[January 2009] Jennifer McNiff, MD, hardly ever sees a specimen that she hasn’t encountered before, but she recently identified a malignant granular cell tumor, a lesion so rare that she’d never seen one in 16 years of practice. McNiff and her colleagues in the dermatopathology lab analyze about 100,000 skin biopsies a year, including all of those done at Yale and most performed by dermatologists and surgeons throughout Connecticut and the region. “The beauty of being a referral center is that we see the common and the rare,” she said. “I think that’s good for patients, because the more you see, the better a pathologist you are.”
Several years ago, McNiff started an immunofluorescence service to diagnose some of the blistering disorders from which patients suffer. Some can’t be distinguished by routine pathology, but immunofluorescence allows McNiff and her colleagues to identify autoantibodies that deposit in the skin, leading to an inflammatory process that causes blisters. She also sees a lot of cutaneous rashes and skin cancers, the latter of which are becoming more prevalent in women between the ages of 20 and 40.
McNiff spends much of her time evaluating slides under the microscope, but new molecular techniques and improvements in immunohistochemical stains help her refine her diagnoses. The spectrum of stains has grown exponentially in recent years and, as a large referral lab, Yale maintains an extensive repertoire to diagnose lesions. To McNiff, the specimens are more than just a collection of cells, however. “Every case that comes across the microscope, I’m keenly aware of the patient at the other end,” she said.
Because they handle so many biopsies, McNiff and the seven other dermatopathologists in the practice review challenging cases during a daily conference that takes place around a 10-headed microscope. They communicate with one another and consult with community physicians. “I think it’s excellent communication that enables the best diagnoses, because you really need to know not only that a patient has a rash, but what the features of the rash are to help you define what the cause is,” she said. “That’s how you deliver good care.”
- Originally published in the January 2009 issue of Yale Practice.
Title: Professor of dermatology and pathology; director, Yale Dermatopathology
Areas of expertise: Histopathologic analysis of skin; cutaneous T-cell lymphoma, immunobullous and connective tissue diseases
Place of birth: Cleveland, Ohio
College: Swarthmore College
Med School: University of Vermont College of Medicine
Training: Anatomic and clinical pathology residency and chief resident, University of Virginia Health Sciences Center; dermatopathology fellowship, Medical College of Virginia
Family: Husband, Mike; children, Anna, 11; Jimmy, 9
What is most challenging to you in academic medicine? For me, it can be a challenge to balance the demands of a busy clinical practice with time to pursue investigative projects and fulfill teaching and administrative responsibilities.
What is most rewarding? The opportunity to practice medicine with a phenomenal peer group in a stimulating environment. There is no better way to stay interested in a field than to be where discoveries are being made, and of course where our role as educators ensures we stay current.
What do you like most about your practice? Our staff at Yale Dermatopathology makes this a wonderful place to practice. From our laboratory technicians to our office staff and our management team, there is a strong commitment to excellence and loyalty in our division. It is also a privilege to work with a diverse group of dermatopathologists who all bring different areas of expertise to our practice.
Personal interests or pastimes: My favorite activities revolve around spending time with my family, whether hiking, swimming, sailing, reading or traveling.
Last book read: We Are Our Mothers’ Daughters, by Perri Klass and Sheila Solomon Klass.
What would you do to improve our clinical environment if you had a magic wand? This will require a large wand, but I would create a geographically centralized practice near or within the medical center. This would allow patients to have easy access to multiple specialties and afford doctors the opportunity to interact more easily in person regarding care of their patients.