Whitney D Tope

Roswell Park Cancer Institute, Buffalo, New York, United States

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Publications (33)143.28 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Data suggest that photodynamic therapy using topical methyl aminolevulinate (MAL PDT) may be a noninvasive alternative to excisional surgery for nodular basal cell carcinoma (BCC). In the studies described here, we investigated the histologic response, tolerability, and cosmetic outcome with MAL PDT for primary nodular BCC (<or= 5 mm in depth). Two multicenter, randomized, double-blind studies with similar design and procedures were conducted. After surface debridement and minor tumor debulking, MAL cream 160 mg/g (66 patients with 75 lesions) or placebo cream (65 patients with 75 lesions) was applied for 3 h, followed by illumination with broad-spectrum red light (75 J/cm(2), 570-670 nm). This was repeated 7 days later. Lesions with a partial response (>or= 50% reduction in greatest diameter) at 3 months were re-treated (21%). Treatment sites were excised at 3 months (clinical nonresponders) or 6 months (clinical responders) after the last treatment. Histologically verified lesion complete response rates were higher with MAL PDT than with placebo [73% (55/75) vs. 27% (20/75)]. Treatment was most effective for facial lesions (89% complete response). Cosmetic outcome was good or excellent in 98% of evaluable, completely responding lesions treated with MAL PDT. Although longer follow-up studies are required, these promising data indicate the potential of topical MAL PDT as a noninvasive treatment alternative for nodular BCC.
    No preview · Article · Nov 2009 · International journal of dermatology
  • Sachin S Bhardwaj · Whitney D Tope · Peter K Lee
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    ABSTRACT: Mohs micrographic surgery (MMS) continues to become a more common and accepted treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM). The primary difficulty encountered lies in the accurate identification of atypical single melanocytes to determine tumor-free margins. Numerous methods have been used to better visualize single melanocytes, with varying results. We present our experience using Mel-5 immunostaining in MMS of LM and LMM. Two hundred patients with primary or recurrent LM or LMM were treated using MMS from 1999 to 2003 at the University of Minnesota. The initial clinical margins were determined by Wood's light examination, and an initial debulk specimen was taken and sent for formalin fixation and later reviewed by a dermatopathologist. The first Mohs layer was then taken, and staining with hemotoxylin and eosin as well as Mel-5 immunostaining was performed. All patients were followed up to evaluate for recurrence, with a mean follow-up time of 38.4 months. Of the 200 patients treated, only one recurrence was noted. This patient had been treated with excision followed by radiation before MMS. Use of Mel-5 immunostaining added approximately 40 minutes to each stage. Use of the Autostainer Immunostaining System (DAKO, Carpenterina, CA, USA) shortened the added time to 20 minutes. MMS with Mel-5 immunostaining yielded excellent results in the treatment of LM and LMM, with only one recurrence noted in 200 patients. When an automated immunostainer was used, minimal time was added to each Mohs stage.
    No preview · Article · Jun 2006 · Dermatologic Surgery
  • Clark C Otley · Thomas Stasko · Whitney D Tope · Mark Lebwohl
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    ABSTRACT: In patients with nonmelanoma skin cancer that is high risk or characterized by numerous tumors, chemoprevention with systemic retinoids may effectively decrease the number of new tumors whereas the chemosuppressive effects may reduce the risk of recurrence or disease progression. A patient's intolerance of the mucocutaneous effects of retinoid therapy or abnormal laboratory findings may hamper continuous therapy. To present a method for optimizing tolerance of systemic retinoids for chemoprevention and for monitoring and managing adverse events. After reviewing the data on the use of systemic retinoids for chemoprevention, we developed a simplified approach for administering oral retinoids for chemoprevention of nonmelanoma skin cancer as well as basic guidelines for the prevention and management of adverse effects and appropriate laboratory monitoring. Chemoprevention with systemic retinoids in patients with a history of numerous tumors or high-risk skin cancer can be optimized with graduated dose escalation and preventive strategies for the most common adverse effects. Routine laboratory monitoring may assist in detecting adverse effects, which can be managed in most cases. In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.
    No preview · Article · May 2006 · Dermatologic Surgery
  • Sachin S Bhardwaj · Whitney D Tope · Peter K Lee
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    ABSTRACT: BACKGROUND: Mohs micrographic surgery (MMS) continues to become a more common and accepted treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM). The primary difficulty encountered lies in the accurate identification of atypical single melanocytes to determine tumor-free margins. Numerous methods have been used to better visualize single melanocytes, with varying results. We present our experience using Mel-5 immunostaining in MMS of LM and LMM. METHODS: Two hundred patients with primary or recurrent LM or LMM were treated using MMS from 1999 to 2003 at the University of Minnesota. The initial clinical margins were determined by Wood's light examination, and an initial debulk specimen was taken and sent for formalin fixation and later reviewed by a dermatopathologist. The first Mohs layer was then taken, and staining with hemotoxylin and eosin as well as Mel-5 immunostaining was performed. All patients were followed up to evaluate for recurrence, with a mean follow-up time of 38.4 months. RESULTS: Of the 200 patients treated, only one recurrence was noted. This patient had been treated with excision followed by radiation before MMS. Use of Mel-5 immunostaining added approximately 40 minutes to each stage. Use of the Autostainer Immunostaining System (DAKO, Carpenterina, CA, USA) shortened the added time to 20 minutes. CONCLUSIONS: MMS with Mel-5 immunostaining yielded excellent results in the treatment of LM and LMM, with only one recurrence noted in 200 patients. When an automated immunostainer was used, minimal time was added to each Mohs stage.
    No preview · Article · May 2006 · Dermatologic Surgery
  • Clark C Otley · Thomas Stasko · Whitney D Tope · Mark Lebwohl
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    ABSTRACT: BACKGROUND: In patients with nonmelanoma skin cancer that is high risk or characterized by numerous tumors, chemoprevention with systemic retinoids may effectively decrease the number of new tumors whereas the chemosuppressive effects may reduce the risk of recurrence or disease progression. A patient's intolerance of the mucocutaneous effects of retinoid therapy or abnormal laboratory findings may hamper continuous therapy. OBJECTIVE: To present a method for optimizing tolerance of systemic retinoids for chemoprevention and for monitoring and managing adverse events. METHODS: After reviewing the data on the use of systemic retinoids for chemoprevention, we developed a simplified approach for administering oral retinoids for chemoprevention of nonmelanoma skin cancer as well as basic guidelines for the prevention and management of adverse effects and appropriate laboratory monitoring. RESULTS: Chemoprevention with systemic retinoids in patients with a history of numerous tumors or high-risk skin cancer can be optimized with graduated dose escalation and preventive strategies for the most common adverse effects. Routine laboratory monitoring may assist in detecting adverse effects, which can be managed in most cases. CONCLUSION: In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.
    No preview · Article · Apr 2006 · Dermatologic Surgery
  • Rhoda S Narins · Whitney D Tope · Karl Pope · Edward V Ross
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    ABSTRACT: Device complication rates were analyzed in the Regulatory and Quality Assurance departments of Thermage, Inc., Hayward, CA, USA, in consultation with Dr. Whitney D. Tope. Corrective treatment in the case study was performed at the Dermatology Surgery and Laser Center, White Plains, NY.Thermage, Inc. loaned the device to perform the biopsy. Rhoda S. Narins, MD, and Whitney D. Tope, Mphil, MD were paid an honorarium for their work on this article. Dr. Tope is a paid consultant for the analysis of safety issues for Thermage, Inc. Karl Pope, MS, is an employee of Thermage.
    No preview · Article · Feb 2006 · Dermatologic Surgery
  • Rhoda S. Narins · Whitney D. Tope · Karl Pope · Edward V. Ross
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    ABSTRACT: Device complication rates were analyzed in the Regulatory and Quality Assurance departments of Thermage, Inc., Hayward, CA, USA, in consultation with Dr. Whitney D.Tope. Corrective treatment in the case study was performed at the Dermatology Surgery and Laser Center, White Plains, NY.
    No preview · Article · Jan 2006 · Dermatologic Surgery
  • Siegrid S Yu · Whitney D Tope · Roy C Grekin
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    ABSTRACT: BACKGROUND AND OBJECTIVE: As the number of patients with implantable cardiac devices escalates, inadvertent electromagnetic interference (EMI) by electrosurgery carries increasing concern for patient safety. Given the trend for dermatologic care delivery by nonphysician providers, supervising physicians must carefully consider the adequacy of perioperative evaluation in elective or cosmetic settings. Rapidly evolving technology also calls into question potential EMI of new therapeutic modalities (radiofrequency resurfacing, electrochemotherapy, and endovenous ablation). The most recently published recommendations (1998) for care of dermatologic patients with cardiac devices do not differ significantly from guidelines proposed in 1975. These recommendations, based on complications experienced during noncutaneous surgery, are exceedingly conservative and do not take into consideration the different electrosurgical modalities and varying degrees of EMI risk. In addition, modern cardiac devices have evolved significantly with increased sophistication in protection from EMI. A survey of dermatologic surgeons demonstrated low compliance with these existing guidelines. METHODS, RESULTS, AND CONCLUSIONS: Based on a review of the literature and current electrosurgical and cardiac devices, we discuss the potential impact of conventional dermatologic electrosurgery and new technologies. We propose that new perioperative guidelines are needed to provide appropriate safety, facile implementation, and cost-effective care for patients with modern implantable cardiac devices.
    No preview · Article · Sep 2005 · Dermatologic Surgery
  • Siegrid S. Yu · Whitney D. Tope · Roy C. Grekin
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    ABSTRACT: Background and Objective: As the number of patients with implantable cardiac devices escalates, inadvertent electromagnetic interference (EMI) by electrosurgery carries increasing concern for patient safety. Given the trend for dermatologic care delivery by nonphysician providers, supervising physicians must carefully consider the adequacy of perioperative evaluation in elective or cosmetic settings. Rapidly evolving technology also calls into question potential EMI of new therapeutic modalities (radiofrequency resurfacing, electrochemotherapy, and endovenous ablation). The most recently published recommendations (1998) for care of dermatologic patients with cardiac devices do not differ significantly from guidelines proposed in 1975. These recommendations, based on complications experienced during noncutaneous surgery, are exceedingly conservative and do not take into consideration the different electrosurgical modalities and varying degrees of EMI risk. In addition, modern cardiac devices have evolved significantly with increased sophistication in protection from EMI. A survey of dermatologic surgeons demonstrated low compliance with these existing guidelines. Methods, Results, and Conclusions: Based on a review of the literature and current electrosurgical and cardiac devices, we discuss the potential impact of conventional dermatologic electrosurgery and new technologies. We propose that new perioperative guidelines are needed to provide appropriate safety, facile implementation, and cost-effective care for patients with modern implantable cardiac devices.
    No preview · Article · Aug 2005 · Dermatologic Surgery
  • Isaac M Neuhaus · Whitney D Tope
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    ABSTRACT: Solid organ transplant recipients are at a significantly increased risk of developing skin cancer. Both systemic and topical retinoids are useful for chemosuppression of skin cancer in this patient population. These drugs can reduce both the present extent and the future development of premalignant and malignant skin lesions. This paper reviews the current data on the chemoprophylactic properties of topical and systemic retinoids. A practical guide for their use in organ transplant recipients is provided. Specific recommendations for implementing and maintaining therapy, as well as appropriate management and monitoring of adverse events, are presented.
    No preview · Article · Jan 2005 · Dermatologic Therapy
  • Anna D Guanche · Kimberly Bohjanen · Whitney D Tope
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    ABSTRACT: Our patient presented with an unusual case of rapidly growing palpebral tumors, which obstructed his vision and caused professional and social impairment. The objective was to report the role of surgical management in a case of the d'emblee variant of cutaneous T-cell lymphoma and to provide a literature review. Tumors of the eyelids previously treated with topical and oral retinoids, indomethacin, dapsone, systemic chemotherapy, and high-dose systemic corticosteroids respond finally to conservative excision and second intention healing. Surgical debulking of palpebral tumors achieved remission of a locally aggressive form of cutaneous T-cell lymphoma and significant restoration of the sight, eyelid function, and social/professional function. In selected cases, surgical excision of tumor tissue may be of significant assistance in managing d'emblee variant cutaneous T-cell lymphoma.
    No preview · Article · Jan 2005 · Dermatologic Surgery
  • Source
    Stephen R Tan · Whitney D Tope
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    ABSTRACT: Persistent erythema and dysesthetic symptoms are typical manifestations of rosacea. We sought to assess improvement in erythema, symptoms, and quality of life after pulsed dye laser treatment. Sixteen patients with erythematotelangiectatic rosacea participated. Spectrophotometric erythema measurements were taken from the right and left malar prominence; chin; and nasal alae, dorsum, and tip. A questionnaire rating the Dermatology Life Quality Index and symptoms of flushing, burning, itching, dryness, swelling, and skin sensitivity was completed. Treatment was undertaken with the pulsed dye laser at purpuragenic fluences. Measurements and treatment were repeated at 8-week intervals for a total of two treatments. A statistically significant improvement was observed in symptoms, quality-of-life score, and erythema in all areas with the exception of erythema of the left nasal ala. Pulsed dye laser treatment at purpuragenic fluences is a safe and effective treatment for symptomatic rosacea, resulting in a significant improvement in erythema, symptoms, and quality of life.
    Preview · Article · Nov 2004 · Journal of the American Academy of Dermatology
  • Stephen R Tan · Whitney D Tope
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    ABSTRACT: Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal.
    No preview · Article · Jun 2004 · Dermatologic Surgery
  • Source
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    ABSTRACT: Solid-organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma (SCC) and often develop multiple and aggressive tumors. There are few published studies or reviews, which provide guidance to the clinician in the treatment of these patients. The objective was to develop useful clinical guidelines for the treatment of skin cancer in organ transplant recipients (OTRs). The members of the Guidelines Committee of the International Transplant-Skin Cancer Collaborative (ITSCC) carried out a computerized search utilizing the databases of the National Library of Medicine for reports in the literature on SCC in OTRs. These reports were collectively examined by the group and combined with experiences from the members' clinical practices in the development of the guidelines. More than 300 articles relating to SCC in OTRs were reviewed. In general, reports concerning the prevention and treatment of SCC in OTRs are of individual cases or small case series. They are retrospective in nature, statistically nonrigorous, and lack the complete epidemiologic data necessary to derive definitive conclusions. Combining these studies and collective clinical experience, however, is at present the best available method for devising guidelines for the treatment of SCC in OTRs. Guidelines developed for the treatment of skin cancer in OTRs, supported by the best available data and collective clinical experience, may assist in the management of OTRs with SCC. The development of clinical pathways and complete documentation with rigorous prospective study is necessary to improve and refine future guideline development.
    Full-text · Article · May 2004 · Dermatologic Surgery
  • Whitney D Tope · A Menter · R. A. El-Azhary · N. J. Lowe

    No preview · Article · Mar 2004 · Journal of the American Academy of Dermatology
  • Source
    Jakub Tolar · Whitney D Tope · Joseph P Neglia

    Preview · Article · Mar 2004 · New England Journal of Medicine
  • Source
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    ABSTRACT: Efficient treatment of patients with multiple synchronous nonmelanoma skin cancers represents a therapeutic challenge. To study the safety and efficacy of photodynamic therapy (PDT) with verteporfin and red light in the treatment of multiple nonmelanoma skin cancers. Open-label, randomized, multicenter, dose-ranging phase 2 study conducted at 4 North American university-based dermatology clinics. Fifty-four patients with 421 multiple nonmelanoma skin cancers including superficial and nodular basal cell carcinoma and squamous cell carcinoma in situ (Bowen disease). A single intravenous infusion of 14 mg/m(2) of verteporfin followed 1 to 3 hours later by exposure of tumors to 60, 120, or 180 J/cm(2) of red light (688 +/- 10 nm) from a light-emitting diode panel. Pathologic response of treated sites was assessed at 6 months. Clinical and cosmetic responses were assessed and graded at 6 weeks, 3 months, and 6 months after verteporfin PDT, with optional follow-up visits at 12, 18, and 24 months. The histopathologic response, defined as absence of tumor on biopsy specimens 6 months after verteporfin PDT, ranged from 69% at 60 J/cm(2) to 93% at 180 J/cm(2). At 24 months of follow-up (276 tumors in 31 patients), the clinical complete response rate ranged from 51% at 60 J/cm(2) to 95% at 180 J/cm(2). No significant systemic adverse events were observed; most events occurred at the treated tumor sites and included events such as pain. Overall, 65% (95% confidence interval, 58%-71%) of tumors were judged to have good to excellent cosmesis at 24 months. A single course of verteporfin PDT showed treatment benefit for patients with multiple nonmelanoma skin cancers.
    Full-text · Article · Feb 2004 · Archives of Dermatology
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    ABSTRACT: Introduction and objectives: Photodynamic therapy (PDT) with verteporfin may be particularly well suited for patients with multiple low risk non-melanoma skin cancers (NMSC) while providing good cosmetic outcomes as compared to standard treatments. The objectives of this study were to prospectively assess the tumor responses and cosmetic outcomes of verteporfin-treated NMSC.Patients and methods: This was a phase 11, open-label, light-dose ranging, multicenter study of 54 patients with multiple NMSC. A total of 421 biopsy-proven tumors that were either basal cell carcinomas or in situ squamous cell carcinomas underwent PDT with intravenous verteporfin 14 mg/m2 followed by exposure to red light from LED diode arrays (658-718 nm FWHM) at fluences of 60, 120, or 180 J/cm2. Each patient was randomly assigned to receive one of the three light doses to all their tumors. Treated tumors underwent follow up biopsies at 6 months after the initial PDT session to determine the pathologic complete response rate. In addition, the treated tumors were assessed clinically for up to 24 months. The cosmetic outcome of each treated tumor site was assessed by the investigators based on color, profile, and surface texture.Results: The pathologic complete response rates at 6 months were 69, 79, and 93% for the 60, 120 and 180 J/cm2 light fluences, respectively. The clinical complete response rates by tumor at 6 months were 78, 89 and 98% at 60, 120 and 180 J/cm2, respectively, while at 24 months, the corresponding rates were 51, 79, and 95%. The cosmetic outcome by tumor at 24 months judged by the investigator to have achieved at least a satisfactory or higher outcome was 92, 76, and 86% at 60, 120 and 180 J/cm2, respectively.Conclusions: PDT of NMSC with verteporfin provides effective tumor clearing that is dose-dependent with satisfactory to excellent outcomes in the majority of patients.
    No preview · Article · Apr 2002 · Photodermatology Photoimmunology and Photomedicine
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    ABSTRACT: To examine relationships between chemical composition, biopsy findings, and clinical outcome in laser-treated tattoos. Observational nonblinded retrospective study. University-based dermatology clinic and private practice. Twenty patients who underwent biopsy of laser-treated tattoos. Biopsy specimens were analyzed after laser treatment, and the depths of changed particles were recorded. Ultrastructure of the changed particles was examined by electron microscopy. Presence of inorganic chemicals was determined by x-ray diffraction. Correlation between x-ray diffraction, microscopy, and clinical response was attempted. Of the 20 tattoos, 7 lightened, 9 failed to change, and 4 darkened after laser treatment. There was a significant association between presence of titanium dioxide and poor response to laser therapy. Microscopic studies showed variable changes in the ink particles, but there was a trend toward residual deep green pigment in the resistant tattoos. Also, round dark stippling was observed superficially in the darkened specimens. Titanium is overrepresented in tattoos that respond poorly to laser treatment. Further studies are necessary to show whether this metal is the primary cause of this poor response.
    No preview · Article · Feb 2001 · Archives of Dermatology
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    ABSTRACT: A novel electrosurgical technology that uses a bipolar electrode-tipped stylet to deliver relatively low-radiofrequency energy through an electrically conductive medium has been developed. To evaluate the efficacy and safety of the radiofrequency resurfacing system for the treatment of facial wrinkles. Multicenter, prospective, noncomparative study with longitudinal follow-up. Four US academic dermatologic surgery clinics. Ninety-five patients with mild to severe photodamage (Fitzpatrick classes I-III) involving periorbital (75 treatment sites) and perioral (50 sites) facial skin. Radiofrequency resurfacing with the use of 2 to 3 passes at 125 or 139 V. Wrinkle and cosmetic improvements evaluated by patients, investigators, and, by means of photographs, an independent panel of 5 evaluators. All evaluators determined a positive mean improvement in wrinkles for both periorbital and perioral anatomic sites, with greater improvement for patients with more severe wrinkles at baseline. An increased number of passes and higher voltage settings had a positive impact on wrinkle improvement. Transient postinflammatory hyperpigmentation occurred in 26% of periorbital and 4% of perioral sites. Hypertrophic scars occurred in 3.8% of treatment sites, with all but 1 scar resolving by 6 months. For the most part, healing was rapid, pain was minimal, and erythema largely resolved within 2 months. Other untoward effects were relatively few and short-lived. At the study settings used, radiofrequency resurfacing is an effective modality in the treatment of periorbital and perioral wrinkles in patients with Fitzpatrick class I, II, and III photodamage. There is less severe postoperative morbidity than seen with carbon dioxide or coagulating erbium:YAG lasers. The potential risks are similar to those seen with other resurfacing modalities.
    Full-text · Article · Dec 2000 · Archives of Dermatology

Publication Stats

1k Citations
143.28 Total Impact Points

Institutions

  • 2009
    • Roswell Park Cancer Institute
      Buffalo, New York, United States
  • 2005-2006
    • University of California, San Francisco
      • Department of Dermatology
      San Francisco, California, United States
  • 2004
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 1999-2002
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 1995-1998
    • Massachusetts General Hospital
      • Department of Dermatology
      Boston, MA, United States