Department of Dermatology - spring 2022

Department of

DERMATOLOGY INNOVATING TREATMENT

Basic science labs contribute to better dermatological care at the bedside page 4

Spring 2022

SPECIALTY CLINICS MULTIDISCIPLINARY CARE BRINGS DOCTORS TOGETHER TO TREAT THE MOST CHALLENGING CONDITIONS

Three-year program now supports nine dermatology residents page 6

PHOTO BY: MARK WASHBURN

RESIDENCY PROGRAM Specialized clinics offer personalized, multidisciplinary care to patients with rare skin diseases.

PHILANTHROPY

Bequest from emeritus professor encourages others to give back page 8

Interested in joining or supporting our team?

Find Department of Dermatolgy employment opportunities at www.DHProviders.org.

Contact Megan Dodge in Medical and Healthcare Advancement at Megan.

Dodge@Hitchcock.org to learn more about opportunities to engage with and support our departmental activities.

Fourteen specialty clinics and counting—they represent a few of the many commitments the Dartmouth Health’s Department of Dermatology at Dartmouth Hitchcock Medial Center has made to caring for patients in unique and compassionate ways.

“Because we’re an academic specialty and were elevated to an independent department in 2020, it is expected that we provide high-level specialty care,” says M. Shane Chapman, MD, MBA, HS’96-99, chair of the Department of Dermatology.

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Dartmouth Hitchcock Medical Center DEPARTMENT OF DERMATOLOGY

PHOTO BY: BRITTANY STARK

MESSAGE FROM OUR CHAIR The dermatology program had a very humble beginning. It started in 1947 at Hitchcock Clinic with just one faculty member. Our training program was nonexistent. We eventually grew into the Section of Dermatology under other departments, but we didn’t stop there—we just kept on growing. new Department of Dermatology newsletter with you.

You’ll find out more about how our specialty clinics care for our community; you’ll see how far our residency program has come and where it’s headed; and you’ll learn how our research is leading to a better world.

Now, 75 years later, we are Dartmouth Health’s Department of Dermatology at Dartmouth Hitchcock Medical Center, with 14 faculty members, nine residents, three fellowships and four PhD scientists. Becoming a stand-alone department has elevated our status as a specialty and has stimulated our faculty members to expand their collaborative research projects with other departments—even beyond the clinical spectrum. Our department status has boosted our role in the larger academic medical center and ambulatory clinics.

Last year we saw more than 50,000 patients and performed more than 2,000 Mohs surgeries. We also run 14 specialty and multidisciplinary clinics for people who might otherwise have nowhere else to turn for highly specialized care.

And that’s just our clinical growth.

As for academics, we have published nearly 45 peerreviewed articles every year for the past three years. Our basic science laboratory footprint is growing, and our grant and external funding is expanding.

To highlight the many areas where our capacity and momentum for great work is growing, I’m sharing our

All in all, our department is not only growing, but thriving.

We are helping to improve the quality of care and research in all areas of Dartmouth Health’s academic medical center— Dartmouth Hitchcock Medical Center. More of our faculty are volunteering for committees, participating in tumor boards, starting grassroots research groups and developing an overall sense of belonging to something bigger.

This enthusiasm is an important force for growing and improving our clinical and academic mission for the future, and it is directly related to our department status.

I want to thank all the former and current faculty and residents who have created and sustained our program for the past 75 years. We will use this opportunity wisely.

M. Shane Chapman, MD, MBA, HS’96-99 Inaugural Chair, Department of Dermatology, Dartmouth Health’s Dartmouth Hitchcock Medical Center; Professor of Dermatology, Geisel School of Medicine at Dartmouth

We’re excited to invite you to join Dermatology alumni, faculty, current residents and friends to celebrate the 2020 establishment of the Department of Dermatology at Dartmouth Hitchcock Medical Center. We have plans to eat, drink, tell stories and share our common bond.

DERMATOLOGY AT DARTMOUTH HITCHCOCK MEDICAL CENTER July 8-9, 2022* | Hanover and Etna, NH

To register, see the full reunion schedule and see who’s coming, please visit go.D-H.org/dermreunion.

Questions? Contact Megan Dodge at 603-646-5742 or D-H.Alumni.Relations@Hitchcock.org.

*Subject to change based on federal, state, local and institutional COVID-19–related ordinances.

Proof of vaccination is required for all in-person gatherings.

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SPECIALTY CLINICS DEPARTMENT ARCHIVES

“We not only serve our local community patients well, but we also accept referrals from doctors who aren’t equipped to treat these patients.

Providers can help their most challenging patients by sending them to us for treatment. These clinics also serve the teaching mission and provide a platform for research.”

The dermatology clinics offer patients truly multidisciplinary care, often having two specialty doctors in the room at the same time. For example, the department’s pioneering specialty clinic, the Dermatology-Rheumatology Clinic, brings in both a dermatologist and a rheumatologist to discuss the patient’s condition and determine, together, the most appropriate treatment in real time, eliminating the need for patients to wait on appointments with different providers.

This archival photo from the 1970s features Marie-Louise Johnson,

In 2011, when the Dermatology-Rheumatology associate professor of medicine in dermatology, and demonstrates how Clinic was created, the department had to work far dermatology as a specialty has advanced and the greater accessibility through early challenges such as scheduling and offered by telehealth consulting. funding. But the department persisted and when the details were figured out, they set their sights on establishing additional specialty clinics to help more patients in need of highly specialized and multidisciplinary care unavailable in other health systems.

Among the subspecialty clinics are a Vulvar-Dermatology Clinic, a Vascular Anomalies Clinic, a Cutaneous Lymphoma Clinic, a High-risk Skin Cancer Clinic and a Hidradenitis Suppurativa Clinic. The dermatology-psychiatry clinic, the hair disorders clinic and the immunobullous disease clinic opened last year to further broaden dermatology’s patient services, and the Down syndrome clinic is the only one of its kind in the country. There is also a clinic that specializes in gender services, providing laser hair removal and treatment for hair loss and skin conditions related to hormonal treatments for transgender patients. On the horizon is a Neurofibromatosis Clinic that will bring together dermatologists, neurologists, neurosurgeons and plastic surgeons.

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Our specialty clinics represent a leap into modern medicine.”

These clinics serve between 1,500 and 2,000 patients per year, which highlights just how specialized the services are. However, while the volume may be low, the value the clinics provide is very high. The department has committed to serving all of these patients in deeply meaningful ways. For example, the Hidradenitis Suppurativa Clinic cares for patients that few other doctors are willing to treat.

M. Shane Chapman MD, MBA, HS’96-99 Chair, Department of Dermatology

“Our specialty clinics represent a leap into modern medicine,” says Chapman, who notes that the clinics also provide specialized experience for residents in dermatology and other fields. “About 40 or 50 years ago, dermatologists were mostly generalists and just treated everyone who walked through the door.

Now we do that really well in a specialized way with more expertise.”

Dartmouth Health | Geisel School of Medicine Department of Dermatology at Dartmouth Hitchcock Medical Center

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INNOVATING TREATMENT Matthew Hayden, MD, PhD, studies how CRISPR technology can be used to detect certain DNA sequences at the point of care, allowing doctors to more quickly diagnose and treat dermatological conditions.

Basic science research in the Department of Dermatology at Dartmouth Hitchcock Medical Center (DHMC) Department of Dermatology may not be part of clinical patient care, but it is no less important. Developing new technologies and treatments for dermatological conditions in the lab translates to better patient care, now and in the future.

“We call it ‘from bench to bedside,’” says M. Shane Chapman, MD, MBA, HS’96-99, chair of the department. “If I have a problem with a patient, I can ask one of our scientists if they can help. If they can, I’ll bring it back to the bedside.”

Read on to learn more about several of the research projects underway in the Department of Dermatology.

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CRISPR technology Matthew Hayden, MD, PhD, the vice chair of research, is collaborating with Excision BioTherapeutics and Alexandra Howell, PhD, at the Veterans Affairs Medical Center to study how CRISPR technology can be used to treat incurable viral infections. CRISPR uses guide RNAs (gRNA) to identify a specific sequence of DNA within a cell and then alters that gene, which can, for example, eliminate a lifelong virus such as HIV. In addition to studying CRISPR in the HIV space, Hayden is working to develop this technology as a diagnostic tool to detect specific DNA or RNA sequences at the point of care. This information will help doctors diagnose and quickly determine appropriate

PHOTO BY: MARK WASHBURN

DEPARTMENTAL RESEARCH AIMS TO IMPROVE DERMATOLOGY CARE

tissue immediately, if treatments for a variety needed. An AI augmented of dermatological surgical workflow allows conditions. Hayden and One of the most rewarding pathologists to more Brian Simmons, MD, easily and rapidly analyze HS’17-20, are developing aspects of this work has been 100% of the removed methods for the rapid the fantastic science done by tissue, rather than only detection of fungal about 1% to 2% using infections. Simmons medical and undergraduate traditional excision earned a research award students. I’m excited to see methods. Mohs surgery of $50,000 from the their continued progress.” results in fewer repeat Dermatology Foundation surgeries and reduced to support this project. recurrence rates—from Another team that Matthew Hayden, MD, PhD about 15% to about 1% for includes Joi Carter, MD, common skin cancers.

MED’05, HS’06-09, and Joshua Levy, PhD, is developing methods to use The benefits provided by 100% real-time margin CRISPR to target the Merkel cell polyomavirus, which assessment can be extended to additional surgical can cause a rare but serious skin cancer. Hayden and settings through AI and automation. Levy says the Jonathan Glass, MD, are developing both diagnostics algorithm is “a stepping-off point for tackling more and therapeutics for HTLV-1. challenging tumor types in collaboration with other surgical subspecialties.” He hopes the algorithm can “These pathogens all have significant genetic diversity, eventually be used for larger, more complex cancers, so first we identify specific genetic sequences that we such as breast or brain tumors. can target. Next, we test a variety of CRISPR tools to see which are best suited for the specific therapeutic Outcome analysis or diagnostic goal,” Hayden explains. “One of the most rewarding aspects of this work has been the fantastic As director of the high-risk skin cancer clinic, Carter science done by medical and undergraduate students. works with medical students and residents to create I’m excited to see their continued progress.” a database of more than 1,000 DHMC patients with squamous cell skin cancer. This database will be used Machine learning to determine which tumor characteristics or patient characteristics are most predictive of outcomes for Levy, in collaboration with Louis Vaickus, MD, PhD, in DHMC patients. the Department of Pathology and Matthew LeBoeuf, MD, PhD, in the Department of Dermatology, has There are a variety of national staging systems available developed an artificial intelligence platform that helps for squamous cell skin cancer that are helpful, but this rapidly assess clinical surgical margins for skin cancer database will allow Carter to provide outcomes specific in real time. The Baughman Scholar Fund, which to the unique nature of the local patient population. originated with Dick and Barbara Couch, is the main source of funding for this project.

“We’re trying to find what our internal recurrence rates and disease-specific mortality are so we can counsel Using the AI algorithm, Levy has created a three-part our patients more appropriately,” Carter says. web application that can be used to increase accuracy and speed in assessing whether and where residual Once complete, the database will aid in identifying tumor remains during Mohs surgery. These tools help the subset of patients with a higher likelihood of technicians, pathologists and surgeons provide more disease recurrence or metastasis so these patients efficient and effective patient care. can be monitored more carefully or treated more aggressively upfront. The database will also allow Carter Used together, these web tools have the potential to and colleagues to identify the patients with low-risk slash the time it takes to conduct an assessment—from squamous cell skin cancer who would benefit from the 30 minutes to less than five minutes. Assessing a least invasive procedures to manage their condition. tumor in real time allows a surgeon to remove more

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Dartmouth Health | Geisel School of Medicine Department of Dermatology at Dartmouth Hitchcock Medical Center

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PHOTO BY: BRITTANY STARK

Current residents (top row, from left): Matthew Davis, MD, HS’20-22; Arthur Marka, MD, MED’20, HS’22-24; Andrew Scripture, MD, HS’20-22; Michael Davis, MD, HS’22-24; and Dhrumil Patel, MD, HS’21-23. (bottom row, from left) Karen Ly, MD, HS’22-24; Gabrielle-Eugenie Duprat, MD, HS’21-23; Jessica Ginsberg, MD, HS’20-22; Kelly Aschenbeck, MD, HS’20-22; Michelle Kim, MD, MED’19, HS’21-23.

RESIDENCY PROGRAM GROWS GRADUATES PURSUE CAREERS IN PRIVATE PRACTICE, ACADEMICS AND LEADERSHIP Every great journey begins with a single step. For the Dermatology Residency program at Dartmouth Hitchcock Medical Center (DHMC), it began with one resident, who graduated in 1950.

Since then, the three-year residency program has grown steadily. One resident per year became two, and now three for a combined total of nine residents.

By the end of academic year 2022, 114 will have graduated. As the number of residents has grown, so has the faculty, which stands at 14.

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Residents have opportunities to hone their skills in forums that range from regional clinics to international partnerships, preparing them for clinical practice, research and academics. When they leave DHMC—or even stay—they are prepared for leadership positions.

Among residents’ regional educational opportunities are DHMC’s 14 highly specialized dermatology clinics that serve patients with rare skin diseases. These settings provide diverse learning opportunities, and without these clinics—and residents—patients may not find the expert care they need.

Additionally, dermatology faculty revamped the curriculum for quality improvement (QI) projects, giving residents better training in designing and implementing QI work.

Residents can carry these experiences forward into either private practice or academic careers.

Residents also have opportunities to present their work regionally, nationally and even internationally. They are able to pursue global health work with department partners in Kenya, India and other countries throughout the world. The pandemic has put these programs on hold, but the department will reignite global health initiatives when it is safe to do so.

And while the focus of the program is for the residents to become exceptional doctors who take good care of their patients, many decide to follow a calling into academics.

“Academics is very different from private practice, and we feel proud of our residents when they do that,” says M. Shane Chapman, MD, MBA, HS’96-99, chair of the Department of Dermatology. “This is a place where you can grow as a clinician and become a leader in medicine, either here or at other institutions.”

The department has a new building designed specifically for dermatology practice, with an expanded Mohs suite and an improved pod system setup for better interactions between staff, schedulers, physicians and residents.

In addition to clinical growth, residents also now have opportunities to train in clinical trials programs and basic science labs.

Looking to the future, Joi Carter, MD, MED’05, HS’06-09, the director of the residency program, wants to inspire more residents to pursue academic careers. “Our preparation for clinical care has always been amazing,” she says. “My future vision is to expand the reach of our academic research.”

To applaud the incredible growth in the Dermatology Department, a reunion gala will be held in July for all past, present and future residents. “We want to celebrate our unified dermatology department,” Chapman says. “We’ll talk about how we started, the good old days, funny stories and where we are going—in long sleeves and hats, of course.”

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I tap into my inner Dr. (Dick) Baughman when confronted with a patient who has been resistant to conventional therapy.

Even if a patient had seen multiple dermatologists, Dr. B could always come up with four or five therapies that hadn’t been tried.”

Diane Hoss, MD, HS’86-89

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During my chief year, Dr. (Marshall) Guill slipped on his stairs at home and sustained a pretty sizable scalp laceration. He called me and asked me to stitch him up. I was so honored that he asked me to do it. I was SO nervous to stitch one of my favorite attending’s scalp, but it came together nicely. For the remainder of my third year, I would discreetly look at his scalp to make sure I had not permanently disfigured him.”

Dartmouth Health | Geisel School of Medicine Department of Dermatology at Dartmouth Hitchcock Medical Center

Joanny Paul, MD, HS’13-16

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PHOTO BY: JEAN HENRY

PHILANTHROPY OUR DEPARTMENT IS GROWING AND WE NEED YOUR SUPPORT

Richard Baughman, MD, HS’60-64, is proud that the Department of Dermatology has become a standalone department at Dartmouth Hitchcock Medical Center.

The Dartmouth Hitchcock Medical Center (DHMC) Dermatology Residency Program is expanding, and your financial support can make a difference in the education and research capabilities of our residents.

The Dermatology Residency Program Fund now supports nine residents and three fellows, making it possible for them to participate in many activities that augment their education. Your donation will support resident participation in: Conferences: These events provide opportunities for researchers to present their posters. The fund offsets the expenses for statistical assessments, airfare, hotel, meals and poster printing.

Research analysis: Statisticians help residents analyze the results of their research, a crucial element in the advancement of medicine. This assistance can cost more than $1,000 per month; the fund supports ongoing resident and statistician collaboration.

Publishing: In our digital age, a journal may accept a resident’s paper and charge a steep fee to publish it. Donations to the fund support the publishing of resident research.

These are only a few examples of how the Dermatology Residency Program Fund fosters Dermatology residents’ education and development.

To discuss making a gift in support of DHMC dermatology residents, contact Dorothy Behlen Heinrichs, the director of Patient and Family Giving, at Dorothy.B.Heinrichs@Hitchcock.org or 203-257-2689.

A GIFT FROM RICHARD BAUGHMAN Richard (Dick) Baughman, MD, HS’60-64, an emeritus professor of Dermatology, made a bequest of $25,000 in his will for two reasons: to show his gratitude and to advance the future of the Department of Dermatology.

He hopes other graduates—and anyone who values dermatology education—will join him in supporting the department in their gift planning.

“I am so grateful to the dermatology program at DHMC for the education I received,” Baughman said. “I wanted to make a pledge to show the importance of the whole specialty program within the medical center and achieving recognition for what we have accomplished. I encourage other graduates, faculty and potential donors to contribute to the future of the department like I did.”

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I am so grateful to the dermatology program at DHMC for the education I received.”

Richard (Dick) Baughman, MD, HS’60-64

Dartmouth Hitchcock Medical Center DEPARTMENT OF DERMATOLOGY

One Medical Center Drive, Lebanon, NH 03766 dartmouth-hitchcock.org

Designer: Linnea Spelman

Writer: Ashley Festa