Departments

The Skin & Kidney Cancer Program at Smilow Cancer Hospital brings together an extensive, multidisciplinary team to diagnose, treat, and care for patients with all types of skin cancers, including melanoma, as well as kidney cancers. Established over 30 years ago, our program includes experts in surgery, medical oncology, dermatology, urology, pathology, dermatopathology, radiology, genetics, and radiation oncology. Members of the team are national and international leaders in clinical and laboratory research focusing on improving treatment and outcomes for our patients. From patients who present with an early-stage diagnosis or more complex, metastatic disease, our team is prepared to provide each patient with the most comprehensive and cutting-edge treatment available. Each patient’s care is reviewed by our multidisciplinary care team to develop a personalized treatment plan. Clinical trials are also available to patients through Yale Cancer Center, bringing the latest treatment options to our clinics to benefit patients. Our doctors are at the forefront of melanoma and kidney cancer treatment and research, including novel immunotherapy approaches and the genetic characterization of kidney cancers. Smilow Cancer Hospital places great emphasis on taking care of all of our patients’ needs through a network of supportive care services. Nurses with dedicated knowledge and skills care for our patients through the continuum of their treatment. Patients and their families also have access to social workers to provide psychosocial support, as well as pastoral support, nutritional counseling, physical therapy, palliative care, and integrative medicine. After the initial diagnosis—and depending on the presentation of the disease—each patient is evaluated by our dermatologists, surgeons, urologists, and/or medical oncologists. For some presentations of melanoma and other skin cancers, particularly in the early stages in which disease has not spread beyond the primary site or lymph nodes close to the primary site, surgery may the preferred initial treatment. Specialized surgical expertise is essential for the management of melanoma and other skin cancers, which can occur on any skin site and even in areas not exposed to the sun. Some skin cancers appear in delicate areas such as the face, nose, ear, or hand and often require the expertise of a plastic surgeon. For certain regions of the body, our team collaborates with other highly trained surgical subspecialties, including thoracic surgery and neurosurgery. To care for kidney cancer, we work closely with oncologists and urologic surgeons. In the early stages of melanoma, pathology results from the tumor will determine the risk of developing metastases (spread to distant organs) in the future. If the results indicate a high risk for melanoma metastases, treatments are available to reduce the risk and possibly prevent or delay melanoma recurrence. Adjuvant therapies (or therapies given after surgery

Our dermatologists are here to help improve the health and appearance of patients’ skin, and to diagnose and treat both benign and malignant skin conditions. We provide specialized care for the full spectrum of skin disorders, including acne, alopecia areata, psoriasis, inherited skin disease, and skin issues arising after organ transplant and during cancer treatment. We are one of two centers in the state with a pigmented lesion clinic, phototherapy center, and cutaneous lymphoma clinic. The clinical research efforts of our dermatologists have contributed significantly to the treatment of skin tumors such as melanomas and cutaneous T-cell lymphomas. We are actively exploring the uses of advanced technologies such as photopheresis, a therapy for life-threatening and debilitating diseases like cutaneous T-cell lymphoma and graft-versus-host disease. A large portion of the department's research is performed through two separate research entities—the Yale SPORE in Skin Cancer Center and the Spitzoid Neoplasm Repository.

Our expert pathologists are key players in all health care provided by Yale Medicine. By studying bodily fluids and tissues, we help other physicians make diagnoses. We offer highly specialized diagnostic and consultation services in all major specialty and subspecialty areas of pathology. Our subspecialists attend all regular meetings in which a number of doctors from various specialties review and discuss a patient's medical condition and treatment options.They are on call around the clock, ensuring that doctors working in oncology, surgery, transplantation, and other service areas always have access to our expert knowledge. Our internationally recognized physicians offer specialized expertise in breast, cytopathology (cell), dermatologic, endocrine, gastrointestinal and liver, gynecological, head and neck, hematologic (blood), neurologic, ophthalmologic, pediatric, kidney, soft-tissue and bone, transplant, thoracic and urologic pathology, molecular and genomic pathology, and autopsy pathology. Specialized care is offered in the following areas: Accredited PD-LI testing Autopsy Cytopathology Intraoperative frozen section and tumor triaging service Molecular diagnostics and tumor genomics profiling Pediatric pathology Support laboratories: histology, immunohistochemistry, translational pathology, and electron microscopy and quantitative immunofluorescence analysis of multiplexed tumor markers Surgical pathology with subspecialty expertise in gastrointestinal tract and liver; prostate; bladder; kidney; gynecological tract; endocrine system; head, neck, and oropharynx; bone and soft tissue; hematologic and lymphoid system; brain, muscle and eye; pulmonary system; and transplantation

The largest center for specialty dermatology in Connecticut, Yale’s Department of Dermatology is among the oldest in the United States. Our doctors and nurses provide safe, compassionate, and innovative care to all members of our community. We offer treatment for skin conditions, all of which can interfere with quality of life. Cutting-edge therapies are often the only hope for patients with resistant dermatologic illness, which affects the whole skin surface. Our physicians are deeply rooted in research, including the exploration of new technologies such as photopheresis for cutaneous T-cell lymphoma and graft-versus-host disease. Our patients often benefit from early access to new treatments and therapies discovered by researchers at Yale. Specialized clinics for organ transplant patients, photopheresis, ichthyosis, and inherited skin disease One of two centers in the state with a pigmented lesion clinic, phototherapy center, and cutaneous lymphoma clinic Cutting-edge microscopically controlled excision (Mohs technique) for recurrence of high-risk cancers Technically advanced referral center for expert diagnosis of benign and malignant skin disorders Large dermatopathology lab, which processes 75,000 patient biopsies annually

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

The Yale Onco-Dermatology Program at Smilow Cancer Hospital serves the dermatologic needs of cancer patients in Connecticut and beyond. We treat concerns including very dry skin, itching, and skin changes that arise as side effects from chemotherapy. We also treat rashes, nail and hair changes, skin infections, cancer involvement of the skin, radiation dermatitis, and other changes due to radiation. We also provide dedicated care for patients with skin cancer, including melanoma and non-melanoma skin cancer, ranging from rigorous skin screening examinations to optimized prevention and therapy.

When skin diseases affect infants, children, and adolescents, our pediatric dermatologists are ready to help. As childhood skin conditions bring not only physical but also psychological challenges, we make it our priority to help prevent permanent scarring and disfigurement. Laser therapy is one tool we use for certain hemangiomas, port-wine stains, and other vascular lesions of the skin. Our pediatric dermatologists also offer expertise in diagnosing and treating a variety of skin conditions, including psoriasis, alopecia areata, atopic dermatitis, vitiligo, acne, and genetic skin diseases. In addition, we conduct advanced research and clinical trials to find breakthrough treatments for childhood skin diseases.

We offer sophisticated approaches for the management of skin cancers, ranging from the most common to the most complicated or rare. At the heart of our program is microscopically controlled excision, known asMohs surgery, the most successful treatment to cure recurrent or other high-risk skin cancers. We have been offering the procedure since 1998, and today, our physicians perform 3,500 Mohs surgeries each year. Mohs surgery has revolutionized the treatment of such skin cancers as basal cell carcinoma and squamous cell carcinoma, and the chances of lasting, disfiguring scars are minimized. In this procedure, the cancer is removed layer by layer, and, after each step, the tissue is examined under a microscope, allowing our dermatologists to confirm that all of the cancer cells have been eliminated as the surgery progresses. This maximizes the chances of removing all of the abnormal cells while still preserving as much of the normal skin tissue as possible.

Myositis is an autoimmune disease that involves chronic inflammation of the muscles, and it can affect almost every system in the body. The Yale Myositis Program takes a comprehensive, multidisciplinary approach to caring for people with this complex condition. Leaders of the Myositis Program hope to establish it as a center of excellence. In addition to treating patients, eventually, the team would like to work with basic researchers and perform clinical trials to understand the pathogenesis of the disease. Another goal is to educate colleagues and primary care physicians about the condition to improve awareness about myositis and hopefully get patients diagnosed earlier in the disease process. The Myositis Program, which opened in October 2022, is one of a few specialized myositis centers in the country, offering a team of dedicated specialists from diverse areas such as neurology, pulmonology, dermatology, pathology, and genetics to provide comprehensive patient care. Myositis is an umbrella term for various conditions (including polymyositis, dermatomyositis, and necrotizing myopathy, among others) that can affect the limbs, skin, and other organs. Complications of the disease can include a debilitating loss of strength, functionality, and mobility; it can be life-threatening when it affects the lungs and heart. Every patient is unique and can have different symptoms, which can change over time. For example, someone can have a skin rash without the muscle component, or they can have muscle weakness and lung inflammation without the skin rash. It can become complicated because patients may not be experiencing all three symptoms simultaneously when they see their doctor, and the treatment typically targets the organ flaring at that particular moment. The good news is that there has been great progress in understanding of the condition, thanks to the development of technologies that allow for early diagnosis and more tailored treatment. The program’s directors are two rheumatologists interested in myositis— assistant professors of clinical medicine Harjinder Chowdhary, MBBS, MD , and Oana Zaha, MD. The idea for a program focusing specifically on myositis came from the chief of Rheumatology, Allergy & Immunology Richard Bucala, MD, PhD, Waldemar Von Zedtwitz Professor of Medicine (Rheumatology) and professor of pathology and epidemiology (microbial diseases); and Vaidehi Chowdhary, MBBS, MD , associate professor of medicine (Rheumatology, Allergy & Immunology) and clinical chief, Rheumatology, Allergy & Immunology.

Since the field of dermatopathology began in 1792, Yale dermatologists and dermatopathologists have earned their place amid the discoveries, innovations, and milestones that have shaped the field. Today, Yale Dermatopathology is currently the most sophisticated and technically advanced laboratory in the region. In our Dermatopathology Lab, our team of highly specialized, board-certified histotechnologists brings a combined 100 years of experience to helping dermatologists provide the most accurate, timely diagnoses to their patients so they can begin the right treatment right away. Our services include examination of the following: Malignant melanoma Melanocytic nevi Cutaneous T cell lymphoma Psoriasis Lichen planus Basal cell carcinoma Kaposi’s sarcoma Erythema multiforme Leukocytoclastic vasculitis

Patients with moderate-to-severe psoriasis often require a host of medications to manage their disease. One type in particular—biologics—are highly effective, but they can be complicated to administer. They are also expensive, which means navigating insurance coverage can be difficult and result in treatment delays. The Psoriasis Treatment Program brings together a board-certified medical dermatologist who specializes in psoriasis and a pharmacist from Yale New Haven Hospital Ambulatory Clinical Pharmacy Services who is an expert in psoriasis medication management and coordinating insurance coverage. Together, this dedicated team can manage patients’ care in a seamless fashion, which ensures prompt care. One medical professional focuses on the disease process and treatment selection; the other medication management. In this collaborative model, patients meet with their physician first to discuss a treatment plan and talk separately with the pharmacist. The pharmacist talks in depth with the patient, obtaining a complete medical history and answering all questions related to potential laboratory tests and prescribed medications, which can include injections they self-administer at home, as well as oral and topical treatments. The two points of access mean that patients aren’t condensing all of their questions about their treatment plan into one appointment, and the two medical professionals communicate closely about their psoriasis patients. If one is not available to help, the other can. Patients can work directly with their pharmacist on all issues related to medications, side effects, and insurance coverage in between follow-up appointments with their physician. Having two points of contact allows patients timely access to their medical team as well as their prescribed medications. The program brings together a physician who has expertise in treating psoriasis and a pharmacist with additional training in outpatient care and in dermatologic medications, including those for psoriasis. Managing medications for dermatologic patients is the pharmacist’s full-time job. The pharmacist educates patients about the medications and can obtain insurance coverage and set up home delivery of the medications, taking many hassles and obstacles out of the patient’s hands.

The Cutaneous Granulomatous Disorders Program brings together dermatologists, dermatopathologists, and researchers with expertise in the evaluation and treatment of granulomatous disorders of the skin. Granulomatous disorders of the skin include the following diagnoses: Sarcoidosis Granuloma annulare Necrobiosis lipoidica Reactive granulomatous dermatitis Interstitial granulomatous dermatitis Interstitial granulomatous drug (medication) reaction Palisaded neutrophilic and granulomatous dermatitis Necrobiotic xanthogranuloma Rubella granulomas Granulomatous dermatitis, not otherwise specified These conditions lead to skin rashes, which can be very problematic and are frequently life-altering. Individuals affected by these disorders may experience frustration due to the lack of Food and Drug Administration (FDA)-approved treatment modalities. Yale’s Cutaneous Granulomatous Disorders Program recognizes this and works individually with each patient to find the treatment approach that is most suited to their particular situation and individual goals. The program also strives to identify and evaluate new therapies for these disorders. The primary goal of the Cutaneous Granulomatous Disorders Program is to provide optimal care for each patient seen in our specialty clinic, where we take an individualized approach to each patient’s diagnosis and their goals, pairing these with the best treatment options. The program also has several active clinical trials; patients who are interested may have the ability to participate, potentially providing access to some of the latest molecular therapies undergoing evaluation for the treatment of these disorders. Patients may also have an opportunity to participate in other research projects designed to better understand the molecular pathogenesis of these diseases and their effect on patient well-being. Our team was assembled with the goal of bringing together leading experts in cutaneous granulomatous disorders. The physicians in the program include internationally recognized leaders in medical education on cutaneous granulomatous disorders, scientists that have deciphered the underlying immunology of these disorders, individuals that have developed consensus diagnostic criteria for necrobiotic xanthogranuloma, and physicians that have led the evaluation of new treatment approaches for patients with sarcoidosis, granuloma annulare, and necrobiosis lipoidica. Our team also includes dedicated pharmacists with specialized training in the practical and safe use of cutting-edge dermatologic medications, including those used to treat cutaneous granulomatous disorders. The pharmacists have vast expertise in effectively coordinating insurance coverage and are another important point of contact for our patients as they navigate coverage of specialty medications. For patients with sarcoidosis involving the skin, our dermatologists will work closely with their other specialists to identify the optimal treatment approach. Ya