Obituary: Dr Neil Smith

Neil Smith was a skin pathologist of international renown, a remarkable clinician, and the leading opinion in the UK on the diagnosis of malignant melanoma and the management of cutaneous lymphoma.

At the time of his death, he was Director of the Skin Tumour Unit at the St John's Institute of Dermatology, St Thomas's Hospital, London, Director of Diagnostic Dermatopathology at the same Institute, and President of the British Society for Dermatopathology. In addition, he had the distinction of being a Fellow of three Royal Colleges: the Royal College of Physicians, the Royal College of Pathologists and the Royal College of Radiologists.

Born in Manchester and educated at Manchester Grammar School for Boys, Smith's study of cutaneous diseases began in 1974 when he joined the Dermatology Department of St George's Hospital, London, having qualified there four years previously. Smith was a very talented artist which perhaps explains his aptitude and early interest in dermato-pathology, the microscopic diagnosis of skin diseases.

In 1977 he moved to the St John's Institute of Dermatology as Lecturer in Histopathology before his appointment as Consultant Dermatologist in 1979 and Director of the Skin Tumour Unit in 1980. Although this Unit treats patients with all forms of skin cancer, its reputation was established principally in the field of cutaneous lymphoma and has become the national referral centre for the management of patients with this complex and sometimes fatal group of diseases.

The Unit has added greatly to our knowledge of cutaneous lymphoma, particularly through the application of molecular biological techniques which are now used routinely as an aid to diagnosis and to determine prognosis. In addition the Unit has introduced new forms of therapy and was the first centre in the UK to use extracorporeal photopheresis, a method of irradiating circulating malignant cells using ultraviolet light. As a member of the European Organisation for Research and Treatment of Cancer (EORTC), Smith was one of a small number of pathologists selected to devise a new histological classification of cutaneous lymphomas.

Although his renown was in the field of skin pathology, Neil Smith was also an outstanding clinician with a meticulous approach to the diagnosis of rare skin disorders. He personally devised a pathology-based classification of skin diseases which comprises over 2,500 conditions. He was disdainful of many other less detailed diagnostic indexes which he regarded as of administrative rather than of clinical value.

Because of his encyclopaedic knowledge of dermatology, Smith was often the opinion of last resort with complex or difficult cases. He was therefore greatly in demand both as a clinical opinion and as a pathologist, but despite these major pressures on his time he expended considerable time and effort on individual patients, many of whom were devoted to him.

Although his NHS appointment entitled him to undertake private work, he never saw patients privately and worked considerably beyond his contracted hours. He could often be found in the Institute before six in the morning and at weekends preparing lectures for meetings. Few doctors nowadays would pursue such a daunting work schedule with such energy and enthusiasm.

He was also a remarkable teacher and lecturer and illustrated many of his lectures with high-quality drawings and diagrams of his own invention. Post-graduates attend the Institute of Dermatology from all parts of the world and dermatopathology is an essential part of their training. Dr Smith's tutorials were always packed, both with information and people. In demand as a teacher and speaker both within the UK and worldwide, he particularly enjoyed visiting Germany; he had acquired a flat in Berlin and delivered his lectures in fluent German. In 1994, the last year he was unaffected by illness, he delivered over 20 guest lectures, in Barcelona, Graz, Brussels, Argentina, South Africa, Brisbane, Boston and Greece. Indeed he loved nothing more than to travel, to meet old friends and make new ones.

Throughout his career Neil Smith wrote or contributed to over 70 major scientific publications and became a member of many learned societies both in the UK and abroad. He became a member of the Royal College of Physicians in 1973 and was made a Fellow in 1987. In 1993 he was elected a Fellow of the Royal College of Pathologists in 1995.

His many interests outside medicine include the theatre and languages, and he will be remembered as the resident, albeit sometimes controversial, cartoonist of the New Musical Express in the 1960s. However, his friends and colleagues will remember him best as a wonderful bon viveur and raconteur. Unfortunately, he required a cardiac valve replacement ten years ago and more recently did not survive a prolonged struggle against the complications of bacterial endocarditis - a struggle he surmounted with characteristic fortitude. He will be remembered by his friends, his colleagues and his patients not only for his wisdom and knowledge but for his incredible generosity and kindness. He is survived by Ron Munro, his devoted partner of 25 years, and his sisters, Brenda and Linda.

Neil Procter Smith, dermatologist: born Manchester 12 December 1996; died London 14 March 1996.

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