Our Approach to Cutaneous (Skin) Cancer Treatment

As a patient in the Center for Cutaneous Oncology, you will be cared for by a comprehensive team that combines leading experts with the latest technological and research advances. Our team works together to create personalized treatment that supports all your medical, nutritional, and emotional needs.

You have access to:

  • Clinical trials involving the latest and most innovative therapies
  • A treatment team of world-renowned experts in:
    • Dermatologic oncology
    • Medical oncology
    • Surgical oncology
    • Radiation oncology
    • Radiology
    • Dermatopathology
  • A full spectrum of state-of-the art diagnostic radiology services, including positron emission tomography / computerized tomography (PET/CT)
  • Support programssocial workerscounseling, and palliative care services to improve quality of life

Other therapies that may be used in your treatment include:

  • Advanced radiation oncology techniques for highly precise, effective, and safe delivery of treatment. In addition to external beam radiation therapy (EBRT), specialists may also use intensity modulated radiation therapy (IMRT) and surface mold computer-optimized high-dose-rate brachytherapy (SMBT) to treat Merkel cell carcinoma, basal and squamous cell carcinomas, cutaneous T cell and B cell lymphoma, Kaposi's sarcoma, and angiosarcoma.
  • Photopheresis, a technique for removing a patient's blood, exposing white blood cells to ultraviolet light, and re-infusing the cells for patients with cutaneous T-cell lymphoma and graft-versus-host disease. Prior to reinfusion, patients are given a medication that is activated by ultraviolet light and retained preferentially in diseased cells.
  • Phototherapy. By using special wavelengths (Psoralen and UVA or UVB) of light to treat inflammation in the skin, phototherapy can be a safe and effective way to treat early stages of cutaneous lymphoma, which can avoid the side effects of other therapies.
  • Other skin-directed therapies such as topical corticosteroids, topical chemotherapy, and intralesional injections of both.

Cutaneous T-cell and B-cell Lymphomas (CTCL and CBCL)

Treatment of CTCL is dependent upon the stage of disease. CTCL limited to the skin can be treated with a skin-directed therapy, while CTCL that also involves blood, lymph nodes, or other organs requires systemic therapy.

Treatment of advanced CTCL is highly specialized. We offer a variety of systemic therapies for CTCL patients with advanced stage disease including:

  • biologic response modifiers
  • retinoids
  • histone deacetylases (HDAC) inhibitors
  • both oral and intravenous single and multi-agent chemotherapies

Cutaneous B cell lymphomas are less common than CTCL. The treatment of most primary CBCLs is very different from B cell lymphoma that involves the lymph nodes. How we treat the disease also depends on the specific cell type features, the extent of skin involvement, and whether or not the blood and lymph nodes are involved.

Recommended treatments may include a variety of therapies, including ultraviolet light therapy, biological response modifier therapy, electron beam radiation therapy, oral or intravenous chemotherapy.

Systemic therapies for cutaneous B cell lymphomas that involve skin and lymph nodes or other organs are similar to those for B cell lymphomas in general. The Center works closely with the Lymphoma Program to make sure our patients receive the appropriate treatment for their disease.

The Cutaneous Lymphoma program also treats very rare diseases of the hematopoietic system involving skin, including Natural Killer Cell Lymphomas (NK lymphomas), NK/T cell lymphomas, Langerhans Cell Histiocytosis, and Leukemia Cutis.

Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine carcinoma. Our team of experts in dermatologic oncology, surgical oncology, radiation oncology, and medical oncology will work to develop a treatment plan depending on the stage of Merkel cell carcinoma. Your evaluation and treatment may include:

  • Histopathological evaluation by our team of dermatopathologists.
  • Diagnostic imaging, including positron emission tomography/computerized tomography (PET/CT).
  • Lymph node evaluation by sentinel lymph node biopsy.
  • Radiation therapy, including external beam radiation therapy (EBRT), intensity modulated radiation therapy (IMRT) and surface-mold computer-optimized high-dose-rate brachytherapy (SMBT).
  • Individualized chemotherapy.

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of cancer, with about one million new cases estimated in the U.S. each year. When detected early, it can be easily treated; however, if not addressed quickly and definitively, it can be difficult to eliminate. Basal cell carcinoma on the face is typically treated with Mohs micrographic surgery, an approach that provides the highest cure rate, lowest recurrence, and the best cosmetic result.

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common form of skin cancer, with more than 250,000 new cases per year estimated in the United States. Most cases of squamous cell carcinoma can be cured when identified early.

Squamous cell carcinoma is usually treated with surgery. Mohs surgery is used if the tumors are located on the face, are larger than a nickel, or have other aggressive features. Surgical oncologists treat localized metastasis, and these patients often require postoperative radiation and chemotherapy.

Rare Skin Cancers

The Center for Cutaneous Oncology also treats rare adnexal tumors of eccrine, apocrine, sebaceous and hair follicle origin. Other extremely rare cutaneous cancers seen at the Center include:

  • Kaposi's Sarcoma, in which malignant cells form in the tissue lining the lymph vessels under the skin or in mucous membranes. It is more likely to occur in people who have immune systems weakened by disease, such as HIV or by drugs given after an organ transplant.
  • Dermatofibrosarcoma protuberans (DFSP), a locally aggressive soft tissue neoplasm with intermediate-to-low grade malignancy and a high recurrence rate. Lesions are typically firm, somewhat scar-like plaques or nodules with a pink to reddish-brown color. Mohs surgery is often employed in these cases.

Hematopoietic Stem Cell Transplant

Increasingly, centers are moving towards allogeneic stem cell transplantation in selected CTCL patients with advanced, refractory, or aggressive disease, with the goal of long term remission and cure. The Center for Cutaneous Oncology works closely with the Bone Marrow Transplant team to offer the best possible treatment for all patients.

Graft-Versus-Host Disease (GVHD)

GVHD occurs as a result of allogeneic hematopoietic stem cell therapy for leukemias and lymphomas, when white blood cells from the donor (the graft) identify cells in the patient's body (the host) as foreign and attack them. Although less common, it can also occur after solid organ transplantation, particularly after liver and small bowel transplantation. Skin is the most common target of involvement in GVHD.

The goal in treating GVHD is to treat the disease without impairing graft-versus-leukemia (or lymphoma) effects. Through our coordinated team, we can choose among various oral pharmacologic therapies, infusion medications, and extracorporeal photopheresis.

Oral and infusion medications such as mycophenolate, tacrolimus, sirolimus and rituximab, among others, are used to treat and prevent disease progression. Physical therapy helps treatment and prevention of joint problems and skin tears. Wound care is central to our therapeutic work, which aims at preventing infection and inducing full wound closure.

Finally, our center is also able to assist with the treatment of drug reactions and other cancer-related skin diseases in patients who also have GVHD.

Though the Center focuses on adult patients, a clinic is also offered for pediatric patients in conjunction with the Jimmy Fund Clinic.

Mohs Micrographic Surgery Center

Developed in the 1940s by Dr. Frederic Mohs, Mohs micrographic surgery is an outpatient procedure that involves surgically removing the visible tumor, along with a thin layer of normal-appearing tissue around and beneath the tumor. This tissue is then frozen and examined under a microscope. If cancer is seen at the edges or under the surface of the removed tissue, additional tissue is removed from the patient, but only in the area where cancer remains.

Mohs is primarily used to treat basal cell carcinoma and squamous cell carcinoma. It has become a standard treatment for tumors on the face, hands, and lower legs, where it is important to preserve normal skin, or where healing is difficult.

Although no treatment is guaranteed, the success rate of Mohs micrographic surgery is very high — 98 percent for most cases — even if other forms of treatment have failed. This is due to the microscopic examination of nearly 100 percent of the cut surgical surface, which minimizes the chance that cancer cells are left behind during surgery.

The rapid and precise examination of the removed skin reduces guesswork, which means as little healthy tissue as possible is removed. As a result, Mohs surgery tends to minimize scarring.