By George Bicher
At the May 27 meeting of the Retired Men’s Association Spike Lipschutz introduced the speaker, Dr. Richard Connors, a well-known and highly respected dermatologist who has cared for patients in our communities, including many RMA members, for over 45 years.
Dr. Connors graduated from Weill Cornell Medical School, did his residency training at New York Hospital, and completed a dermato-pathology fellowship at New York University. He served as Assistant Professor in the NYU Dermatology Department for 43 years, teaching dermatology fellows. He has a private practice in Greenwich and has been a member of the Greenwich Hospital Medical Staff for many years. The title of Dr. Connors presentation was “Skin Disorders: From the Commonplace to the Critical.”
In what felt more like a community gathering than a medical seminar, Dr. Connors took his audience on a journey across the human landscape, from the itchy indignities of high school to the life-threatening precipices of the oncology ward. He spoke with the easy authority of a veteran who had witnessed dermatology evolve from an era of “smelly coal tar” into a high-tech frontier of immunotherapy. Yet , despi te the breakthroughs, Dr. Connors remained a self-described “neutral observer”—a solo practitioner in a world of corporate medical groups, still stunned by the $2,500 price tag on a single tube of cream.
He began with the “commonplace,” introducing his own “Therapeutic Success Index” to grade how well modern medicine can actually help a patient. On this one-to-three scale, he gave acne a triumphant “3,” recalling his own teenage years plagued by high school breakouts that would have made him a candidate for Accutane had it existed then. He noted that while dermatology was once mocked as a field where “no one improves, but no one dies,” immunology has redefined the stakes. He spoke of warts with less optimism, grading their treatment a “1,” but found a critical success in the Gardasil 9 vaccine. He urged the audience to ensure that their grandchildren received the shot, citing the dramatic decrease in cancerous genital lesions among those vaccinated against the human papillomavirus.
The presentation moved into the environmental hazards of a Connecticut summer. Dr. Connors warned of the “leaves three, let it be” rule for poison ivy, explaining that the chemical urushiol— which he noted almost never degrades—can cause a rash even from a dead vine pulled in April. He shared a curious case of “lime juice” dermatitis, or phytophotodermatitis, where furocoumarins in citrus or celery sensitize the skin to the sun, leading to “accentuated burns” for those who spray lime on a salad before lounging on a deck.
As the talk shifted to the “critical,” Dr. Connors described the dormant chickenpox virus as a “brown bear in the winter,” sleeping in the nerve centers before waking as shingles. He spoke with urgency about the Shingrix vaccine, noting that for seniors, the resulting pain can be a torment that lasts for years. He also touched on the dangers of the deer tick, though he was quick to mention that a tick must usually be attached for thirtysix hours to transmit Lyme disease. More devastating, he said, was Rocky Mountain Spotted Fever, caused by the Rickettsia bacterium; he warned that if the resulting “purpuric” rash is not treated with doxycycline within five days, the prognosis can be grim.
In the latter half of his talk, Dr. Connors focused on the malignancies of the epidermis. He credited Dr. Frederick Mohs, a general surgeon at the University of Wisconsin, for developing the methodical shaving technique now known as Mohs surgery. To illustrate the precision of modern care, he introduced Dr. Kishwer Nehal, a former resident of his at New York University who now leads the dermatologic surgery department at Memorial Sloan Kettering Cancer Center. Dr. Nehal uses surface microscopy to define the invisible borders of lentigo maligna, a challenge because the margins are often more extensive than they appear to the naked eye.
The most sobering moment for the local crowd came when Dr. Connors pulled out statistics from the Connecticut Tumor Registry. He revealed that Greenwich is a “melanoma capital,” with an incidence rate that rivals or even exceeds Queensland, Australia. While the national average is roughly 22 cases per 100,000 people, Greenwich—with its fair-skinned population and a culture of boating at Tod’s Point or Nantucket— frequently records between 46 and 61 cases annually. He even touched on Merkel cell carcinoma, a red nodule he described as “more serious than melanoma,” typically found in fair-skinned senior men.
Dr. Connors did not shy away from the financial reality of these breakthroughs. He detailed the “waterboarding” process of insurance prior authorizations, where doctors are forced to try ineffective treatments before being allowed to prescribe what actually works. He pointed to new Janus kinase inhibitors like Opzelura, which costs $2,500 for a small tube, and Rinvoq, which carries a staggering price tag of over $21,000 for a three-month supply. He remained stunned that companies would charge so much for medications that can finally clear “once-intractable” inflammations. He encouraged the use of simple, wide-brimmed hats and mineral sunscreens like those from La RochePosay, warning that “wrinkle machines”—tanning beds—are the primary reason his generation is now “popping out” skin cancers decades after their last summer burn.
The presentation ended with an informative Q&A session.
The talk can be viewed by going to the RMA website at https://greenwichrma.org, clicking on “Speakers,” then “Past Speakers,” and then “RMA Vimeo Library.”
Note: The views expressed in these presentations are those of the speakers. They are not intended to represent the views of the RMA or its members.
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