My Untold Journey to Dermatopathology

My beauties, I’M BACK – as an official board-certified Dermatopathologist! I know, it’s been a while since the last episode and that’s because these past months have been a whirlwind, to say the least. As I mentioned in Episode 43, I went through a cross-country move back to my hometown in Cleveland, Ohio. Then, I spent some good family time for a bit right before preparing for and taking (and passing!) my last board-certification examination three weeks ago! 

With that, I’ll share with you the story of my recently completed Dermatopathology journey today. 

Special Thanks to You

Before anything else, however, I would like to thank you. Thanks so much, my beauties, for staying on this journey with me. Thank you for patiently waiting for new episodes (I know there’s been wide gaps between some of them). BUT I assure you, I’ve brought back better knowledge and skills to continue developing my (science-backed) beauty advice as your go-to Dermatologist! 

A ton of value – this is what I’m SO excited to give you now that the podcast and blog schedules are back on track. Each episode is made special for all of you Superwomen who continue to follow The Dr. Nikoleta Show!

What Dermatopathologists Do 

With this new development in my career, you might be thinking, “What else does Nikoleta do now, aside from her Dermatologist work?” or “What does a Dermatopathologist actually do?”  Let me explain. 

A board-certified Dermatopathologist is a medical doctor who specializes in both Dermatology and Pathology, combined. Their most integral trait is their ability to accurately diagnose skin, hair, and nail diseases – especially ones whose pathology needs examination. 

The sheer number and variety of skin disorders (more than 1500 of them) – ranging from rashes to tumors – is one of Dermatopathology’s greatest challenges. This is why, despite Dermatologists’ expertise on diseases’ appearances, anatomic distributions, and behavior, conclusive diagnosis is impossible to accurately come to from these three factors alone sometimes. For that, they need to take a skin sample to be examined by a Dermatopathologist. 

By the end of their training, Dermatopathologists will have grown to be uniquely attuned to rare and common manifestations of skin, hair, and nail diseases. 

It works this way: for every medical specialty, a pathologist works in the field to diagnose diseases (outside of the main physician’s specialty) and help provide insight on patient care as needed. For Optometry, they have Ophthalmic Pathologists who study eye tissues retrieved by Ophthalmologists. For Dentists, on one hand, they have Oral Pathologists who study the pathology of diseases of the teeth, gums, and other parts of the mouth. In my field – Dermatology – we have Dermatopathologists to provide precise diagnoses and treatment advice for skin, hair, and nail diseases.  

Dermatopathologists have definitely mastered such a unique and integral skill. Dermatopoathologists will save patients time and money through offering reliable clinical, pathological correlation and give up-to-date and detailed suggestions for diagnostic testing. 

This expertise in Dermatology and Surgical Pathology – Dermatopathologists study for this for around 13 years or more, as I have. Here’s a breakdown of my years of study towards becoming a board-certified Dermatologist AND Dermatopathologist:

• 4 years – College (2-year accelerated Bachelors of Science Program and Double-Major  in Biology and Combined Sciences) 
• 4 years – Medical School (Doctor of Medicine degree)
• 1 year – Internship in Internal Medicine
• 3 years – Residency in Dermatology
• 1 year – Fellowship Training for Subspecialty (Dermatopathology)

During the Fellowship, we took two in-service exams where they assessed our knowledge and measured if we’re up for taking the final Board Certification Exam. The Boards Exams are administered by the American Board of Pathology in the Fall – I took mine this past September. Now I’m a board-certified Dermatopathologist, I can keep my certification for up to 10 years as long as I continue my clinical work and maintenance of certification requirements.

I know I keep saying “they” in reference to Dermatopathologists – I just haven’t gotten used to being called one yet. It really is a dream come true, from 13 years of hard work. So, let me tell you how my day-to-day Dermatopathology Fellowship in Galveston looked.

Story Time: My Dermatopathology Fellowship

It’s finally time to share my Fellowship with you since I’ve already shared much about my Dermatology Residency journey. Unlike the Residency which ran for 3 years, my Dermatopathology Fellowship in Galveston, Texas only ran from July 2020 to June of 2021. It wasn’t any less busy, however, if not busier. Intense – that’s how I’d describe that whole year. 

The experience was definitely made easier by my co-fellow, however. Since he was a Pathologist (who also went through another Fellowship for Surgical Pathology), he had answers for my questions on tissue examination and all things Pathology. As someone with a background in Dermatology, he asked me all the clinical questions about the hair, skin, and nails in return. We supported each other throughout the year – it felt great, living with that kind of camaraderie. 

I absolutely loved all of my teachers – the Dermatopathologists who I worked with – they’re incredible as well. Aside from being excellent in teaching, they made it their mission to help us too. They were all around very nice people. All these people certainly helped make my Fellowship strong – preparing me for the real-world demands for Dermatopathologists.

One way they equipped me was by making me study as many slides as  I can throughout the year – because that is how you get better. The more slides you read of various biopsy specimens, the better you’ll do during the Board Exams and beyond. Unlike in Residency where there’s more study time, the Fellowship’s focus was more on getting us to encounter various kinds of skin, hair, and nail diseases in slides day-to-day. 

My mornings (8am-12nn) were composed of reading the private practice Dermatopathologist slides. My co-fellow and I would actually preview the slides the day before – all 160 of them – and split them to about 80 for each of us. Our duty was to put down our diagnosis for whatever disease we think is in each slide. The following morning, we would review it, and officially sign them out with our Dermatopathology attending who is a Pathologist, Dermatologist, and Dermatopathologist (awesome, I know!) who has a private practice with so many slides. 

After signing out cases in the morning, we’d then preview the cases for the afternoon during our lunch hour. From 1:30pm to around 5 or 6pm, we’d be signing out cases with another university Dermatopathologist. We usually encounter more complex cases – basically more on soft tissue (e.g., a variety of severe Dermatological rashes) – during the afternoon. These are different from the usual morning cases of bread-and-butter Dermatology composed of Tumors and Skin Cancers. 

Daily – depending on the day – we read around 300 to 400 slides. We either previewed them all or we sat and read them out with the Dermatopathology attending. All this exposure to different biopsies and building a familiarity for the many Dermatopathological diseases built my Dermatopathology foundation strongly. The more cases I encountered, the faster, more efficient I got in diagnosing and giving my opinion on everything pertaining to the cases.

All in all, I absolutely enjoyed my entire fellowship year. I even got to have a few couple of months to prepare for the Boards – it was immensely helpful since during the Fellowship itself, there’s little time to spare outside studying slides. For that, and for everything (and everyone) in the Fellowship – I fared well with the exams. 

Why (and When to) Choose Dermatopathologists 

Now that you know the kind of training that I went through before becoming a board-certified Dermatopathologist, let me clear up everything about the services we provide.

First of all, us Dermatopathologists work very closely (and this is key) with dermatologists and clinicians who are taking the biopsies. As I mentioned above, Dermatopathologists provide a closer look for the Dermatologist – giving specific and accurate diagnoses by examining samples under a microscope. 

Simply put, us Dermatopathologists can explain to you certain characteristics about your disease that a dermatologist may not be able to explain. As discussed, we often save patients time and money by getting to the exact nature of their disease – allowing more focus on treatment procedures than diagnosis. 

Cases when our special expertise in skin pathology are especially valuable include:

• Distinguishing benign pigmented lesions (from Melanomas)
• Distinguishing Atypical Nevi (irregular moles)
• Distinguishing different benign Tumors of follicles or sweat glands that could resemble Skin Cancer
• Distinguishing benign Vascular Lesions
• Distinguishing among Rashes (e.g., Eczema, Psoriasis, Lichen Planus, Drug Eruptions, etc.)

There’s an entire list of both Non-Neoplastic Dermatopathology (Non-Skin Cancer) cases and Neoplastic (Skin Cancer and Tumors) cases.

It All Paid Off

This is the end of my 13-year journey AND the beginning of my life as a Dermatopathologist. I am beyond thrilled – as well as humbled and grateful to every single year I spent studying. Of course, I couldn’t have gotten here now without my mentors and all the good people I’ve met all throughout. I’d like to extend my gratitude to each of them. 

All my hard work from the MCAT to a 2-year accelerated Bachelor of Science program to double majoring in Biology and Combined Sciences. To then completing a year of Dermatology research to 4 years of medical school in California. To then publishing 20 Dermatologic peer-reviewed articles followed by a 1-year internship in Internal Medicine and then 3 years of Dermatology Residency and finally, a whole year of Dermatopathology Fellowship. All of my 16,000+ hours of patient care – all the time I spent on pursuing my dream – it all paid off. 

The future waits for me and you (whose skin, hair, and nail needs I’ll always be there for) – let’s head forward! Again, thank you for coming with me on this journey. 

My Wins are Your Wins Too

This huge milestone I recently achieved means a huge leap for The Dr. Nikoleta Show (a.k.a. my service to you) too! Let me remind you that this goes for all and any milestones I achieve – whatever knowledge and skills I add to my existing Dermatologic arsenal, I’ll make sure you reap the results of them too. Better information, better advice, better YOU. 

So, my beauties, let’s take this healthy skin journey to the next level. I’ll bust myths, provide clear skin, hair, and nail care roadmaps, and make sure we’ll smoothly cruise along this path to a healthier YOU. Let’s go? 

Would you love more health and beauty advice from your go-to board-certified Dermatologist? I’m now accepting waitlist applications for the first round of The Healthy Skin Blueprint!

Also, if you forget to apply your sunscreen in the morning, or totally forget to wash your face and apply retinol and night cream at night, text “PODCAST” to 480-530-8187 to get skincare routine reminders and healthy skin affirmations directly from me.

If you enjoyed this episode, be sure to let me know on Instagram! You can tag me, @drnikoleta, with a screenshot of the episode and your greatest takeaways. I’d also really appreciate it if you would subscribe and leave a five-star rating on Apple Podcasts — that helps us share the podcast with more people like you who are looking to achieve the skin of their dreams! 

Until next time, Step Out with Confidence® and never give up on your dreams – no matter how massive they seem to be!

Dr. Nikoleta