6^th International Conference on Clinical and Experimental Dermatology May 04-06, 2016 Chicago,Illinois, USA

Biography:

Drazen M Jukic is a private practice Dermatopathologist in Savannah GA. He maintains active digital Dermatopathology consultation service and serves as a Telepathology Consultant for VISN 8 and James A. Haley VA Hospital, Tampa, Florida and is a Member of Advisory Board of Castle Biosciences, Inc. He also maintains a consultation service via his company Advanced Digital Anatomic Pathology Technologies (ADAPT) and as a Medical Officer in Digipath, Inc. In the past, he served as a Director of dermatopathology fellowship, University of Pittsburgh (for 10 years), Medical Advisory Board at Digipath and was a Founding Member of a clinical team at Omnyx, LLC. He is a Visiting Associate Professor, School of Medicine of University of Zagreb, Croatia. His area of expertise includes immunohistochemistry, cutaneous lymphomas and molecular pathology as it pertains to dermatopathology.

Abstract:

Two of the applications of digitized medicine as applied to the dermatology are poised to change the practice as we know it today, namely teledermatology and teledermatopathology. The implementation of teledermatology has seen a huge interest, especially when applied with the patient in mind. Some business models have focused on delivery of the care to the underserved areas (areas without adequate dermatology coverage) and others have been implemented as patient initiated consultations. However, if the biopsies are done, it is questionable where does the pathology end up and who is actually reading the biopsies, potentially skewing the interpretation and allowing for a diagnostic bias. On the other hand, although well accepted and utilized, conventional dermatopathology workflow is not ideal, especially if viewed in light of the increasing demands in terms of reporting, turnaround time and patient safety. Implementation of telepathology in any surrounding is a challenge, though, as most pathologists trained to use current systems are comfortable with standard, glass based pathology and are resistant to adopting new approaches to workflow without evidence of an immediate benefit. Furthermore, telepathology has not been adequately explored for evaluation of specific diagnostic features in dermatopathology, which is often a single person operation, thus not allowing for additional opinion or real time quality assurance. By employing telepathology, real time remote case review and delayed image review as well as second opinions, additional subspecialty reviews, sign out collaborations and expert reviews can be easily conducted. In some cases, this is the only way these imperative procedures can be accomplished, especially considering their time sensitive nature. In the future, one would hope to see a combined teledermatology/teledermatopathology system for delivery of the optimal care for a dermatologic patient.

Biography:

Shaofeng Yan is the Director of the Dermatopathology Section and Dermatopathology Fellowship Program at Dartmouth Hitchcock Medical Center. She has received MD from Peking Union Medical College and PhD from University of Washington. She has received Anatomic and Clinical Pathology Residency Training at Dartmouth Hitchcock Medical Center and Dermatopathology Fellowship Training at Harvard Dermatopathology Fellowship Program. She became a Faculty Member of Dartmouth Hitchcock Medical Center in 2006. Since then she has published in the field of Dermatopathology. She has been serving as Editorial Board Member and Reviewer for different journals

Abstract:

Histological and immunohistochemical (IHC) studies have been used to evaluate metastatic melanoma in sentinel lymph nodes (SLN). Occasionally, isolated IHC positive (IHC+) cells have been identified in SLN without atypical cells seen on H&E stained sections. We previously reported isolated IHC+ cells in lymph nodes from patients without melanoma. The aim of this study is to evaluate the prognostic significance of these IHC+ cells in SLN from melanoma patients, compared to patients with negative SLN and patients with SLN positive for metastatic melanoma. 826 melanoma patients who received a sentinel lymph node biopsy between 2000 and 2012 were identified from a tertiary medical center. Among them, 125 had metastatic disease in SLN, 639 had negative SLN and 60 had rare IHC+ cells in SLN without atypical cells seen on H&E sections. Within the SLN+ group, 51 had metastatic deposits <0.2 mm, 44 had deposits >2 mm and 30 had deposits between 0.2 and 2 mm. A control group was created by selecting 125 patients from the 639 negative SLN group to match the positive SLN group, based on age and sex. With a mean follow-up time of 58.8 months, the disease specific survival of patients with rare IHC+ cells in SLN was similar to patients with negative SLN and patients with tumor deposits less than 0.2 mm (P=0.19), but was significantly different from those with metastatic deposits between 0.2 mm and 2 mm and those with deposits >2 mm (P<0.0001). Further studies with longer follow up are needed.

Biography:

Bertha Baum has built a reputation as a Cosmetic Dermatologist by providing leading-edge treatments, dedicated and personalized patient care and excellent aesthetic results throughout her career. She is often asked to share her expertise to the English and Spanish-speaking media about the latest advancements in skin care technologies. She has collaborated in several publications, in world renowned dermatological journals and books with her research. She remains committed to the highest standards of patient care and actively involved in several professional organizations. She is proud to treat patients of all ages and skin types and has experience in cosmetic, general, surgical and pediatric dermatology. She is a proud alumna of the University of Miami with a Bachelor of Science in Neuroscience Summa Cum Laude, received her Medical degree from the Nova Southeastern University College of Osteopathic Medicine. Upon graduation, she has completed an Internship in Westchester Hospital, as well as a Residency in Dermatology at the NSU COM Larkin Community Hospital, where she was Chief Resident during her last year.

Abstract:

Background: Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect. Objective: This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected non-melanoma skin cancer biopsy sites. Methods: In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment. Results: Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred. Conclusion: Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.

Biography:

Drazen M Jukic is a private practice Dermatopathologist in Savannah GA. He maintains active digital Dermatopathology consultation service and serves as a Telepathology Consultant for VISN 8 and James A. Haley VA Hospital, Tampa, Florida and is a Member of Advisory Board of Castle Biosciences, Inc. He also maintains a consultation service via his company Advanced Digital Anatomic Pathology Technologies (ADAPT) and as a Medical Officer in Digipath, Inc. In the past, he served as a Director of dermatopathology fellowship, University of Pittsburgh (for 10 years), Medical Advisory Board at Digipath and was a Founding Member of a clinical team at Omnyx, LLC. He is a Visiting Associate Professor, School of Medicine of University of Zagreb, Croatia. His area of expertise includes immunohistochemistry, cutaneous lymphomas and molecular pathology as it pertains to dermatopathology.

Abstract:

Two of the applications of digitized medicine as applied to the dermatology are poised to change the practice as we know it today, namely teledermatology and teledermatopathology. The implementation of teledermatology has seen a huge interest, especially when applied with the patient in mind. Some business models have focused on delivery of the care to the underserved areas (areas without adequate dermatology coverage) and others have been implemented as patient initiated consultations. However, if the biopsies are done, it is questionable where does the pathology end up and who is actually reading the biopsies, potentially skewing the interpretation and allowing for a diagnostic bias. On the other hand, although well accepted and utilized, conventional dermatopathology workflow is not ideal, especially if viewed in light of the increasing demands in terms of reporting, turnaround time and patient safety. Implementation of telepathology in any surrounding is a challenge, though, as most pathologists trained to use current systems are comfortable with standard, glass based pathology and are resistant to adopting new approaches to workflow without evidence of an immediate benefit. Furthermore, telepathology has not been adequately explored for evaluation of specific diagnostic features in dermatopathology, which is often a single person operation, thus not allowing for additional opinion or real time quality assurance. By employing telepathology, real time remote case review and delayed image review as well as second opinions, additional subspecialty reviews, sign out collaborations and expert reviews can be easily conducted. In some cases, this is the only way these imperative procedures can be accomplished, especially considering their time sensitive nature. In the future, one would hope to see a combined teledermatology/teledermatopathology system for delivery of the optimal care for a dermatologic patient.

Biography:

Stephen M Mastorides is the Chief of Pathology and Laboratory Medicine Service of the James A Haley Veterans Hospital in Tampa, Florida for the past ten years. He is a skilled Pathologist with many years of experience in management specializing in the introduction of new and advanced technologies into the clinical laboratory. As Chief, he has helped to develop the Tampa VA Molecular Diagnostics Center of Excellence, which provides molecular testing services for numerous medical centers in the VISN 8 including the Orlando VAMC, North Florida/South Georgia VAMC, Miami VAMC and Bay Pines VAMC. He also oversees a large inpatient and outpatient phlebotomy service which draws over 700 patients and 2100 specimens per day. His research focuses on investigating advanced laboratory technologies including but not limited to telepathology, molecular diagnostics, diagnostic nanotechnologies and practical implementation of genomic and proteomic testing. He is also the Site Director of the Million Veteran Program (CSP #G002).

Abstract:

Healthcare managers and pathologists have been tasked to find solutions to improve pathology workflow and provide all patients with access to specialty pathologists. As a result, the James A. Haley Veterans’ Hospital established a Telepathology Center of Excellence. Telepathology is defined as electronic multimedia communication between an acquisition site and a remote site pathologist for the purpose of primary diagnosis and second opinion consultations. The James A. Haley Veterans’ Hospital Telepathology Center of Excellence has identified requirements for interoperable telepathology systems and pioneered a solution for dermatopathology which works integrated with our Computerized Patient Record System (CPRS). The Apollo Robotic Telepathology Workstation, utilized in our system, is a dynamic telepathology system designed utilizing a multi tiered open system software solution. Apollo Path Picture Archiving and Communication Systems (PACS) manage images from all laboratory imaging devices and related hardware. The telepathology objectives include: Expediting referrals to experts and specialists, improving telehealth workload capture, enhancing secondary reading for diagnostic verification, peer review and quality assurance as well as group discussion and education during clinical pathological conferences (tumor board). The implementation deployed Apollo systems to Bay Pines VA Medical Center (St. Petersburg, FL) and the VA Caribbean Healthcare System (San Juan, PR). Both systems are live and used for second opinion diagnostic dermatopathology consultations (Dermatopathologist is at James A. Haley Veterans’ Hospital). This system implementation has brought quicker, more accurate diagnoses across VISN 8 and the results of the implementation provide useful information to healthcare managers and decision makers who must find a more efficient way to provide care to our nation’s Veterans.

Biography:

Kate Ross has completed her Medical degree from the Florida State College of Medicine. She has completed a Dermatology Residency at the University of South Florida. She has her board certification in Dermatology from the American Board of Dermatology. She currently works at LA Plastic Surgery & Dermatology in private practice in Sarasota and Bradenton, FL. She also spends 1 day a week seeing patients at the James A Haley VA Hospital in Dermatology. She is an Associate Clinical Faculty Member at the Florida State College of Medicine.

Abstract:

This presentation will give an overview of a few available telemedicine systems currently in use in a private practice setting and compare these to the telehealth system currently being used at the VA hospital. It will further discuss how one practice is integrating teledermatology into day to day business to make patient care easier and more HIPAA compliant. I will explore how one VA is using telehealth to improve consultation between dermatology and non-dermatology practitioners. This will finish with a review of the barriers to widespread use of these systems in a busy practice as well as limitations of use in the governmental systems. Finally we will visit new features being promised by telemedicine companies in the years to come.

Biography:

Srdjan Prodanovich, MD, FAAD has completed his medical school and dermatology residency at the University of Miami School of Medicine in Miami, Florida. He is actively practicing Dermatology in Naples, Florida and is a CEO of EZDERM, LLC (ezderm.com), a premier software company that develops state of the art medical record systems. He has published multiple research papers.

Abstract:

Pathology plays an essential role in healthcare. While still relying on glass slide microscopy and paper reports, digitalization of modern healthcare calls for a better delivery method of pathology results. Digital pathology can significantly improve patient care outcomes by allowing instant access of pathology images to multiple members of the patient care team.

Biography:

Kate Ross has completed her Medical degree from the Florida State College of Medicine. She has completed a Dermatology Residency at the University of South Florida. She has her board certification in Dermatology from the American Board of Dermatology. She currently works at LA Plastic Surgery & Dermatology in private practice in Sarasota and Bradenton, FL. She also spends 1 day a week seeing patients at the James A Haley VA Hospital in Dermatology. She is an Associate Clinical Faculty Member at the Florida State College of Medicine.

Abstract:

This presentation will give an overview of a few available telemedicine systems currently in use in a private practice setting and compare these to the telehealth system currently being used at the VA hospital. It will further discuss how one practice is integrating teledermatology into day to day business to make patient care easier and more HIPAA compliant. I will explore how one VA is using telehealth to improve consultation between dermatology and non-dermatology practitioners. This will finish with a review of the barriers to widespread use of these systems in a busy practice as well as limitations of use in the governmental systems. Finally we will visit new features being promised by telemedicine companies in the years to come.

Biography:

Daniel Schramek has completed his MSc from University of Vienna and Sydney, PhD in Genetics from University of Vienna and an Executive MSc in Technology Management (NYU) always with highest distinction and undertook his Postdoctoral studies as Emerald Foundation Young Investigator with Elaine Fuchs at the Howard Hughes Medical Institute at the Rockefeller University in New York. Currently, he leads his lab for Functional Cancer Genomics at the Lunenfeld-Tanenbaum Research Institute and is an Assistant Professor at the Department of Molecular Genetics//Faculty of Medicine/University of Toronto. He has published over 25 papers in reputed journals such as Nature, Science, Cell or Nature Genetics.

Abstract:

Mining the wealth of genomic data for personalized cancer therapies poses one of the biggest challenges for translational cancer research today and is predicated on weeding out ‘bystander’ mutation and identifying the ‘driver’ mutations and pathways responsible for initiating tumorigenesis and metastasis. We thus developed a novel RNAi methodology that allows us to simultaneously screen hundreds of putative human cancer genes directly in vivo using various mouse models of cancer. Importantly, this method tests gene function within the native tissue architecture, stromal cues and immune system. First, we focused on Head & Neck squamous cell carcinomas (HNSCCs), which represent the 6th most common cancer with a mortality >50%. Using ultrasound-guided in utero injections of lentiviral particles, we selectively delivered shRNAs to the single-layered surface ectoderm of living E9.5 mouse embryos, where stem cells stably incorporate and propagate the desired genetic alterations (RNAi) into adulthood in a mosaic fashion. This allowed us to identified seven novel tumor suppressors including Myh9, which encodes non-muscle myosin IIA. Mechanistically, we uncovered that myosin IIA’s function is manifested not only in conventional actin-related processes but also in regulating p53 activation. Clinically, low Myh9 expression stratifies HNSCCs patients with poorest survival. We have now expanded our technology to various other epithelial cancer models, included CRISPR-mediated gene-editing and started with negative screening to elucidate physiological regulators of oncogenic growth further highlighting the utility of direct in vivo screening to integrate human cancer genomics and mouse modeling for rapid and systematic discovery of cancer driver mutations and novel cancer vulnerabilities.

Biography:

Abstract:

Analysis of skin cancers was conducted on materials obtained from an Oncology Clinic. The samples represented mostly Carcinoma basocellulare solidum. Histological preparations were made from the skin samples and used for histological observation, as well as for selecting pieces for further research using scanning microscope connected with chemical analysis (EDS method). Scanning microscopes Jeol 540 and 560, made in Japan, were used. Special attention was paid to areas of increased mineralization. It was observed that mineralization within the cancerous areas is of dual nature. Hidden mineralization manifests only as increased levels of certain elements in the chemical analysis of tissue. SEM observations indicate that the hidden mineralization consists of elements embedded in biological structures of tissue. It does not create mineralgrains or crystals in tissue. It can only be detected using sensitive chemical methods. Next to the hidden mineralization, organic-mineral micro-grains containing increased amounts of elements were observed. We may assume that those are the result of evolution (further mineralization) of the hidden mineralization, which may remain on the hidden level or evolve into the form that may be observed microscopically (SEM). Uneven distribution of the increased amounts of tested elements in the aforementioned forms confirms that they are mostly organic-mineral grains. Conducted research, which proves the presence of mineralization in cancerous tissue, shows the need for discussion: what is the order of the observed phenomena? Does the local tissue mineralization cause the modification of certain cells into their cancerous form, or do cancerous tissues have predisposition to concentrating certain elements? Co-existing of both phenomena is also possible, which hinders the interpretation of obtained results. Further research is necessary to understand this important problem.