More than skin-deep
A growing program focuses on melanoma and other sometimes-deadly
cancers
By Richard Saltus
A photograph of a dermoscope
Our skin can seem fragile when it's cut, annoying when it itches, and distressing when it ages. Considering all it's asked to do, however, this eight-pound organ has remarkable powers.
Skin keeps us from drying out, helps regulate temperature and excrete wastes, and produces vitamin D. It's also a shield against sunlight, poisons, bacteria, and other invaders. It even serves as an outpost of the immune system, recruiting white blood cells to fight off infections.
But long-term guard duty takes a toll. Over years and decades of being zapped by ultraviolet radiation, skin becomes damaged and, as a result, half of all Americans will develop skin cancer at least once, says the American Cancer Society (ACS). Most of these cancers — known as squamous and basal cell — will be easily cured if caught early, but some types, like malignant melanoma, can be deadly. Melanoma is life-threatening when the tumor penetrates the skin and spreads through the circulation to other organs.
A dermoscope helps clinicians examine skin.
Dana-Farber's Cutaneous Oncology Disease Center, part of the Dana-Farber/Brigham and Women's Cancer Center, is equipped to diagnose and treat early-stage and advanced melanoma and other, rarer, skin cancers. Over the last five years, this multidisciplinary effort has grown and includes dermatologists, surgical and medical oncologists, plastic surgeons, radiation oncologists, nurse practitioners, and others with expertise in these challenging cancers.
"Prior to 1999, there was no organized clinical program designed to diagnose and treat patients with different types of skin cancer," says Thomas Kupper, MD, founder and current director of the cutaneous oncology center. "Now, after five years of hard work by our physicians and nurses, we're beginning to see patients from around the country with melanoma, CTCL (cutaneous T-cell lymphoma), and complicated non-melanoma skin cancers, such as the rare Merkel cell carcinoma."
The center also offers a specialized technique, Mohs surgery, that minimizes the amount of tissue excised in cosmetically sensitive areas. Opened in 1998, the DFCI Mohs Center treats more than 700 patients annually. It is led by Carl Schanbacher, MD, who stresses that the technique has been shown to be the most effective method of curing these cancers.
The skin cancer center's growth owes much to a federal grant from the National Cancer Institute (NCI) through a Specialized Program of Research Excellence, or SPORE. Headed by Kupper, this five-year, $14.25 million initiative also involving Harvard Medical School and affiliated hospitals is the nation's only such program in the field. In addition, individual NCI grants and foundation funds support skin cancer research at DFCI.
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