This Roswell Park dermatologist and dermatopathologist learned an early lesson in how health affects our goals
As a preschooler, a young Susan Pei remembers shouting out an answer when her teacher asked the class what they hoped to become later in life. But the teacher’s reply to the girl deeply affected her for years to come.
“My answer was ‘Astronaut!’ to which the teacher rather sternly replied, ‘You have to be in perfect health in order to be up in space.’ I remember thinking ‘I have cavities, so that means I’m not perfectly healthy and I guess that means I can’t ever be an astronaut.’ I vividly remember the sense of dejection and disappointment, of thinking that something was completely out of my reach,” she says.
Fortunately, she had many other interests, though still not medicine, as she grew.
“I decided if I can’t be an astronaut, I could be a cosmologist — a theoretical physicist — because I could study the stars from my desk and no tooth ailment was going to prevent me from doing that!” she says. “I also wanted to be an animator and work for Disney because I enjoyed art. And I wanted to be a guidance counselor or a teacher, because I enjoyed teaching and especially finding resources to help people achieve their dream careers.”
But even after young Susan voiced her disappointment to the teacher whose words caused her childhood dream to be an astronaut to “basically end on the spot,” the woman didn’t revise her response. That set the future Susan Pei, MD, to thinking.
Healthy or not, how we achieve our goals
“Whenever I think back to that, a couple of things stand out to me,” she says.
“One, about the misconceptions of what ‘health’ means and represents to every individual. Two, how vital health is to people achieving their goals, or on the flip side, how individuals can achieve goals in spite of their physical condition, if only we can enable and support them along the way.”
Those thoughts followed her through college, where she still hadn’t decided upon her ultimate career choice — until her last semester.
“In college, my favorite courses were diverse: art history, animal behavior and abstract algebra, in that order. It wasn’t until the very last course I took in college — a neuroscience course uniting basic science of neurobiology with medical neurology — that my interest in medicine was sparked,” Dr. Pei says. “I was really interested because the science could be so tangibly applied to improve people’s lives. I didn’t want anyone to be like preschool me, to think that their health or physical condition would stand in the way of achieving whatever life goals they have.”
Today, Dr. Pei works as a dermatologist and dermatopathologist in the dermatology and pathology departments at Roswell Park Comprehensive Cancer Center, where she treats all adult patients with skin conditions — not only skin cancer or conditions related to cancers.
She chose Roswell Park for its people
Roswell Park was the last place she interviewed, via a virtual meeting that took place during the pandemic. She already had other job offers at the time.
“I had never set foot in Buffalo and had no connections here. People ask me, ‘Why did you choose Roswell then?’ It’s simple: the people. Even in a virtual interview, through a screen, everyone’s energy, excitement for medicine and dedication to patient care was palpable,” she says. “This is a place where everything is possible, opportunities abound and you can really make an impact on patient’s lives, on health care and on future generations of physicians. Both the dermatology and pathology departments, as well as the division of dermatopathology, are helmed by leaders with a clear vision towards innovation and pushing the field forward in cancer care, and I wanted to be part of that.”
Dr. Pei says she was inspired to pursue dermatology because the skin is one of the most fascinating organs. “It is the most visible, so patients with skin diseases may feel social stigma when those around them can see their skin condition, which creates additional stress on top of them already dealing with their skin conditions,” she says.
“The skin is also a complex organ that ties together the fields of immunology, infectious disease, oncology and so on. Skin diseases are not just endemic to the skin; they can be reflective of underlying internal conditions, such as immunologic conditions and gastrointestinal diseases.”
Dr. Pei also enjoys that dermatology allows her to take care of patients across all age groups, from babies to grandparents. “People often think of dermatology as a subspecialty, and it is, we are skin experts who are consulted on for the most rare and obscure skin conditions, yet dermatology also includes primary care, including preventive care, and I enjoy that duality,” she says.
“Dermatology is also a very visual field. You have to be able to pick up all the minute subtle differences in each different types of rashes or skin tumors, and as I mentioned before, I enjoy art, so I really enjoy the visual challenge of dermatology.”
Becoming a doctor and a detective
But her passion is in dermatopathology, the diagnosis of skin conditions — cancers and rashes — through histologic, or microscopic, examination. An experience she had while working with a dermatologist early in medical school inspired her to follow this field.
“A man in his 20s had a very common skin rash, which required the dermatologist to immediately do a KOH scraping at the bedside — basically gently scraping the surface of the skin and transferring that onto a microscope slide, then adding special stains to examine the findings under the microscope. He was able to immediately diagnose the patient on the spot, giving the patient a treatment recommendation as well as reassuring the patient it was a benign rash,” she recalls.
“Observing all this in action was like watching a detective on a TV show. The fascinating thing about dermatopathology is that being able to recognize what the skin and skin conditions look like under the microscope makes you a stronger clinical dermatologist, because you are able to unite the microscopic as well as macroscopic presentation of skin disease. It makes you pick up on very subtle clues on a patient’s skin when you evaluate them in clinic that you may otherwise miss.
“It goes the opposite way too. Having experience diagnosing and treating patients in clinic helps me make the right diagnosis under the microscope. Very often the correct microscopic diagnosis can only be achieved if you are well versed in how the patient’s skin condition appears clinically or how the condition responded or did not respond to treatment.”
New life-saving therapies
For her cancer patients, Dr. Pei is excited about the emergence in recent years of immunotherapies and targeted therapies, “in which medications and treatments harness the patient’s own immune system to fight cancer.” She says she is fascinated by this field for two reasons.
“One, these new therapies can be life-saving. It is therefore critically important that patients be able to remain on these cancer therapies for as long as possible.
“Dermatology is often dismissed — incorrectly — in medicine as focused only on ‘superficial’ aspects. Surely the skin is the last thing a patient would focus on when they are battling life-threatening metastatic breast or lung cancer, right? But immunotherapy and targeted therapy-induced rashes can greatly affect patients’ quality of life and sometimes even be dangerous. The last thing we want is for patients to have to discontinue their life-saving therapies due to rash.
“The second thing is that by studying such rashes, we may be able to unlock secrets of what causes skin conditions in patients not undergoing cancer therapy. Why is it that when we rev up the immune system to fight cancer, these patients get rashes similar to rashes that patients without cancer get? What are the implications of the immune system in causing or driving certain rashes? Those are very interesting questions, and something I would like to study and explore more in depth, especially in collaboration with my colleagues in medical oncology and immunology.”
New technology to better treat patients
Dr. Pei and the dermatology department are in the process of acquiring and implementing non-invasive skin imaging to detect, treat and manage skin cancers and conditions.
“This is really cutting-edge technology that very few places in the country have. Traditionally, in order to make a histologic diagnosis, you need to take a biopsy from the patient, meaning the patient has to undergo an invasive procedure,” she explains. “With this new and emerging skin imaging technology, we may be able to diagnose skin cancers and conditions with a non-invasive imaging device, without the patient needing to undergo a biopsy. It has the potential to transform how we diagnose and treat certain skin cancers.”
Dr. Pei especially enjoys being a researcher and detective of sorts in her work at Roswell Park.
“I love digging through the medical literature or books to figure out a really obscure or rare diagnosis. It requires uniting my strengths as a clinical dermatologist and a dermatopathologist. I will go the extra mile and read the patient’s clinical chart, review their labs and look at the clinical photos of the rash or tumor in order to put all the pieces of the puzzle together,” she says. “It feels very fulfilling because clinicians, whether other dermatologists, oncologists or surgeons, are relying on you as the dermatopathologists to make a diagnosis. A pathologist is the ‘doctor’s doctor’ after all.”
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A doctor who teaches, too
And Dr. Pei, who taught university English in China on a U.S. Fulbright grant prior to medical school, likes the teaching aspect of her job.
“I enjoy teaching patients about skin health, about their skin conditions. I feel it empowers them to make the best healthcare decisions for themselves. I also love teaching student learners, whether pre-med students, medical students, residents or fellows. It’s exciting to share your knowledge and students always keep me on my toes. They challenge me to think about old concepts in new ways all the time,” she says.
Certainly, Dr. Pei has emerged as a more positive educator than the preschool teacher who discouraged her dream of becoming an astronaut. Her goal is to encourage everyone she encounters, from patients to students to colleagues and friends.
“It all comes back to what I said before, how I enjoy helping people achieve their goals,” she says. “Health is so fundamental to the human condition that you can make such a big impact on someone’s life by helping them achieve their health goals, whether it’s preventive care, curing a disease, managing a chronic condition, or palliative care. There is so much misunderstanding and miscommunication about health information and knowledge, so the teacher in me enjoys the opportunity to communicate medical information to my patients in a way that they can understand and feel confident about."
It seems she’s on the right path with teaching medical students and residents, which is a step toward fulfilling her goal to help train future generations of dermatologists and dermatopathologists.
“I started teaching dermatopathology to a group of dermatology residents, and after the first session, a senior resident told me that it was the best dermatopathology session she had ever had,” she says. “I was really grateful and humbled by that.”