Reflections on legacies, lessons and inspirations

The New Year is a time during which most of us celebrate the idea of fresh starts and resolve to create new healthier habits, improved relationships, and revised budgets, to name a few. It’s also a time of reflection. Some of us look back at the previous year and ruminate over what was left undone, what was lost and some of us will even ponder our own mortality - do we still have time to accomplish all of the things we’d hoped for ourselves. All of us want to be remembered after we're gone, and physicians are no different. After all, doctors spend their lives working to help people heal, and many hope to inspire others to follow in their footsteps.

What about dermatologists? Who inspires you? What lessons do you hope to leave to future generations? In the spirit of this New Year, Dermatology Times asked several top dermatologists to ponder their legacies. Here are excerpts from our conversations.

NEXT: Neglected Specialty

Uniquely Focused on a Neglected Specialty

Paradi Mirmirani, M.D., dermatologist and director, Hair Disorders, The Permanente Medical Group, Vallejo, Calif.

Whose legacy has influenced you?

My mentor Dr. Vera Price [a professor of dermatology at the University of California at San Francisco and former director of the American Academy of Dermatology] was the one who drew me to this subspecialty.

She was my attending during my first year of residency, and we just happened to hit is off. She convinced me to spend more time with her in the clinic and to learn more about hair disorders.

Once I learned more about hair, I realized that this tissue was unique in many ways. It regenerates continuously during our life, and it has stem cells. The research questions being asked were very exciting.

Do you think your legacy will involve your focus on hair?

Hair is sometimes an "orphan" in that many dermatologists have not had extensive training or prefer to focus on skin disorders or procedures.

I do hope to continue in the tradition of Dr. Price to bring a focus to hair disorders within the specialty of dermatology and to continue to train residents on how to give the best care to patients with hair disorders.

I still have a lot of questions about hair disorders, so I guess I'll continue to focus on hair until some of them get answered.

NEXT: Education through Hollywood

Educating the Public with Help from Hollywood

Vail Reese, M.D., dermatologist in private practice and assistant clinical professor, University of California at San Francisco. Founder and curator, Skinema.com.

Do you think you’ll leave a legacy to the wider world beyond your dermatology practice?

Working with Dr. Ilona Frieden, a pediatric dermatologist at UCSF, we wrote up several cases of a syndrome that had not previously been described, involving large facial hemangiomas associated with congenital defects of the brain and other organ systems.

A dermatologist resident at that point, I developed the acronym for the condition, PHACES. Unlike many acronyms, this one actually reflects the main dermatology feature, a large facial lesion. 

Now, 20 years later, Ilona and her colleagues continue to elucidate the pathogenesis. There is a PHACES support group for families, and current derm residents are expected to answer questions about the condition for the boards.

What about Skinema.com - now more than two decades old - which has long monitored skin conditions on screen and in real-life celebrities?

During residency, I recognized that many skin defects shown onscreen were used to identify evil characters, such as Darth Vader or Freddy Krueger, both who have scarring. Some conditions were manifested by the actors themselves, such as Richard Gere’s Becker’s nevus and Jon Hamm’s vitiligo.

And rarely, sympathetic characters have been shown with derm issues. Recent instances are the lawyer with eczema in the HBO series “The Night Of” and the physically powerful, wise-cracking yet emotionally and physically scarred superhero in “Deadpool.” 

At lectures at AAD meetings and elsewhere, I continue to explore the idea that the media can be used to educate and influence the public’s perception of skin conditions. And I continue to update the site. They keep making movies and TV shows, and the characters continue to have skin, even if computer generated!

NEXT: Alert Eye, Generous Heart

An Alert Eye and a Generous Heart

Donna A. Serure, D.O., dermatologist in private practice and chairperson, Department of Dermatology, St. Catherine of Sienna Medical Center, Smithtown, N.Y.

What does leaving a legacy mean to you?

My legacy is not about my residency training or my board scores or being on the cover of a magazine. It's about making a difference and touching the lives of the people that I am so blessed and honored to have in my world everyday.

I had a young woman who came in for her routine annual skin exam, and I noticed her fingernails had an unusual shape to them. She presented with clubbing and had no underlying lung disease. I sent her for a chest x-ray. A mass was found, and she was subsequently diagnosed with lung cancer.

One man came to see me every six months for his skin exams. On this particular day, I felt a nodule in his neck. I called his primary care doctor, we ordered a CT scan, and he was diagnosed with advanced esophageal cancer.

And there is my 50-year-old patient whom I diagnosed with metastatic melanoma. He refused to go through disfiguring and painful surgery.

I had brutally honest conversations week after week with this man who was willing to give up.  I was relentless. “These are your options: You can choose to live or you can choose to die."

This man, statistically speaking, should not be alive today. But he beat the odds. He had multiple surgeries, went through horrible treatments. It is now three years later, and he is cancer free. I look forward to his hugs every three months.

NEXT: Derm's Giants

Remembering Dermatology's Giants

Terrence A. Cronin, Jr., M.D., dermatologist, Melbourne, Fla.

Have the legacies of other dermatologists touched you?

Our professors and training programs provide the excellence for the future by training the residents to become great physicians.

There are great names associated with diseases like Kaposi's sarcoma, Clark's level, Majocchi's granuloma. And I think many of the textbooks we use also provide long lasting legacies - Andrews, Fitzpatrick, Rook, Bolognia, Nouri, and Gross.

What legacy do you hope to leave as a dermatologist to your patients and your practice?

I find it humbling to watch many of my colleagues retire and their patients move on to a new doctor. There seem to be minimal long-lasting legacies besides the fond memories of good work done on their behalf. The only thing that seems to last and be remembered is the love you showed your patients.

I certainly think I will rightly be forgotten by my future colleagues and the specialty as a whole, and that other better physicians will take up my passions for the skin, our patients, and our profession. I do hope that future dermatologists will be allowed to do more than what I can do and not less.