SIGNOUT
1701 Divisadero
Room #450
12:45 PM DAILY
CONSENSUS
CONFERENCE
All dermpath
faculty
1701 Divisadero
Room #450
9:00 AM –12:00 PM
SIGNOUT
1701 Divisadero
Room #450
12:45 PM DAILY
CONSENSUS
CONFERENCE
All dermpath
faculty
1701 Divisadero
Room #450
REVISED 6-23-2009 1

DERMATOPATHOLOGY
Morning signout will be conducted by the dermpath faculty on consultation material. As
the pace of signout can be rapid, we encourage you to ask to see a slide we have
reviewed on your own if you need more time to study it. We will also tell the UCSF
dermatology resident on the rotation how to arrange to spend a 1-2 hour session with our
grossing supervisor, David Marrs, to gain a better understanding of how tissue is handled
after receipt. The dermatology resident will also spend a session with Dr. Kari Connolly in
the immunofluorescence laboratory. These are required.
The Consensus Conference meets daily promptly at 12:45 PM, during which time the
dermpath faculty bring cases for interest or consultation.
Dermatology Grand Rounds (a 1-hour lecture on an important topic regarding clinical
dermatology or dermatopathology) is from 8-9 on most Wednesday mornings. Please
check with the online schedule of the Dermatology Department for the month or months
you are on rotation. Dermatology "Staff Conference" (from 9-10 on Wednesday mornings)
is one of the opportunities to see patients during the rotation. The dermatopathologic
findings are often presented as well. Attendance is expected. The dermatology and
pathology departments also have other conferences which may be of interest – ask for the
month’s schedule.
The afternoons on the rotation have been reserved for your independent study, while
teaching signout may continue into the afternoon on occasion. Many resources are
available with respect to how to make the most of this time (see below).
Dermatopathology Etiquette
The learning environment around the microscope may be different than you have
encountered previously. So we offer a few words on that account:
1. Please be on time to teaching signout (which may vary slightly in its start time,
but will not start before 9 AM), teaching sessions and faculty consensus
conference, to avoid disruption.
2. While it is fine to bring reading material to refer to during the session, please
keep conversation to a minimum, especially while the faculty is dictating.
Remember, it is a working signout, while also a teaching session. There is also
important learning information being transmitted about the material during
dictation, so listen in.
3. Unless there is an urgent need, please keep your cell phones and pagers in
silent mode.
4. It is alright to bring a beverage into the scope room, but no food please.
REVISED 6-23-2009 2

Perspective on the UCSF Dermatopathology Service
DERMATOPATHOLOGY
The UCSF Dermatopathology Service has evolved into the only vehicle at the University
for the instruction of skin pathology to both pathologists and dermatologists. Without the
service, much of the breadth and volume of the dermpath experience we provide would be
lost. Residents on the rotation have an active role in the service, and interpretation of
specimens by the attending is done in the presence of the residents and fellows. Keep in
mind that our service attempts to meet the financial challenges of managed care, while
simultaneously providing "cutting edge" diagnostic work with maximal information provided
on each specimen.
Case Numbering Systems and Retrieval of Results
Cases prior to 1995 were assigned to one of multiple numbering systems, depending upon
how the case arrived at the service. All cases after 1995 are assigned a unique accession
number consisting of the year, then a hyphen, then an additional number (for example, the
first case accessioned in 1998 was “98-00001”; the second case was “98-00002.”) Each
case is also assigned to a lettering system, depending upon how the case entered the
department and some other factors. The lettering system is generally used for billing and
statistical purposes and can be ignored for the most part. Some letters you may see are
DT – wet tissue specimens originating from outside the hospital
DS – slide consultations
DH – all hospital cases, whether inpatient or outpatient
DI -- immunofluorescence cases
DR – research cases
DN – no charge cases
Different departments of the hospital use different report retrieval systems which are not
completely linked. Almost all reports after 1990 can be retrieved through the Intellipath
system, which is found only on terminals within the dermatopathology offices. The
personnel in the Service office at 353-7546 will be happy to retrieve these reports for you.
Reports prior to 1990 can be obtained through Mary Kate Fitzsimon in the Academic office.
Some cases are logged into the Co-path system found in the pathology department, but
the diagnoses and reports for those cases are usually NOT entered into this system and
the cases usually appear as “incomplete” even after they are signed out. A patient who
has a UC identification number which is known to the dermatopathology service (in other
words, the patient was seen within the medical center) should have a complete report
available within the STOR system.
REVISED 6-23-2009 3

Available Educational Materials in Dermatopathology
DERMATOPATHOLOGY
The standard texts are Weedon’s Skin Pathology*, Lever's Histopathology of the Skin, and
McKee’s Pathology of the Skin. Chapters from Maize’s Cutaneous Pathology are
generally the basis for the Dermatopathology lectures on Monday mornings. These are all
available in our office, as is the most comprehensive text on inflammatory skin disease,
Ackerman's Histopathology of Inflammatory Skin Disease: A Method by Pattern Analysis.
There are also a number of monographs available on specific topics in Dermatopathology,
such as adnexal neoplasms, melanoma, and lymphomas. The best way to develop skill in
the field is to read about cases you encounter and to master basic dermatopathologic
concepts. Please do not remove these resources from the Department. Depending of
course on your background, during the rotation, you should work toward mastery of the
following introductory topics:
1. pattern analysis of basal cell carcinoma
2. types of melanocytic nevi and eponymic naming of nevi
3. architectural criteria for recognition of melanoma and distinction of melanoma from
melanocytic nevi
4. architectural criteria for mycosis fungoides
5. recognition of the basic patterns of inflammatory skin disease, with a brief
differential diagnosis for each pattern.
*UCSF residents may check out a copy of Weedon’s during their rotation, from our
academic office. All first year UCSF dermatology residents will be provided with their own
copy compliments of the Dermatopathology faculty.
In addition, there is a list of dermpath diagnoses that each UCSF dermatology resident
should master according to their year of training, which can be found in the dermatology
resident glass slide collection. Please make sure that those have been studied during your
time on the rotation.
An invaluable correlate for pathology residents rotating through dermatopathology is a
basic knowledge of clinical dermatology. The paperback by Lookingbill and Marks, Clinical
Dermatology, is the one used as an introduction for residents and medical students
rotating through dermatology. We highly recommend that you read the book in its entirety
at the start of your rotation. The brief paperback, Dermatopathology by Burgdorf
(Springer-Verlag, 1984) can also be read in its entirety and provides a valuable overview.
We have lost our copy of this book, but you may be able to find one elsewhere.
There are glass slide collections available in the scope room – we would encourage you to
use them. Looking at unknown cases and then reading about the entities you encounter is
one of the best ways to gain skill in any pathology discipline, including dermatopathology.
The importance of reading during the rotation cannot be overstated.
Another informative study tool is the website http://www.mdlive.net/ Under Program
Series Available, there is the Dermatopathology Master Series covering many topics on
dermatopathology. Under “Archived Lectures”, find Dermatopathology Master Classes for
the available programs. Sign the Guest Book (no password required) to access the
lectures.
REVISED 6-23-2009 4

Rules regarding study set slides
DERMATOPATHOLOGY
1. All boxes should be maintained in consecutive order within their present
location.
2. Only one box will be removed for study at a time.
3. Slides should be replaced into the proper slot in the box. Please do not leave
slides out on surfaces.
4. When study of the cases from one box has been completed, this box should be
replaced and then the new box can be removed for study.
5. The slide boxes should never be left at your microscope but should be replaced
in the filing location as soon as you have finished your study. This means that
all boxes should be replaced over lunch and overnight.
6. Please notify Mary Kate regarding any missing slides (include the box number
and the case number). They will consult with us to determine if replacement is in
order.
7. Please notify Mary Kate if you believe there is a case with an incorrect diagnosis.
They will consult with us to see if a correction is necessary.
8. Slide boxes may not be removed from the Department for any reason.
Clinicopathologic correlation
We are occasionally asked as a group to see patients in the dermatology clinic for
clinicopathologic correlation. As such, please dress professionally (no sweats, scrubs,
jeans or tennis shoes). Be considerate of the patient’s privacy and reserve any
commentary to a time when outside the examination room.
Immunofluorescence and Specialty Clinics in the UCSF Dermatology Department
Since 1995, immunofluorescence diagnostic testing has been available through our
service by Dr. M. Kari Connolly. Talk to us for additional information regarding Dr.
Connolly’s signout schedule. Signout sessions will be arranged for the dermatology
resident on the rotation. There are two specialty clinics that may be of interest. The
Melanoma Clinic and Cutaneous Lymphoma Clinic, headed by Dr. Mohammed Kashani-
Sabet, provide an opportunity to see patients with disorders in which clinicopathologic
correlation is extremely important. Please ask us to make arrangements should you wish
to observe either clinic.
Research Opportunities
For interested residents and students, a variety of writing and investigative opportunities
are available. Both case reports and projects can be pursued that may culminate in
publication. If you wish to consider a research project, see us for ideas and details.
REVISED 6-23-2009 5

Goals and Objectives of Dermatopathology
First-Year Residents
1. Learn a general approach to histopathologic diagnosis.
DERMATOPATHOLOGY
2. Be able to identify common cutaneous neoplasms (i.e. seborrheic keratosis,
malanocytic nevus, etc.) and common inflammatory patterns (i.e. spongiotic dermatitis,
interface dermatitis, etc.) with reasonable reliability.
3. Understand basic principles of gross pathology: how specimens are “cut in” and how
that affects the practice of pathology.
4. Understand fundamentals of clinicopathologic correlation.
5. Be able to rationally explain the fundamental nature of disease processes (i.e. cysts,
malformations, hamartomas, hyperplasias, benign and malignant neoplasms, etc).
6. For UC trainees, review the UCSF dermatology resident slide set of diagnoses based
on your year of training, and read on those as well.
Readings
Skin Pathology, David Weedon; contributor, Geoffrey Strutton. 2nd ed. London; New York:
Churchill Livingstone, 2002
Also see the Differential Diagnosis I through IV by A. Bernard Ackerman, available in our
library.
REVISED 6-23-2009 6

Goals and Objectives of Dermatopathology
Second-Year Residents
1. Learn criteria for specific diseases and be able to express them lucidly.
DERMATOPATHOLOGY
2. Develop differential diagnoses for commonly encountered histopathologic patterns.
3. Be able to identify and subcategorize, with reasonable reliability for level of training,
variants of common cutaneous neoplasms (i.e. types of basal cell carcinoma, other
carcinomas, melanocytic nevi, etc.).
4. For UC trainees, review the UCSF dermatology resident slide set of diagnoses based
on your year of training, and read on those as well.
Readings
Skin Pathology, David Weedon ; contributor, Geoffrey Strutton. 2nd ed. London ; New York
: Churchill Livingstone, 2002
REVISED 6-23-2009 7

Goals and Objectives of Dermatopathology
Third-Year Residents
1. Learn features of less common diseases, both inflammatory and neoplastic.
DERMATOPATHOLOGY
2. Learn limitations of microscopic diagnosis (i.e. which diseases cannot be distinguished
microscopically).
3. Be able to state some of the arguments on both sides of current debates on major
issues in dermatopathology.
4. For UC trainees, review the UCSF dermatology resident slide set of diagnoses based
on your year of training, and read on those as well.
Readings
Skin Pathology, David Weedon ; contributor, Geoffrey Strutton. 2nd ed. London ; New York
: Churchill Livingstone, 2002
REVISED 6-23-2009 8