Overview of Dermatopathology
The Dermatopathology Unit at the MGH, led by Dr. Lyn McDivitt Duncan, is a world leader in diagnostic dermatopathology, dermatopathology training and investigative dermatology.
Lyn M. Duncan, M.D., Chief, MGH Dermatopathology Unit; Co-director, Harvard Dermatopathology Training Program; Associate Professor of Pathology, Harvard Medical School
Mai P. Hoang, M.D., Director, Harvard Dermatopathology CME Course; Assistant Professor of Pathology, Harvard Medical School
Rosalynn M. Nazarian, M.D., Instructor in Pathology, Harvard Medical School
Adriano Piris, M.D., Instructor in Pathology, Harvard Medical School
Martin C. Mihm, M.D., Senior Dermatopathologist; Director, MGH Vascular Anomalies Clinic; Clinical Professor of Pathology, Harvard Medical School
Dermatopathology Clinical Program
The Dermatopathology Unit is responsible for diagnosing skin biopsies from a variety of sources, including MGH inpatients, patients seen in outpatient clinics at the MGH and in the Boston metropolitan area, and patients who have had initial diagnoses that we are asked to review in consultation. These specimens include routine histology, immunofluorescence, immunohistochemistry and in situ hybridization studies.
The Dermatopathology Unit has a long history of being a leader in clinicopathological studies of melanocytic tumors. Current projects range from comparative histomorphology to transcriptional genomic profiling. Recent reports from the MGH Dermatopathology Unit include morphologic descriptions of benign versus malignant melanocytic proliferations including dysplastic nevi, Spitzís nevi, lentigo maligna, desmoplastic melanoma, animal type melanoma, nevoid melanoma, and a protocol for sentinel node biopsies in melanoma. In addition, we have reported studies of prognostic factors in melanoma, particularly the evaluation of tumor infiltrating lymphocytes in melanoma and the value of a unique melanocyte specific gene, TRPM1 (MLSN/melastatin).
In collaboration with investigators at the Brigham and Women's Hospital and the Dana Farber Cancer Institute we also have reported the expression of newly identified melanoma biomarkers in human melanocytic tumor progression. In addition to his ongoing contributions in teaching and providing consultative expertise in melanocytic tumors, Dr. Mihm has initiated and is the director of Vascular Anomalies Clinic. This clinic offers a multidisciplinary approach to complicated vascular anomalies which includes dermatologists, pathologists, surgeons, and laser medicine.
Faculty Academic and Research Interests
Dr. Duncan's research activities focus on cutaneous oncology, specifically cutaneous lymphoma and malignant melanoma. She serves as the Scientific co-Chair of the cooperative group trial CALGB 500105, and as the MGH PI of the Harvard Skin SPORE (Specialized Program of Research Excellence). Dr. Duncan and colleagues, including Dr. Nancy Harris and Dr. Judith Ferry, described a previously under recognized form of cutaneous lymphoma that has provided insight into the clinical and histologic heterogeneity of cutaneous B-cell lymphomas. Marginal zone B-cell lymphoma mimics a benign reactive process, and is now recognized as the second most common form of primary cutaneous B-cell lymphoma.
Dr. Mihm and Dr. Duncan participated in the NCI development of a list of melanoma biomarkers deemed as most promising diagnostic or therapeutic targets. The analysis of these markers in a coordinated fashion is one focus of Dr. Duncan's work. The melanocyte specific gene TRPM1 (MLSN/melastatin) was identified by Dr. Duncan in collaboration with Millennium Pharmaceuticals, Inc as a melanoma prognostic factor that acts independently from the current gold standard, tumor thickness.
In a collaborative effort with Dr. F. Stephen Hodi at the Dana-Farber Cancer Institute, Dr. Duncan is evaluating the combined impact of TRPM1 and sentinel lymph node status in predicting the outcome in melanoma patients in the CALGB 500105 cooperative group trial entitled "Prospective Study of Melastatin Expression in Predicting the Risk for Developing Local Regional Metastases of Primary Melanoma."
As the MGH Co-PI of the Harvard Skin Cancer SPORE, Dr. Duncan is leading investigation on melanoma biomarkers in cohorts of clinically annotated melanoma tissue specimens and in the Skin SPORE collaborative melanocytic tumor progression Tissue Microarray (TMA). This TMA work is a collaborative effort led by Dr. Duncan with Dr. David Rimm, Dr. David Elder, Dr. Victor Prieto and Dr. George Murphy of the Univ. of Pennsylvania, Yale University, MD Anderson and Harvard Skin SPOREs, respectively.
Dr. Hoang's research focuses on the diagnostic utility of immunohistochemistry in cutaneous neoplasms and the development of educational platforms using the latest technology.
Dr. Mihm's research is focused on the biology and pathology of malignant melanoma and the evolution of the delayed hypersensitivity reaction and allograft rejection in humans.
Dr. Mihm also works with Dr. Glenn Dranoff of the Dana Farber Cancer Institute in the study of the reactions of lung cancer patients and melanoma patients to autologous transfected melanoma cell vaccination. They also study the evolution of malignancies in various strains of mice bred with different defects in their immune system.
Dr. Mihm established the Dermatopathology Residency Training Program at MGH and spearheaded the development of diagnostic immunofluorescence of the skin at MGH. He has recently begun to study the pathogenesis of hemangiomas in children and other vascular malformations, and he established two multidisciplinary clinics for their evaluation and treatment at the MGH and at the Albany Medical Center. He also studies the manifestations of cutaneous lymphoma and leukemia. He is the co-director of the WHO Melanoma Pathology Committee and external coordinator of the WHO Rare Tumor Institute.
Dr. Mihm has established and is director of the MGH Multidisciplinary Clinic for Vascular Malformations. This clinic is attended by several specialists in the area but with the principal collaboration of Dr. Jay Vacanti of the Pediatric Surgery group and the Dermatology Department. The co-Director is Dr. Jay Austen of Plastic Surgery. Patients of all ages may be seen at the clinic. All types of treatment including medical, surgical, plastic surgical, and laser are offered.
Dr. Mihm is principal investigator of a grant from the Cancer Research Institute of New York for the study of tumor infiltrating lymphoctyes in melanoma. He is a consultant/adviser to the Pathology Committee of the European Organization for the Research and Treatment of Cancer and will be involved in some of their research initiatives. Dr. Mihm is also involved in the research to understand the pathogenesis of vascular malformations in children and adults with Dr. Paula North, Chief of Pathology at the Medical College of Wisconsin.
Dr. Nazarian's research is focused on elucidating the pathophysiologic mechanisms of fibrosing disorders of the skin, with particular interest in nephrogenic systemic fibrosis.
Dr. Piris is focusing his research efforts in the field of immunology of human cutaneous melanoma. Through collaborations with the melanoma research group in the National Cancer Institute of Milan, and the University of Pennsylvania Pigmented Lesion Group, Dr. Piris and Dr. Mihm are studying tumor infiltrating lymphocytes and the circulating lymphocytes of patients with metastatic malignant melanoma, as well as the distribution and function of lymphocytes in primary and metastatic tumors. Dr. Piris is also involved in the meta-analysis of tumor infiltrating lymphocytes in human cutaneous melanoma for classification of primary tumors according to the presence or absence, and distribution of tumor infiltrating lymphocytes with the aim of establishing their prognostic significance.
Teaching and Educational Activities
Dr. Duncan serves on the Advisory Board of the Harvard/MIT Health Sciences and Technology Program Dr. Duncan is also the MGH co-Director of the Harvard Dermatopathology Training Program, after a decade of service as the Harvard Dermatopathology Training Program Director. All members of the Dermatopathology Unit actively teach Residents in Pathology and Dermatology and Dermatopathology Fellows during daily dermatopathology signout. There are three dermatopathology services, with full signout activities each day in a recently designed interactive signout facility that includes two 40 inch plasma screen monitors linked by camera to a multi-headed microscope and by ethernet to the electronic medical record, e-textbooks, and via the internet, Medline and Pubmed.
In addition to this teaching there are numerous teaching conferences specific to Dermatopathology including:
- Dermatology Resident biopsy review conference
- MGH Dermatology Grand Rounds
- Harvard Dermatopathology Lecture series
- Dermatopathology Unknown slides for Pathology and Dermatology Residents
- Melanoma Tumor Board
- Dermatopathology Consensus Conference