Local Dermatopathology Services Improve Patient Care

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.

What is dermatopathology?

Dermatopathology is a subspecialty within the fields of pathology and dermatology. Dermatopathologists are trained to correlate what a particular condition looks like on the skin’s surface with how it looks under the microscope and diagnose skin diseases and cancer.

What special 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.

Do you collaborate with general and plastic surgeons in the treatment of skin cancer and melanoma?

One of the ways in which I’m 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 expertise.

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 patient care.

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.

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