EDF Guidelines

EDF guidelines

	Guidelines Committee of EDF
	Guideline on venous leg ulcers
	Guidelines for the Management of Actinic Keratoses
	Guidelines on Basal Cell Carcinoma
•	Guidelines for the Management of Dermatopathology
	Definition, Classification and Diagnosis of Urticaria (PDF 99KB)
	Management of Urticaria (PDF 119KB)
	Guest book

Guidelines
for the Management of
DERMATOPATHOLOGY

Developed by the Guidelines Subcommittee of the
European Dermatology Forum

Subcommittee Members:

Prof. Dr. Helmut Kerl, Graz (Austria)
Prof. Dr. Günther Burg, Zürich (Switzerland)
Prof. Dr. Rino Cerio, London (United Kingdom)
Prof. Dr. Lorenzo Cerroni, Graz (Austria)
Prof. Dr. Bernard Cribier, Strasbourg (France)
Prof. Dr. Harald Gollnick, Magdeburg (Germany)
Prof. Dr. Heinz Kutzner, Friedrichshafen (Germany)
Prof. Dr. Wolfram Sterry, Berlin (Germany)

"DERMATOPATHOLOGY"

prepared by H. Kerl (Austria), G. Burg (Switzerland), R. Cerio (United Kingdom),
L. Cerroni (Austria/Italy), B. Cribier (France), H. Gollnick (Germany),
H. Kutzner (Germany), W. Sterry (Germany)

I)	Special Qualification (Expertise) in Dermatopathology

Special qualification in dermatopathology can only be achieved by years of practice and experience.

1.	Regulations and Requirements for Accreditation of Speciality Training Programmes in Dermatopathology

Identification of accredited training programmes and eligibility assessment for the examination could be accomplished by a Review Subcommittee, which includes equal members from both, Pathology and Dermatology Boards. This subcommittee cannot function in a licensing role (as this is governmental task), however, it would be responsible for reviewing the performance (structure, program design) of the teaching institution. Programmes wishing to be accredited will have documentation as to requirements and on-site inspection that will include evaluation of the facility, interview with the director of dermatopathology and teaching staff and the trainees. The programme must have ongoing mechanisms of evaluation (re-accreditation).

Training for special qualifications in dermatopathology can be completed by European physicians also in the USA when accepted by Dermatopathology Centers with ACGME (= Accreditation Council for General Medical Education)-approved training programmes.

The following guidelines could be used:

•	Training must be directed and closely supervised by a pathologist / dermatologist with documented qualifications in dermatopathology (International Board of Dermatopathology; Royal College of Pathologists; American Board of Dermatopathology). The trainee must be given the opportunity to "sign out" under supervision.

•	Training in dermatopathology must be linked with a university clinic, hospital or a comprehensive dermatopathology center.

•	The programme must provide organized training in the following areas concerning dermatopathology:
	- routine histology - special stains - immunofluorescence and immunoperoxidase techniques - molecular techniques (PCR) *) - (electron microscopy - optional) - laboratory management, quality assurance

•	A sufficient number and variety of dermatopathology specimens - at least 3000 new accessions per annum - must be available for the trainees to gain experience in diagnostic dermatopathology. In addition study sets and other educational materials should be provided.

•	Candidates for speciality training in dermatopathology must have successfully completed their residency training in dermatology/pathology, as required by the various national licensing bodies. They should also confirm continuous and authentic exposure to dermatopathology during their residency time.

•	Discussions, tutorial rounds, lectures, and conferences must be regularly scheduled and held. Especially clinico-pathological conferences, scheduled on a regular base within qualified dermatological clinics, are important in this respect.

2.	Recommendations for Length of Speciality Training

•	Satisfactory completion of two years of speciality training in dermatopathology in a programme accredited for such training.

•	Dermatologists would also be expected to spend a minimum period of 6 months in a Pathology Department studying anatomic and surgical pathology.

II)

Organisation of a Dermatopathology-Laboratory and Requirements

The institution must provide for the practical service and training in dermatopathology the following facilities:

1.	Laboratories (within the training institution) with adequate space and technical equipment for:

- routine histology
- special stains
- immunofluorescence and immunoperoxidase techniques
- molecular techniques (DNA-PCR) *)
- (electron microscopy - optional)
- laboratory management, quality assurance

2.	Personnel

	-	A programme director who is responsible for the direction and general administration of the laboratory. He must show documented qualifications in dermatopathology (experience training; Diploma in Dermatopathology) and is especially responsible for the training programme.

	-	There must be a sufficient number of qualified physicians (pathologists, dermatologists) with documented experience and qualifications in dermatopathology. (In the USA for dermatology there is a ratio of one full-time faculty member to 3 trainees.)

	-	Other staff: There must be a sufficient number of qualified technicians and clerical staff to support practical laboratory work and to meet the service responsibilities.

3.	Dermatopathology specimens

The number of routine dermatopathology specimens from within the institution and from outside (including referrals) must be at least 3000 per annum. This material must be available for examination to residents and to trainees seeking special qualification in dermatopathology. In addition slide sets should be provided.

4.	Microscopes including a multi-headed microscope
	(Projection microscopes linked to a television video monitor)

5.	Office facilities

	-	Computers, computer medical databases and a multi-user network system for input of data and generation of dermatopathology reports.

	-	Conference room to support teaching and educational responsibilities.

	-	Research space for scientific projects in dermatopathology.

	-	Library with journals, textbooks and other teaching aids related to dermatopathology and pathology.

III)

Examination - Diploma of Dermatopathology

After having completed the full requirements (see Section I and II) in an institutional training programme, which has been accredited, physicians would be qualified to appear before a Commission of Pathologists and Dermatologists to take the examination for special qualification in dermatopathology.

Certification will be based on the examination, which consists of a written and oral test and a practical part comprising histopathologic sections.

Candidates who have been successful in the examination will be awarded the Diploma of Dermatopathology.

Definitions

•	Special Qualification in Dermatopathology All pathologists and dermatologists have training in dermatopathology during their residency. To achieve, however, special qualification in dermatopathology we must accept the fact that dermatopathology cannot be practised as an avocation and therefore additional extensive training leading to a Diploma in Dermatopathology must be obtained. A pathologist or a dermatologist with special qualification in dermatopathology ("practising" dermatopathologist) is a pathologist or dermatologist with special training and/or certification in dermatopathology, who devotes a substantial portion of his professional effort to the reading of cutaneous pathology. Candidates must fulfil specific minimum requirements of training in an accredited center and must have taken the examination for the Diploma in Dermatopathology (exception: grandfather clause) held under the auspices of the International Committee for Dermatopathology. While there is no legal reason why a pathologist would need this special qualification for the ability to read dermatological sections, some might welcome the opportunity to be officially certified as dermatopathologists. For a dermatologist, passing the examination would represent recognition of competency in dermatopathology.

•	Experience Training (grandfather clause) This particular component is the most difficult to define. It is suggested that an initial period of 5 years be allowed for approval of training based on prior experience. This time period can be adjusted and should be related to the establishment of accredited training programmes. The specific details for the accreditation or approval of experience training will be the role of the Review Subcommittee (Board) for accreditation of dermatopathology training. Experience training should basically cover past experience with all of the various disciplines listed under requirements for speciality training in dermatopathology.

•	It is also important to recognise the distinction between several terms commonly used regarding speciality status). Accreditation* has to do with approval of training programmes. Examination is a process whereby competence is ascertained. Certification is attested by a certificate issued by an official body. Certification may be regarding expertise, training, of competence. Licensure is a function of states, nations, and/or governing bodies regulating practice in geographic areas. At present there is a need for the definition of accreditation of training programmes, of certification based on the examination, and of maintaining the competence in dermatopathology (continuing medical education and continuing professional development) in most countries of Europe and many other states in the world outside of the USA.

	*) These definitions were prepared by Mark Allen Everett, M.D., University of Oklahoma, USA.

Guideline development standard operating Procedure of EDF

Step

Responsible

Task

EDF Guidelines
Committee (EDF-GC)

Decision of topic of specific guideline

EDF Guidelines
Committee

Foundation of subcommittee for specific guidelines, nomination of EDF members (50 %)

EDF Guidelines
Subcommittee
(EDF-GSubC)

Identify all existing guidelines for the specific guideline (active process: literature survey plus contact to Dermatological Societies)

EDF Guidelines
Subcommittee

Select the guidelines with highest quality. Criteria for selection:

	1.	Availability of strength of evidence
	2.	Availability of strength of recommendation
	3.	Evidence of mechanics of literature review

EDF Guidelines
Subcommittee

Identification/nomination of additional 50 % EDF members for the EDF-GsubC from amongst the authors of the best guidelines

EDF Guidelines
Subcommittee

Nomination of chairperson for EDF-GSubC from the GSubC members

Chairperson

Consider involvement of other disciplines and patients´ organisations

EDF Guidelines
Subcommittee

Meet

	1.	to decide the author of the first draft and to discuss the present guidelines, their strengths and weaknesses
	2.	6 months later to discuss the draft (consensus conference)

Chairperson

Circulate the guideline draft to national dermatological societies for comments

Guidelines
Subcommittee

Circulate final version for approval among members of the guideline subcommittee

Chairperson of
Subcommittee

Deliver final version to EDF guideline chairperson

EDF Guidelines
Committee

Review and comment guideline

EDF Guidelines
Committee
chairperson

Send guideline for official approval to UEMS (formal approval)

EDF secretary

Distribute guideline for in advance information to EDF members and National Dermatological Societies

EDF

Publication

	1.	on EDF homepage
	2.	in European Journal of Dermatology, British Journal of Dermatology and Journal of Deutsche Dermatologische Gesellschaft

Expiry date 7/2008

	Guidelines Committee of EDF
	Guideline on venous leg ulcers
	Guidelines for the Management of Actinic Keratoses
	Guidelines on Basal Cell Carcinoma
•	Guidelines for the Management of Dermatopathology
	Definition, Classification and Diagnosis of Urticaria (PDF 99KB)
	Management of Urticaria (PDF 119KB)
	Guest book

EDF guidelines