Departments

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

Whereas laboratory scientists typically analyze blood or other fluids from patients, anatomic pathologists evaluate tissue specimens, which include cervical scrapings (i.e., PAP smears), biopsies, surgical resections, and whole-body evaluations at autopsy. Anatomic Pathology has three major divisions: Surgical Pathology. This is the examination of tissue removed as a biopsy or as part of a surgical procedure. When a biopsy is done (typically a small sampling of a lesion by incision or by an invasive technique like a core needle biopsy or endoscopy), the pathologist determines what disease process is present, and/or the extent of disease. In all cases, pathologists make their diagnoses by examining thin slices of the lesion under a microscope. Pathologists often also use a variety of specialized molecular techniques to further refine the diagnosis and to predict how the disease may respond to various types of treatment. In this way, the pathologist helps guide any subsequent therapy the patient may need. Cytopathology: This is the examination of very small amounts of tissue removed by scraping a surface, or by aspiration through a fine needle. Obtaining a cytopathology specimen is typically less invasive than obtaining a surgical pathology specimen, so these procedures can be performed in a clinic or a physician’s office. Cytopathologists examine individual cells and small collections of cells to assess for the presence or absence of malignancy. Autopsy Pathology: This is the anatomic examination of a deceased patient to determine what diseases were present and how extensive they were, and to assemble these findings into an explanation for why the patient died. Autopsy examination can answer questions family members may have about the patient’s death, but can also increase understanding of disease for the physicians caring for the patient.

The Breast Pathology program specializes in interpreting and evaluating core needle breast biopsies, incisional and excisional biopsies, lumpectomy or partial and total mastectomy specimens, sentinel lymph nodes, axillary dissections, prophylactic and oncoplastic reduction mammoplasty, and neoadjuvant breast cases. The faculty is board-certified in anatomic pathology and many of the pathologists also have subspecialty expertise in breast pathology. We provide state-of-the-art diagnostic services focused on precise diagnoses of both benign and malignant breast diseases. In cases with malignant diagnosis, additional ancillary studies for receptors are reported with two- to three-day turnaround times. We work closely with our clinical team to ensure that our patients get accurate and reliable results that are critical to patient care. The first question a breast pathologist seeks to answer when reading a breast biopsy is whether cancer is present. But the information included in the pathology report goes far beyond the “yes” or “no” diagnosis. Even if the biopsy is benign, we need to ensure that the calcifications seen on imaging correlate with calcifications seen on the core biopsy pathology specimen. The earliest stage of breast cancer, called ductal carcinoma in situ (DCIS), is usually detected in this manner. Discordance between pathology and imaging is addressed by means of communication between the radiologist and pathologist in a radiology-pathology conference or by individual communication. A pathology report always has a detailed visual morphologic description of the tumor. The initial biopsy report includes information on whether the cancer is confined within the ducts (in situ carcinoma) or has breached the duct wall and invaded into the adjacent stroma (invasive carcinoma). We provide intraoperative consultation on sentinel lymph nodes in the frozen section suite to detect metastases, which will then help the surgeon in planning patient management. Additional details will be studied and added to the pathological report after mastectomy and sentinel node biopsy to determine whether the cancer has metastasized or spread to any lymph nodes. Tumor size, histologic grade, and lymph node status are prognostic indicators that provide valuable information about the likely clinical outcome. For example, a patient whose tumor is well-differentiated and has negative margins, i.e., has clear margins, has a better prognosis than a patient whose tumor is one that is poorly differentiated and is present at the margin.

Our most comprehensive diagnostic service, Surgical Pathology includes the subspecialties of more than 40 physicians. Our board-certified pathologists offer complete pathology services for a wide range of cancerous and noncancerous diseases and conditions. We provide diagnostic services in the following specialty areas: Breast Pathology Bone & Soft Tissue Pathology Dermatopathology Endocrine, Head & Neck Pathology Gastrointestinal & Liver Pathology Genitourinary Pathology Gynecological Pathology Hematopathology Medical Renal Pathology and Electron Microscopy Neuropathology Ophthalmic Pathology Pediatric & Placental Pathology Thoracic Pathology

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

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.

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.

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

Through laser surgery and other cutting-edge techniques, our board-certified dermatologists can help brighten and rejuvenate our patients’ skin. Our range of expertise includes removal of benign growths such as skin tags and cysts; laser treatment of facial telangiectasias; and the precise placement of fillers to enhance appearance. Laser Treatments For the treatment of broken capillaries on the face due to sun damage, aging, and rosacea, we use a pulsed dye laser to specifically target and destroy these blood vessels. This laser is also used for the treatment of port-wine stains and hemangiomas. For unwanted hair growth, we offer two types of lasers that work either in light or dark skin tones with medium- to dark-colored hair. Over a series of treatments, depending on the site, a significant reduction in hair growth is achieved. Fillers There are a variety of injectable materials that can be placed in the skin to replace volume loss that leads to an aged appearance, or to fill in crevices caused by wrinkles. Common places to use fillers include the lips, smile lines, smoker’s lines, and in the cheeks. We currently offer a range of hyaluronic acid fillers, including Juvéderm®, Restylane®, and Perlane®, which each lasts up to six months. More permanent fillers, such as Sculptra™ and Radiesse®, are also available. Prior to injection of any filler, we perform a cosmetic consultation to assess patients’ expectations and areas of concern to provide the best correction possible. Botulinum Toxin A (Botox) Our physicians are experts in facial anatomy, and perform Botulinum Toxin A injections to minimize the appearance of wrinkles that naturally occur through facial expression. The result is a softening of creases and an overall more “relaxed” appearance. These injections can also be placed on the neck and used to decrease excessive sweating in the armpits, hands, or feet.

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.

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

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.