Yale dermatologist blends creativity and science, personally and professionally

June 1, 2012

It was the late 1980s, and David J. Leffell, M.D., set out to launch a dermatologic surgery and oncology program at Yale University School of Medicine. His aim: To marry advanced diagnostic and treatment techniques in cutaneous oncology with clinical research.

Key Points

It was the late 1980s, and David J. Leffell, M.D., set out to launch a dermatologic surgery and oncology program at Yale University School of Medicine.

There were naysayers, says Dr. Leffell, who today is the David Paige Smith professor of dermatology and surgery and section chief, dermatologic surgery and cutaneous oncology at Yale. He also serves as deputy dean for clinical affairs at the university. He remembers one colleague who said there was no skin cancer in Connecticut and told Dr. Leffell to go somewhere south.

His perseverance paid off. Among Dr. Leffell's biggest research accomplishments was the discovery of the first skin cancer gene, PTCH1, in 1996, in collaboration with colleagues in the department of genetics. Since its discovery, the gene has become a key player in the understanding of cancer. In fact, Genentech/Roche got approval earlier this year for a drug to treat serious skin cancer (vismodegib, Erivedge) based on the pathway in which the PTCH1 tumor suppressor gene plays a critical role.

Working out the science

Dr. Leffell says much of his research focuses on working out the science of skin cancer.

"We just published an article in one of the genetics journals about further parsing out the genetics of basal cell cancer (Heffelfinger C, Ouyang Z, Engberg A, et al. G3 (Bethesda). 2012:2(2):279-286). And most recently, we published a large study on the use of tanning parlors by young women (Ferrucci LM, Cartmel B, Molinaro AM, et al. J Am Acad Dermatol. Epub 2011 Dec. 8). We already knew that tanning parlor use by young women increases the risk of melanoma, but this was the first time it was shown that indoor tanning increases the risk of basal cell cancer," he says.

Dr. Leffell is also an editor of the latest (eighth) edition of Fitzpatrick's Dermatology General Medicine. And in 2000, Hyperion, a New York publisher, published his consumer book titled Total Skin: The Definitive Guide to Whole Skin Care for Life.

Creativity and teaching

While research and publishing are his passions, Dr. Leffell says his greatest professional satisfaction comes from having trained 17 fellows and countless residents.

Residents certainly need to have command of book knowledge, but in dermatologic surgery, one needs to have a plan, he says. When it comes to facial reconstruction after Mohs surgery, it's equally important to be creative.

"You always have to be flexible enough to have plan B, because things don't always work out the way you want," Dr. Leffell says. "What I say to patients is, 'Removing the cancer with the Mohs technique is a process that's relatively well defined. But reconstruction is improvisational, like jazz. You have general guidelines about what you need to do, but every patient is different, and every wound is different.'"

Creativity is a big part of Dr. Leffell's personal life. A photographer who says he prefers photographing things that don't have a pulse, he recently published a large-format book titled Connecticut Pastoral ( http://www.gaohpress.com/) featuring scenes from northwest Connecticut and the lower Berkshires.

He also enjoys oil and mixed media painting and furniture making. "My wife always does a finger count when I come back (from my workshop)," he says.