|
|
ASDP's History
The history of the organization is best described in the following
article:
Reprinted from the Journal of Cutaneous Pathology with
permission from the publisher, Munksgaard. J Cutan Pathol 1993: 279-287,
© Munksgaard 1993
In Memoriam: The author of this article, Robert G. Freeman, MD,
passed away October 19, 2007, in Dallas, at age 80. Dr. Freeman was an
honorary member of ASDP, and served as president in 1979. He spent his
career teaching in the departments of dermatology and pathology at the
University of Texas Southwestern Medical School, and Baylor University
College of Medicine, where he also earned his MD. Later, Dr. Freeman
served as ASDP historian. He is survived by sons David and Mark,
daughters Angie and Sara, and six grandchildren.
Special Article
The American Society of Dermatopathology. The First 30 Years
By: Robert G. Freeman, MD*
*Historian, American Society of Dermatopathology, on the occasion of
the thirtieth anniversary of the society.
The American Society of Dermatopathology (ASD) is 30 years old!! The
original group of nine men, consisting of members of the Committee on
Pathology of the American Academy of Dermatology (AAD) and a few invited
dermatopathologists met to organize a society exclusively for
dermatopathology on a Tuesday afternoon, December 2, 1962, while at the
annual meeting of the AAD. The members of the Committee on Pathology and
others elected as the first Officers and committee chairmen of the new
ASD became the founding members. Two days later, they met again and
adopted a constitution and bylaws establishing the ASD. During 1963
other interested persons were added as charter members. The first
scientific meeting with 45 attending was held on Tuesday evening during
the 1963 AAD meeting. This was a small but significant beginning.
Prior to the establishment of the ASD, the major forum for the
presentation and discussion of anything new in dermatopathology was in
the dermatopathology courses and the Clinicopathologic conference (CPC)
of the AAD. These are still significant forums for discussion of
dermatopathology topics, but, increasingly, discussion of new topics and
innovations shifted to the ASD. Initially the two societies remained
closely linked and the programs were held concurrently. However, the AAD
administration at that time was not enthusiastic about concurrent
society programs that might detract from their own meeting; and the ASD
was allowed to meet only in the evening and only at a time that did not
interfere with scheduled AAD scientific or social functions – thus
the initial meetings on Tuesday evenings preceding the Wednesday
CPC.
Roots of the Society
Dermatology and pathology have always been linked closely. Some of
the earliest treaters of skin disease were pathologists who had already
learned the skills of careful observation and analysis of morphological
data that make up the core of work of both specialties. Discovery of
aniline dyes and development of histological techniques allowed the
application of histopathology to the study of skin diseases at an early
period in the evolution of dermatology. In fact, dermatopathology was,
for a period, the "cutting edge" of dermatology, much as immunology, and
now molecular biology are today. Dermatopathology as an early area of
interest to dermatologists is also attested to by the textbooks on the
subject such as those written by Simon (1848), Unna (1894), McCarthy
(1931), Lever (1949; through eight editions), and others. Topics in
dermatopathology were presented at various meetings such as the American
Dermatological Association (ADA) from its inception in 1876. With the
establishment of the AAD in 1938, regular sessions on dermatopathology
were held in the form of Courses and the CPC. The major dermatological
teaching centers often had dermatopathologists on their staff. But at
this point, it is not intended to review all the dermatopathologists who
contributed to our early teaching and knowledge. They built a foundation
for dermatopathology but most did not make a direct impact on the
ASD.
| Table 1. Past
Presidents. |
| Hamilton Montgomery, M.D. |
1963 |
| Hermann Pinkus, M.D. |
1964 |
| Elson B. Helwig, M.D. |
1965 |
| Herman Beerman, M.D. |
1966 |
| Herbert Z. Lund, M.D. |
1967 |
| Francis Ellis, M.D. |
1968 |
| Walter F. Lever, M.D. |
1969 |
| Daniel F. Richfield, M.D. |
1970 |
| Walter R. Nickel, M.D. |
1971 |
| Louis H. Winer, M.D. |
1972 |
| John R. Haserick, M.D. |
1973 |
| Alvin J. Co, M.D. |
1974 |
| Edward P. Cawley, M.D. |
1975 |
| James H. Graham, M.D. |
1976 |
| Richard K. Winkelmann, M.D. |
1977 |
| George Ioannides, M.D. |
1978 |
| Robert G. Freeman, M.D. |
1979 |
| Mark Allen Everett, M.D. |
1980 |
| Robert W. Goltz, M.D. |
1981 |
| Amir H. Mehregan, M.D. |
1982 |
| John T. Headington, M.D. |
1983 |
| Martin H. Brownstein, M.D. |
1984 |
| A. Bernard Ackerman, M.D. |
1985 |
| Kurt S. Stenn, M.D. |
1986 |
| Ken Hashimoto, M.D. |
1987 |
| Waine C. Johnson, M.D. |
1988 |
| Ronald J. Barr, M.D. |
1989 |
| Loren E. Golitz, M.D. |
1990 |
| Evan R. Farmer, M.D. |
1991 |
| Beno Michel, M.D. |
1992 |
Some of the more notable dermatopathologists who were active in the
AAD just preceding the founding of the ASD were men like Dr. Fred
Weidman of Philadelphia, Dr. Marcus Caro of Chicago, and the founding
members. Dr. Herman Beerman of Philadelphia then, and for 17 years, was
chairman of the CPC. During this era anything new and significant in
dermatopathology would almost certainly be presented at the CPC. Dr.
Montgomery was still active at the time of initiation of plans for a
society of dermatopathology. In fact he was the chairman of the
Committee on Pathology of the AAD that initiated the discussion of such
a society; he was very active in the organization of the organizational
meetings in 1962 and was elected as its first president. I clearly
recall Dr. Montgomery standing in the foyer of the 4th floor of the
Palmer House in 1963 with the master list in his hand discussing and
adding names of potential charter members.
The first official meeting of the ASD took place December 2, 1962, at
a meeting of the committee on Pathology in which Dr. Montgomery
presided. Other members of that committee were Drs. Herman Beerman, John
R. Haserick, Arthur B. Hyman, Walter F. Lever, Walter R. Nickel, Louis
H. Winer, and Marcus R. Caro. However, Dr. Caro had died in May 1962.
Drs. Beerman and Haserick were recorded as absent from this first
meeting; and Dr. Elson Helwig and Dr. Hermann Pinkus were invited to
attend. At this meeting the decision was made to establish a society of
dermatopathology, and a second meeting was scheduled two days later.
Prior to this first meeting of the ASD, there must have been informal
discussions about the organization of a society for dermatopathology to
prompt the calling of such a meeting. At the second meeting two days
later a constitution and bylaws already were prepared for approval,
indicating prior preparation. Between 1975 and 1984, I attempted to
interview as many of the founding members as possible about the source
of the idea and the planning for the ASD. Very few details about the
origin of the idea were forthcoming; and most of those interviewed said
they did not recall whose idea it was or how the planning came about.
Dr. John Haserick, who did not attend the first meeting, distinctly
recalls suggesting the idea of a society. Perhaps his suggestion was
made a year or two prior to the first meeting in 1962.
There is little doubt, however, that Dr. Montgomery was the key
organizer, supported by the other members of the AAD Committee on
Pathology and other founding members, all of whom were active in AAD
teaching of dermatopathology. The Committee on Pathology in 1961
included Drs. Montgomery, Beerman, Caro, Haserick, Lever and Winer. The
Instructors in the Histopathology Special Course in 1961 were Drs.
Winer, Nickel, Helwig, Beerman, Lever, Samuel W. Becker Jr., and David
W. Kersting. At the CPC, Dr. Beerman was the moderator, and Drs. George
W. Binkley, Grier F. Starr, Hyman, and Lever were presenters. Consulting
panel members included Drs. Becker, Cawley, Ellis, Fasal, Ginsberg,
Goltz, Helwig, Kersting, Knox, Lockwood, Lund, Mescon, Montgomery,
Nickel Pinkus, Richfield, Stoughton, Szymanski, Wilson, Winer, and Wood.
This list includes most of the names of prominent dermatopathologists of
that era on which a new society could depend and from which its
membership developed.
The decision to organize a society of dermatopathology was not
unanimous. At least one, and probably two individuals attending the
first two meetings expressed the idea that such a society was not
necessary and would likely fail. But once the decision was made to
organize, all of the attendees supported the action, and those early
objectors later served as presidents of the new society (Table 1).
The dermatopathology activities in the AAD during this era consisted
primarily of the courses in dermatopathology, given on the weekend of
the annual meeting, and the CPC, held on Wednesday each year. These were
the main forums for the presentation of anything new or different in
dermatopathology. The only other existing regular forums in
dermatopathology at that time were the Zola Cooper Seminar, organized in
1953 by Dr. James Burks to meet annually with the Southern Medical
Association, and the Dermatopathology Seminar, held annually at the
meeting of the Pacific Dermatological Association. These sessions still
are held regularly, but with the organization of the ASD, the shift of
emphasis and prestige to this new forum began and has increased steadily
since.
| Table 2. Past
secretary-treasurers. |
| Walter F. Nickel, M.D. |
1963-1969 |
| James H. Graham, M.D. |
1970-1974 |
| Robert G. Freeman, M.D. |
1974-1977 |
| John T. Headington, M.D. |
1978-1981 |
| Kurt S. Stenn, M.D. |
1982-1984 |
| Loren E. Golitz, M.D. |
1985-1988 |
| Antoinette F. Hood, M.D. |
1989-1992 |
Initially, the governing body of the ASD, as specified in the bylaws,
was the Executive Committee composed of the AAD Committee on Pathology
and the chairmen of standing ASD committees. Thus the ASD grew out of
and was sustained by the existing leadership in dermatopathology. It
became clear, however, that this composition of the Executive Committee
was improper, creating a conflict of interest between the two
organizations, and putting the ASD at the mercy of the officers of the
AAD by virtue of appointment powers of the AAD President to the
Committee on Pathology. This error was recognized by 1970 and was
corrected by changes in the bylaws approved in 1974 at the time of the
incorporation of the ASD as a non-profit educational corporation. Dr.
James H. Graham, the second secretary-treasurer (Table 2), was the prime
mover for these changes and for the incorporation. Since 1974, the
Executive Committee, still the governing body of the ASD, has consisted
of the elected officers, chairmen of the standing committees, and the
three past presidents, with no relationship to the AAD.
Although the ASD grew out of the AAD, and its leaders often were also
leaders in the AAD, the relationship between the two was not always
harmonious. The AAD administration was not at that time enthusiastic
about any societies associating themselves with their annual meeting,
apparently because they felt this would detract from the meeting and
divert interest and support from the AAD. Perhaps this protective
attitude derives from the same source that had the academy meet in
Chicago each December where there would be nothing else to do and no
other place to go but to the meeting. At any rate, for about the first
15 years of its life, the ASD was not allowed to meet in conflict with
any scientific or social functions of the AAD.
When the ASD decided to meet on Friday beforehand, the AAD would not
change the time of the Wednesday CPC meeting to coordinate with the ASD
meeting. Thus dermatopathologists had to stay at the meeting from
Thursday thorough the following Wednesday to participate in both
sessions. Very few dermatopathologists could stay away from their
teaching and diagnostic work for that long. This condition, as much as
anything else, probably led to the decline of the CPC in the 1960s and
1970s. Moreover, the ASD was frequently excluded from the major hotels
reserved by the AAD. As a result, the ASD meeting initially was held on
Tuesday evenings prior to the Wednesday CPC, or on Thursday afternoon
after the end of the AAD meeting. At these early meetings, the
attendance was poor, some people had already gone home, everyone was
tired after a week of meetings and the discussion was not very
active.
Later, the meetings were moved to the Friday preceding the AAD
meeting, with better results, except that some members still could not
arrive early for the meeting and stay for the AAD meetings too. Often
the meetings were in other hotels, such as the Balmoral Hotel adjacent
to the Americana Hotel in Bal Harbour, Fla., or near the Palmer House at
the University Club in Chicago, courtesy of Dr. Fred Szymanski. Twice
the meeting was held in separate cities.
Growth of the Society
After a few lean years, the significance of and support for the ASD
began to be recognized. The need for an identity for dermatopathologists
was increasingly obvious as an academic forum as well as a need for
definition of the subspecialty for certification, relicensure, and
accreditation and other intrusions by third parties; which need also
prompted the establishment of the special competency Board Examination
for Dermatopathology in 1973.
The Initial Concept
The initial concept of the ASD, as explained by Dr. Walter Nickel,
its secretary-treasurer for the first seven years, was to maintain a
small relatively exclusive group of physicians who were intensely
interested in and actively practicing the subspecialty. The concept of a
small group was to encourage free discussion at the meetings at which
everyone was known. This was a format dear to the heart of Dr. Nickel
and others; although it may not have been shared by all the early
members. It is clear that these ideas were incorporated in the
organizational structure of the society in the form of (1) mandatory
attendance at least once every three years to maintain membership in the
society, and (2) a limit of 125 fellows in the society, creating an
exclusive category of membership. The attendance requirement was
unpopular with some members, especially pathologists, who might not plan
to attend the academy meeting. Before his death, Dr. Nickel told me that
he was disappointed that these principles had not been maintained, and
that he thought the organization had grown to be too big and was no
longer any fun. By this time, there was pressure to shorten the time of
presentation and discussion of papers in order to include as many papers
as possible on the Friday program, and free discussion was inhibited. At
any rate, Dr. Nickel served the society well, and deserves a major share
of the credit for its survival and early growth and for initiating
innovative programs. Later, bylaw changes eliminated these restricting
principles after it became obvious that the specialty was growing
rapidly and that the ASD would need to grow and change to meet the needs
of a membership of more than 700 plus the trainees wishing to attend the
meeting. Today the membership totals 909, including 106 international
members.
Related Organizations
American Academy of Dermatology
The AAD has established relationships with several related
organizations. The growth of the ASD out of the AAD already has been
recounted, as has the administrative separation of the ASD from the
Committee on Pathology of the AAD. As the AAD developed a permanent
staff and offices, affiliated organizations were welcomed to meet at the
time of the annual meeting of the AAD, and in the early 1980s, their
offer to provide administrative services for the ASD was considered but
was declined. The annual meeting of the ASD has been held with the AAD
meeting every year except 1975 when the ASD met at the Hotel Del
Coronado in California, and 1976, at the Mayo Clinic, Rochester, MN.
These 20 separate meetings which I helped arrange as secretary-treasurer
were the result of thinking among some of the members that the ASD might
better serve both dermatology and pathology members and might grow
stronger and more independent with separate meetings. But separate
meetings were not universally popular, and in 1976 a poll of the members
showed that most favored meeting with the AAD for convenience, economy
of travel and the opportunity for trainees to attend both meetings. The
only other recorded suggestion for a separate meeting was made in 1968
by Dr. Nickel, the secretary-treasurer, whose proposal to meet in the
Bahamas was rejected.
International Academy of Pathology
At the suggestion of Dr. James Graham, one of my first actions
as secretary-treasurer in 1975 was to contact the officers of the
International Academy of Pathology (IAP) to inquire about the
possibility of establishing a relationship with that organization by
holding an annual joint session on dermatopathology at the time of their
annual meeting in March. They first proposed joint sponsorship of a
dermatopathology session at the International Congress of Pathology.
This session, organized and moderated by Dr. Waine Johnson, was held in
Washington, D.C., in October 1976. The first combined meeting with the
IAP consisted of an afternoon session on "Cutaneous Vasculitis"
organized by Dr. Richard K. Winkelmann and myself and held in Toronto in
March 1977 with about 250 pathologists in attendance. This was
considered highly successful, and joint meetings with the IAP have been
continued since. Later, a group of pathologist-dermatopathologists
meeting as the Dermatopathology Club at the same time as other pathology
organizations held joint meetings with the society and the IAP for
several years in the 1970s and eventually merged, with the group meeting
with the IAP.
Intersociety Pathology Council
In 1973, the ASD agreed to send a representative to meet with
representatives of other pathology organizations at the meetings of the
Intersociety Pathology Council, recognition by pathologists that the ASD
represented a significant segment of pathology. At this time
negotiations were ongoing to establish a mechanism for board
certification in dermatopathology. The ASD secretaries or other
designated pathologist representatives have attended many of the
biannual meetings, and report back to the ASD Executive Committee on any
events of interest to dermatopathologists.
American Medical Association
In 1975, the annual meeting of the ASD was the site of
inspection by AMA representatives with a view to approving the program
for Continuing Medical Education. This meeting was held at the Hotel Del
Coronado, Calif. It was the first two-day meeting of the society and the
meeting at which the first self-assessment course was held under
direction of Dr. Walter Nickel and his colleagues from Southern
California. The application was approved by the AMA, and the ASD has
been accredited for CME ever since. Incidentally, one of the AMA
representatives applied for membership in the ASD the next year.
American Registry of Pathology
The American Registry of Pathology (ARP) was established by
Congress as a civilian organization to interface with the Armed Forces
Institute of Pathology (AFIP) and the various registries of pathology
maintained there. In 1976, the ASD voted to make an annual donation of
$1,000 to the ARP and to join the AAD as co-sponsor of Dermatopathology
Registry since 1938, a relationship fostered by Drs. Weidman, Montgomery
and Col. J. Ash of the AFIP. Through this relationship the AFIP
established a repository for dermatopathology slide sets, and provided
these sets for enrollees in the AAD courses on histopathology of the
skin. These courses and slide sets were organized in four courses:
Course 1, Inflammatory Dermatoses; Course 2, Granulomatous Dermatoses;
Course 3, Nevi and Neoplasmas; and Course 4, Reticulo-endothelial and
Alterative Dermatoses. Anyone teaching dermatopathology at the AAD in
the 1950s and 1960s probably used this course material. Such sets are
still available, and the AFIP later also became a repository for slide
sets generated in conjunction with the self-assessment courses initiated
by the ASD in 1975, and incorporated for the first time in the AAD
program by Dr. James Graham in 1976. In 1950, the Osborne Fellowship was
assigned to the AFIP under the supervision of Dr. Elson B. Helwig,
director of the Dermatopathology Registry. In 1977, the Osborne
Fellowship was transferred by the AAD to the Dermatology Foundation to
support research projects, but the AAD continues its support of the
Dermatopathology Registry.
American Board of Dermatology and American Board of
Pathology
In 1970, the society approved a resolution to request the two
above-named boards to consider provision for Subspecialization in
Dermatopathology. In 1971, Dr. Robert Goltz reported that the American
Board of Dermatology had proposed such a move to the American Board of
Pathology but had received a cool reception. Negotiations were
continued, however, and by 1972 a joint Committee for Special Competence
in Dermatopathology had been established with three members from each
Board. In 1973, an agreement was reached for joint certification, and it
was approved by the American Board of Medical Specialties.
The first examination for Special Competence in Dermatopathology was
held in 1974 in Washington D.C., and in the same year a Residency Review
Committee for Dermatopathology was organized to review and accredit
training programs in Dermatopathology. Initially formal fellowship
training in dermatopathology was not required to qualify for the
examination. Dermatopathologists already in practice were permitted to
claim practice time to qualify, but everyone was required to take the
examination to receive this certification. The occasion of the first
examination was an impressive sight with names such as Lever, Pinkus,
Nickel, Winer, Helwig, etc., on the list. Even the members of the Test
Committee were required to take an examination, which they did by
quizzing each other in a separate room. This examination went
uneventfully for most, although quite a few people were nervous about
being embarrassed by taking the examination. A few individuals had
problems; for example, Dr. Winer was assigned alphabetically to sit at
the back of the large meeting room, He could not see the screen when
Kodachromes were projected, but he was not allowed to move closer to the
screen. Instructions had been sent out that one might need binoculars to
see the screen!
In 1982, it was announced that a candidate for certification in
dermatopathology must complete a residency in either pathology or
dermatology before taking a fellowship in dermatopathology and that at
least one year of fellowship training in an accredited program in
dermatopathology would henceforth be mandatory before the candidate
would be allowed to sit for the examination for Special Competence in
Dermatopathology. These committees for dermatopathology examination and
for residency review remain active to the present time. They are
assisted in the preparation of questions by a test committee for
dermatopathology with three members from each specialty.
Dermatopathology board certification became a requirement for membership
in the ASD.
The Scientific Program
The first scientific program of the American Society of
Dermatopathology met December 3, 1963, at 4:30 p.m. for two hours with
four speakers, all on the subject of "Melanoma." There were 45
attendees. The printed program covered half a page of paper, triple
spaced. In 1991, the scientific program extended over 2–1/2 days
with 15 sessions lasting a full day or a half-day, with as many as five
sessions running simultaneously, and with more people attending any one
session than had attended the first session in 1963. The printed program
was a slick preprinted bound booklet with 166 pages and a multicolored
cover. Many changes have occurred in the past 30 years!
A Beginning
The first scientific program of the society was held on Tuesday
afternoon, 4:30 p.m. to 6:30 p.m., December 3, 1963, in Private Dining
Room #18 of the Palmer House in Chicago. Dr. Herbert Lund was appointed
the first chairman of the Committee on Program and Research; however,
since he was committed to a heavy workload at homes, the next committee
member in line, Dr. Richard K. Winkelmann, planned the first program and
is listed as the moderator. The program began with a short presidential
address by Dr. Montgomery, then the subject of the rest of the program
was "Melanoma" and the speakers were Drs. Helwig, Haserick, T.
Fitzpatrick and A. S. Zelickson.
The same format was followed in 1964 on "Epidermal Malignancy" and in
1965, with presentations by five different speakers on subjects of their
choice. The Tuesday afternoon format with invited speakers continued
through 1967. In the 1967 program, Dr. Winkelmann reviewed the
highlights of the 78 cases presented at the Pacific Dermatological
Association's dermatopathology Seminar. In 1968, the meeting was held at
the University Club, Chicago, and it included five speakers and a review
of Pacific dermatological cases by Dr. Herbert Lund and Zola Cooper and
seminar cases by Dr. James Graham. For the first 15 years of the
society, most of the details were dealt with by the secretaries, their
personal secretaries, and their spouses. The society is indebted to Mona
Nickel, Helen Winer, Ann Graham, Lila Freeman and others for their
assistance with registration, record keeping, planning for banquets,
prevention of gate crashing at the banquets, and endless other details
required to make the meetings as successful as possible.
From 1969 through 1972, the meeting was held on the Friday preceding
the academy meeting, allowing more time for the session. The program was
composed of about 15 submitted papers by different speakers. All papers
submitted were accepted. In 1973 and 1974, the meeting was moved back to
the Palmer House and held on Wednesday evening and Thursday afternoon
after the academy meeting. During these years, the scientific program
consisted of a presidential address and submitted papers entirely. A
business meeting was held, usually after lunch, and then the papers
resumed. An evening banquet was being held by this time. Also by 1973,
the program, for the first time, had expanded beyond one page; it
consisted of six mimeographed pages stapled together giving the meeting
schedule, the agenda for the business meeting, and a listing of the
committees and the past presidents. By 1974, enough papers were
submitted to the Program committee to fill the program time and allow
selection of topics, with rejection of two or three papers. The
abstracts were always reviewed anonymously by the committee members, and
their ratings were compiled by the Secretary. Rejections at that time
had been unheard of and some of the rejections led to protests and even
a proposal that each member be required to present a paper every three
years. During these years, many of the abstracts submitted were single
ones by individuals, but the program was supported strongly by four or
five abstracts every year from the training programs of Dr. Winkelmann
and Dr. Bernie Ackerman.
The Self-Assessment Course
In 1975, the scientific meeting was moved permanently to Friday
preceding the academy meeting. In this year the first major expansion of
the scientific program to two days was achieved with the presentation on
Thursday of the first self-assessment course and with submitted papers
and business meeting on Friday. The self-assessment course was conceived
by Dr. Walter Nickel who also helped arrange for the meeting to be held
in the Hotel Del Coronado in Southern California, preceding the AAD in
San Francisco. The format for the first self-assessment course was
essentially the same as today. Participants reviewed unknown microscopic
slides using individual microscopes in the morning, and those same cases
are discussed by several discussants in the afternoon. At the first
course, Dr. Nickel was assisted by Dr. Louis Winer, Dr. James Graham,
Dr. William Reed, Dr. James Nickel, and Dr. Joe Wood. Mr. Gary Nickel of
Micro-Optics Co. provided 75 Olympus microscopes for the session. The
cases selected were randomly chosen to include a variety of cases from
daily practice, with no topical emphasis. Thus the participants were
able to gauge their individual performance against the panel of experts.
The 75 available microscopes were fully utilized, and a few individuals,
including a contingent of Australian dermatologists, were only allowed
to sit in on the afternoon discussion.
This program was very successful, and this format has remained
extremely popular. It has remained a regular feature of the annual
meeting for 17 years, and recently three sessions have been required. It
was adapted for the AAD meeting in 1976 by Dr. Graham and the format has
been adapted for other dermatopathology courses since.
The similarity of the formatting of this program to the formatting of
the 1974 examination for Special Competence in Dermatopathology is
striking. That examination was conducted according to the standard
format of the microscopic practical examinations given each year by the
American Board of Pathology. It was first experienced by dermatologists
at the 1974 examination. It is almost certainly the source of Dr.
Nickel's idea for the session.
The Special Courses
The Friday scientific session of submitted papers has continued to
be well attended, and the Self-Assessment Course on Thursdays has always
been fully subscribed. Even in 1975, it was obvious that an interest
existed for even more scientific sessions. Some members were interested
in a two-day meeting but they did not care to repeat the Self-assessment
Course, so plans were begun for a simultaneous scientific session on
Thursday. Since then, research-oriented Special Courses have been a
regular part of the program, on topics such as Advances in
Dermatopathology (1980); From Subjectivity to Objectivity (1981); Nevi
and Melanoma (1982); Adnesal Neoplasms and Histiocytic Disorders (1983);
Soft Tissue Tumors and Basement Membrane Zone Symposium (1984);
Dermatopathologic Clues to Systemic Disease, Dysplastic Nevi, and
Ichthyosis (1985); Coetaneous Lymphomas (1986); Silver Anniversary:
Landmarks in Dermatopathology, Unconventional Diagnostic Approaches, and
Pediatric Dermatopathology (1987); Computer Utilization, Disorders of
the Melanocyte, and Dermatopathology in AIDS (1988); Comparative
Dermatopathology, Political and Economic Issues, and Eosinophils in
Dermatopathology (1989); Molecular Genetics, Mast Cells and Basophils,
Lymphohistiocytic Infiltrations, and Historical Perspectives (1990); and
Pediatric Dermatopathology Imports (1991).
Poster Exhibits
Poster exhibits were first presented as a part of the program in
New Orleans in 1982. This was supervised by Dr. Clark Lambert. The idea
was encouraged to allow more members and trainees to participate in the
program by presenting data in poster form when they were not allotted a
space on the regular program of scientific presentations. This reflects
the large number of projects being completed in dermatopathology, in
contrast to a decade earlier, when anyone submitting an abstract for the
program could get it accepted.
In the early years of the society, nearly all the papers were
presentations of descriptive pathology, and at that time, such subjects
reflected the interest of the members and were generally preferred by
the Program Committee. By 1982, newer techniques, such as
immunofluorescence and immunoperoxidase, were being applied to problems
in dermatopathology, and these subjects were increasingly included in
the programs. Some complained that the program was composed of basic
techniques and that it was virtually impossible to get a descriptive
pathology paper accepted for floor presentation. For several years,
special sessions were held in which poster presenters were allowed to
give a brief presentation of their material, but this became too
difficult and was discontinued.
Seminal Cases and Slide Sessions
In 1983, the first session of Seminal Cases was scheduled to allow
individuals to present a case of interest that was thought-provoking and
a subject for discussion. This initially was a three-hour session held
on Thursday afternoon, concurrently with the Special Courses. It has
been extended to six hours and in 1991 was held as a Wednesday evening
session. In 1985, an evening slide session, with viewing and discussion
of microscopic slides, was instituted for Friday evening. Thus, there
were still opportunities for those interested to present and discuss
descriptive pathology, the main basis for the dermatopathologist's daily
work. In 1989, a new feature of the program was the presentation of
interesting cases from the society's Slide Reference Library, which is
maintained under the supervision of Dr. Arthur Balin.
Special Lectures
The President's Address has been a part of the society's scientific
program from the beginning. The first program lasted only two hours, but
Dr. Montgomery, the first president, made a few brief remarks to begin
the first meeting in 1963. And, ever since, the Presidential Address has
begun the scientific session; it has not been open for discussion from
the floor, as are all other papers.
One of the more significant changes in the scientific program is the
institution of a special lecture honoring one of the founding members,
Dr. Hermann Pinkus. The Pinkus Lecture is given during the scientific
session by an invited scientist on a subject of general interest. The
Pinkus Lecturers and their topics have been Dr. Tung-Tien Sun, "Pathways
of Epidermal Differentiation from Skin to Black Hairy Tongue" (1986);
Dr. Clive Taylor, "Immunohistologic Approaches to Tumor Diagnosis"
(1987); Dr. Join Ooita, "Molecular Pathology of Collagen in the Skin"
(1988); Dr. John R. Stanley, "Examination of Pemphigus and Pemphigoid
Under Higher Magnification: Autoantibodies Against Adhesion Junction
Molecules" (1989); Dr. Lance Liotta, "Molecular Mechanisms of Cancer
Invasion Metastasis" (1990); and Dr. S. Katz, "The Skin Immune System:
Allergic Contact Dermatitis as a Paradigm" (1991). This was instituted
by the society at the urging of Dr. Kurt Stenn, then
secretary-treasurer.
A society dinner or banquet was initiated early in the history of the
society. Initially, a speaker was not featured at the banquet. Later,
speakers were included, but the records available do not consistently
document who these speakers were or the subjects on which they
spoke.
Consultations in Dermatopathology
In 1990 and 1991, the newest feature of the program was
Consultations in Dermatopathology, a series of informal sessions
allowing a small group of participants to review glass slides directly
using a multiheaded microscope and discuss topics of interest with one
of the "real experts (Masters) in dermatopathology. Such "masters" have
included Drs. Ackerman, Barr, Cooper, Headington, McNutt, Mihm, Santa
Cruz, Wick and Winkelmann.
The Founders Award
As the society grew and expanded its program and activities, several
awards and lectureships were considered, and it was agreed that the
society was now able to support such activities. In 1980, the society
elected to acknowledge the contributions of the Founding Members by
elevating each to the category of honorary member, a designation
reserved for those members giving dedicated and meritorious service to
dermatopathology. Also, under the guidance of Dr. Kurt Stenn, the
secretary-treasurer, a Founder's Award was instituted to recognize those
members for long and distinguished service to the society. To date, the
following members have received the Founder's Award:
1984 - Dr. Hermann Pinkus
1985 - Dr. Elson B. Helwig
1986 - Dr. Walter Lever
1987 - Dr. Richard K. Winkelmann
1988 - Dr. Wallace Clark
1989 - Dr. A. Bernard Ackerman
1990 - Dr. James H. Graham
1991 - Dr. Robert G. Freeman
Quality Control and Proficiency Testing
The regulation of laboratories became an issue for all laboratories
including dermatopathologists with the passage of the Clinical
Laboratories Improvement Act of 1967. By 1971, the implementation of the
provisions of this act had become a major concern for any laboratory
doing business in interstate commerce. In addition, some state
governments were becoming involved in laboratory regulation and in
making requirements more stringent for relicensure. In 1971, a report on
licensure of dermatopathology laboratories engaged in interstate
commerce was given at the annual meeting. In 1972, the society approved
the establishment of a standing Committee on Peer Review to report on
the possibility of establishing a Laboratory Proficiency Testing
program, and this report was given in 1973. The society approved the
establishment of a program for Quality Control, Proficiency Testing, and
Laboratory Inspection at the meeting in 1974, to be implemented
beginning in 1975. Dr. James H. Graham was secretary-treasurer and Dr.
George Ioannides was the main organizer and first director of the
program. The program was to provide a means whereby enrolled members
could receive tissues for processing in their laboratory with the slides
being reviewed by the committee members to determine proficiency in
slide preparation. Second, a set of prepared slides was circulated to
participants for their interpretation and evaluation of their diagnostic
ability. Third, a laboratory inspection comparable to that given by the
CLIA inspectors was offered to individuals who desired an on-site
inspection by a society member.
In 1975, 42 subscribers were enrolled. In 1976, 42 enrolled and 17
laboratories were inspected. In 1981, laboratory inspection was
discontinued due to lack of interest and the development of alternate
accreditation mechanisms. Quality Control and Proficiency Testing
programs are still active, and represent the only such program
specifically for dermatopathology. A suggestion was considered, but
declined, to add a program for quality control for
immunofluorescence.
Slide Library
In 1982, a committee was appointed, on the recommendation of Dr.
Kurt Stenn, secretary-treasurer, for the collection and archival storage
of dermatopathology slides that could serve as a reference collection
for the members. This was implemented, and the collection has been
maintained since by Dr. Arthur Balin. These slides are available for
study and review, and selected cases have been presented at the annual
meeting. Contribution of new cases to add to the collection is
encouraged.
A Society Journal
As early as 1973, a suggestion was made and an ad hoc committee was
appointed to evaluate the feasibility of establishing a society journal.
Sentiment was expressed in favor of a Society journal because of
difficulty some members had experienced in getting manuscripts accepted
in established journals. At the 1974 meeting, Dr. Herbert Lund,
committee chairman, reported that the committee did not feel that a
journal was feasible at that time and recommended an affiliation with an
established journal as an alternative. After this, I was unable to
arrange an affiliation with any journal, but Dr. John Epstein, editor of
the Archives of Dermatology, agreed to publish the abstracts of the
annual meeting of the ASD in the December issue of the Archives that was
circulated just prior to the annual meeting in December. This practice
was continued until the ASD succeeded in establishing its official
journal through Munksgaard.
Later, during the tenure of Dr. Terry Headington as
secretary-treasurer, the matter of a society journal was again raised.
An ad hoc committee chaired by Dr. Martin Brownstein was appointed to
investigate this question. A recommendation was made that the existing
Journal of Cutaneous Pathology (Munksgaard) become the official
journal, but the decision was delayed a year in order to investigate
other alternatives such as a link with the existing American Journal
of Dermatopathology or with another publisher to establish a new
journal. In the interim, Drs. Brownstein and Mehregan assumed the
editorship of the Journal of Cutaneous Pathology. Then on
approval of the agreement with Munksgaard, Dr. Evan Farmer became the
society's first editor. The second and current editor is Dr. Philip
Cooper.
Concluding Observations
The growth and development of the ASD has been spectacular in its
relatively short 30-year existence. I have been privileged to attend
every meeting and to be a part of this growth. It was established with a
great deal of optimism by its founders at a time when many wondered "Why
a society for dermatopathology?" But they correctly judged that the
subspecialty of dermatopathology was coming into its own and was
beginning to grow. Following Dr. Nickel as secretary-treasurer, Dr. Jim
Graham succeeded in putting the society on a firm foundation with new
bylaws and incorporation, expanding the meeting to accommodate rising
attendance, and instituting new programs such as the quality control and
proficiency testing program. The momentum was already mounting when I
took over the secretary's job in 1975, and we were able to continue to
expand these programs, increase the membership, and increase attendance
and double the program to two full days.
During the tenure of Dr. Terry Headington, the membership more than
doubled, the program was expanded and ties with pathology groups were
strengthened. International interest was stimulated with the result that
dermatopathologists in other countries have now established their own
national societies while many still attend our meetings. Also, the
mechanism for a journal was set in motion. And other troublesome
problems for the society were resolved. While he was
secretary-treasurer, Dr. Stenn further enhanced recruiting and
membership, and also initiated several society activities such as the
Pinkus Lectures, the Founder's Award, the Reference Library, a society
logo, and a banquet speaker. Dr. Loren Golitz further expanded the
program, accommodated a growing membership, guided the society toward
greater maturity and initiated discussion of common problems among
teachers of dermatopathology. Dr. Toni Hood has overseen a veritable
explosion of activity with expansion of the meeting to two and one-half
days with 15 different sessions, as many as five of which ran
simultaneously, and many of which are still crowded. Along with this,
there has been board of directors retreats, establishment of criteria
for selecting the founder's awardee, audiotaping of lectures and a
resident appreciation award, consultants tutorials, and overall a more
polished professional operation than ever before.
I do not think that Dr. Montgomery or Dr. Nickel, or others who
did not live to see it, would believe what has grown out of their little
huddle late one Tuesday afternoon in 1962 in the Red Lacquer room of the
Palmer House. It is amazing to see the interest, attendance and
enthusiasm shown by this group when they get together. It is
unparalleled. It is time to look back for a moment and thank those who
made it possible. It is also time to look forward and resolve to carry
on with the dedication, selflessness and enthusiasm it will take to
maintain the momentum and achievement for the public good.
|