Candice E. Brem, MD ‘14 has always had an eye for detail. From sketching intricate drawings as a fine arts major, to studying skin slides in pathology, she welcomes the opportunity to stare at an image and see what only a few trained individuals can see.
It’s that visual acuity—and a whole lot of hard work—that’s helped her earn a fellowship in Dermatopathology at Boston University, starting in July 2018. Until then, she’s finishing out her AP/CP Pathology residency at Allegheny General Hospital (AGH) in Pittsburgh, PA.
Dr. Brem went to The George Washington University on a fine art scholarship and graduated with a B.A. in fine arts and a B.S. in biology, concentrating in developmental biology. These two subjects might sound like totally different ends of the spectrum, but according to Dr. Brem, who describes herself as a color pencilist by trade, they’re much closer than you might think.
“I like the nitty-gritty details,” she says. “When I started pathology, it was like rediscovering art. Disease entities are like half-finished paintings. Looking at them, you discover certain little pieces that are integral to understanding what they might become.”
A Day in the Life
A few of the most common diseases that Dr. Brem typically identifies while perusing dermatopathology slides are squamous cell carcinoma, basal cell carcinoma, and melanoma. But there’s a myriad of possibilities that she might sift through—vesiculobullous lesions (e.g., friction blisters), primary cutaneous lymphomas, dermal hypersensitivity reactions, and a milieu of inflammatory and neoplastic (abnormal growth) conditions.
Sometimes, she explains, you can look at a skin slide for two seconds and you know what it is. Other times, it could take more than a week and perhaps warrant expert consultation.
While there’s a perception that pathology is a solitary discipline, Dr. Brem says that’s not accurate. “We don’t work in a vacuum,” she says. “In dermatopathology, we consult with dermatologists, surgeons and other physicians quite often to learn more information about the patient. For example, where is the rash, how long has it been there, has it gotten better or worse?”
It’s especially important, Dr. Brem says, to note if the patients have treated themselves or applied home remedies or over-the-counter medications. “These treatments can blur the original histology of a lesion," she says. "Overall, we need to know where a lesion started in order to better predict where it will end up or what it will become.”
The Path to Fellowship
After her first brush with dermatopathology in pathology class at AUC, Dr. Brem was determined to earn a spot in this competitive subspecialty. She made it known throughout her clinical rotations that she was interested in dermatopathology. In turn, many of her attendings allowed her to evaluate their patients presenting with interesting skin lesions, and invited her to relevant presentations. Through these opportunities, Dr. Brem was able to see a variety of rare skin conditions (i.e. congenital ichthyosis, measles, Steven Johnson Syndrome), which further solidified her love of all things relating to the skin.
"When I started pathology, it was like rediscovering art."
During residency, Dr. Brem found a mentor in Dr. Jeffrey Uchin, the Director of Dermatopathology at Allegheny General Hospital. With Dr. Uchin’s excellent guidance and the overt support of the AGH pathology department, her family, friends and fellow AUC graduate John Paul Brady IV, MD ’14, Dr. Brem dedicated herself to the field, presenting five posters at the American Society of Dermatopathology (ASDP) annual meetings in 2015 and 2016.
She is currently preparing a sixth poster for the future October 2017 ASDP meeting. It’s valuable experience for her fellowship: The Boston University program will include a year of in-depth research in addition to a year of practical dermatopathology training.
“I’m grateful to AUC for the unique memories and varied clinical opportunities that allowed me to pursue my dream of becoming a Dermatopathologist, which is arguably the most competitive pathology subspecialty,” Dr. Brem says. “After all, it was AUC’s pathology course, taught by Dr. Phillip Tisdall, that initially introduced me to the beautiful mysteries of the epidermis, dermis and subcutis, and ultimately led to my decision to pursue a pathology residency.”
