University of Minnesota Expands its Expertise in Dermatopathology

August 2018

pathologist“As dermatopathologists, our primary clients are dermatologists, and they are very sophisticated clinicians," says Alessio Giubellino, a dermatopathologist who joined the LMP faculty last summer. "Dermatologists know a lot about dermatopathology because it’s part of their training.” Giubellino observed that in their reports dermatopathologists try to include details that can help dermatologists understand the pathology and likely course of a lesion.

An LMP assistant professor, Giubellino is one of three dermatopathologists at the U. Dermatology assistant professors Daniel Miller and Kevin Gaddis--both fellowship-trained dermatopathologists--in partnership with Giubellino represent an expanding clinical expertise in the field. 

The demand for expertise in dermatopathology is growing. The recent addition of six new dermatologists in the U's Department of Dermatology, which includes specialists in melanoma and pigmentation disorders, "will really expand the types of cases we see," Miller said.

Giubellino concurs. The group reviews cases from MHealth and Fairview Health Services hospitals and are receiving more consultation and second opinion requests from outside clinics. Giubellino said “We often sit with residents in pathology and examine the slides together. We discuss the histopathology finding of the lesion and, if necessary, order ancillary tests.”

millerIf you have questions about how to refer a consult to our University of Minnesota Physicians Outreach Laboratories or about pricing, contact Laura Funches at 612-625-3949 or at funches10@umphysicians.umn.edu or contact Giubellino, Miller, or Gaddis directly (see sidebars). A large part of the University’s dermatology practice is skin cancer. “We see a lot of melanoma and non-melanoma skin cancer cases here,” Miller said. With the new dermatology clinicians, one of whom is melanoma and pigmented tissues expert who will work in a multidisciplinary clinic with oncology, “we expect to see not only an increase in case volume but in second opinion requests as well.”

The incidence rate of melanoma has risen by more than 50 percent over the past decade. Melanoma is an active clinical and research focus for both Giubellino and Miller. “Melanoma and melanocytic lesions are a large part of our practice,” Giubellino said. “Melanocytic lesions are sent to us for histopathologic evaluation. Now, with more advanced technical capabilities, we are able to arrive at a diagnosis earlier than ever before.” Histopathology remains the “gold standard” for diagnosing melanoma, but molecular biomarkers are making inroads. Ancillary studies may involve immunohistochemistry or molecular analysis in difficult cases.

Miller and Gaddis are also building high-level expertise in complex inflammatory skin diseases where dermatology and rheumatology overlap. “For challenging inflammation diseases in skin we can be an excellent resource for people, especially surgical pathologists, who may not have access to a dermpath subspecialty,” Miller said.

One of the group’s new technical capabilities is a fully operational direct immunofluorescence (DIF) lab, an especially valuable assay for autoimmune blistering diseases, which are becoming more common. “People are sending samples because they don’t have DIF capability,” Miller said. Giubellino added that samples can be sent by dermatologists but also by in-patient facilities and family practitioners.