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Cancer (Oncology)

Skin Cancer

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NewYork-Presbyterian Cancer Centers have a history of innovation, leadership, and expertise in the diagnosis and treatment of skin cancers of all kinds, of which there are more than 1.3 million new cases each year. The Cancer Centers offer patients the latest medical and surgical treatment options, including Mohs micrographic surgery – a highly specialized procedure that has the highest cure rate of all surgical treatments for basal cell and squamous cell carcinoma. Physicians are pursuing research that is expanding cancer chemoprevention efforts and clinical care, including new uses of the body's natural immune system to treat melanoma and novel means of vaccinating people against their tumors using their own immune system. Positive developments in the treatment of skin cancer are the result of years of innovation shared among researchers in dermatology as well as in many other fields.

Diagnostic Innovations

About one in five Americans will develop some type of skin cancer in their lifetime. As with most cancers, early diagnosis can be the key to survival. NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center offer annual free screenings – visual inspection of the skin – for melanoma and other skin cancers.

Genetics have been found to play a role in skin cancer, with Caucasians experiencing the highest incidence of the disease. Researchers at the NewYork-Presbyterian Cancer Centers are engaged in genetic studies to better characterize the risk factors for malignant melanoma, specifically studying families who have large numbers of pigmented moles and, therefore, a significantly higher risk of developing melanoma.

To better map and track moles, NewYork-Presbyterian/Columbia recently acquired state- of-the-art MoleMap technology. Performing a full body scan, MoleMap digitally records the location of moles and gives doctors a better sense of whether a lesion has changed or if new lesions have appeared. This is especially helpful for those patients with atypical mole syndrome, in which large irregular moles occur, increasing the risk of developing malignant melanoma. Doctors at NewYork-Presbyterian/Weill Cornell use full-body photography to similarly follow patients for any change in existing moles or the development of new pigmented lesions. Any new or changed lesions are removed surgically for detailed analysis.

Transplant patients represent a new segment of the population with a higher risk for skin cancers. Because of the immune suppression required to block the rejection of transplanted organs, clinicians have found that any undetected pre-cancerous or cancerous cells in these patients behave more aggressively. In response, doctors at the Cancer Centers are forming a new unit to screen transplant patients for pre-malignant and malignant skin lesions. This pre- transplant screening will make it possible to educate patients in ways to minimize their risk of developing skin cancers before their immune system is compromised. Studies are now underway at NewYork-Presbyterian/Weill Cornell to determine which groups of transplant patients face the greatest risk of aggressive skin cancers and the molecular and cellular basis for increased risk in these patients.

Therapeutic Excellence

NewYork-Presbyterian Hospital offers comprehensive programs for patients with melanoma. Highly skilled multidisciplinary teams permit patients to obtain early access to clinical trials that explore the newest options in melanoma therapy. In addition to dermatologists, our staff includes nationally recognized specialists in surgical oncology, medical oncology, radiation oncology, dermatologic surgery, head and neck surgery, plastic and reconstructive surgery, and dermatopathology. Treatment strategies include excisional surgery, Mohs micrographic surgery, sentinel node biopsy, radiation therapy, gamma knife surgery, interferon therapy, interleukin-2 (IL-2) therapy, tumor vaccines, and chemotherapy. At NewYork-Presbyterian/Columbia, the Ludwig Institute for Cancer Research, a large nonprofit cancer research institute, recently established a melanoma laboratory within the center and is facilitating access to the latest vaccines.

Advances in Surgery

Mohs Micrographic Surgery

NewYork-Presbyterian Cancer Centers are among the leaders in Mohs micrographic surgery, the treatment of choice for the majority of high-risk basal cell and squamous cell cancers. The procedure involves the removal of a skin tumor one layer at a time. The layers are immediately examined under a microscope to detect cancer cells. The procedure ensures complete removal of all cancer cells while assuring optimal cosmetic results by minimizing tissue to be removed.

Sentinel Node Mapping and Biopsy (Lymphadenectomy)

The Cancer Centers' physicians are also advancing the use of sentinel lymph node mapping. This highly sensitive technique can track melanomas that may have spread to the lymph nodes. Sentinel lymphadenectomy involves identification and removal of very few (one to two) key lymph nodes to assess the possibility that the cancer has spread.

Radiation Therapy

Gamma Knife Radiation

This radiosurgery system at NewYork-Presbyterian is one of less than 100 in use worldwide, and doctors here were the first to use the procedure on melanoma patients with small brain metastases. Sometimes used in combination with immunotherapy, the procedure is extending life expectancy in these patients. Using a three-dimensional approach, the system is capable of directing up to 201 beams of gamma radiation to converge, with pinpoint accuracy, on a target within the brain. The gamma knife technology allows for the highest level of precision in positioning radiosurgical beams, minimizing damage to surrounding healthy tissue and increasing effectiveness. Less invasive than traditional treatments, gamma knife radiosurgery significantly increases patient comfort. Unlike traditional open skull procedures, which can require several days in the hospital and weeks or months of recuperation, patients treated with the gamma knife can often go home the same day and return to work or school immediately.

Electron Beam Radiation
NewYork-Presbyterian Cancer Centers' radiation oncology team is one of only a handful of centers in the United States offering this therapy. Total skin electron beam radiation is used for certain types lymphomas that affect the skin and may result in the development of rashes, plaques, and tumors. The procedure administers a uniform dose of electron beam therapy to a patient's entire body and can induce prolonged remissions of this type of cutaneous lymphoma.

Immunotherapy

NewYork-Presbyterian/Columbia is the only comprehensive high-dose Interleukin-2 (IL-2) Unit in New York City. Comprised of a dedicated team of health-care professionals, the unit routinely uses high-dose IL-2 for the treatment of patients with advanced malignant melanoma and kidney cancer. IL-2 is a natural protein produced in the body that stimulates certain types of white blood cells, called T-lymphocytes or T- cells. T-cells produce IL-2 to help them grow, divide, and develop into tumor-killing cells. Researchers have found a way to produce IL-2 in the laboratory, and when given intravenously in high doses, it can help stimulate the immune system to help fight cancer cells. High dose IL-2 has resulted in disease regression in 15 to 20 percent of patients with metastatic melanoma. About 6 to 8 percent of patients experience complete regression of all disease.

Experimental Immunotherapy
NewYork-Presbyterian/Columbia is the only site in the United States authorized to conduct clinical trials using a vaccine containing co-stimulatory viruses to fight melanoma. Specifically, the research focuses on a strain of virus used to prevent smallpox that is injected with co-stimulatory molecules and chemokine genes, which play a critical role in many normal and pathophysiological processes. The molecules help stimulate T-cells, which stimulate the immune system to fight cancer. Unlike other vaccine trials, our clinicians are administering the vaccine at the site of tumor growth, which directly treats the tumor and enhances immune responses. Studies have shown dramatic responses in some patients. Doctors believe the vaccine augments the ability of the immune system to attack the tumor. This research is supported by funds from the National Institutes of Health and the Doris Duke Foundation.

NewYork-Presbyterian/Weill Cornell researchers are studying novel ways to induce anti-tumor immunity. One area of investigation focuses on the role of antigen-presenting cells – cells that initiate immune responses. Our research scientists were the first to show that antigen-presenting cells in the skin can present tumor antigens (proteins in tumors that can be recognized by the immune system) for stimulation of an immune response – an important advance in understanding how the immune system fights against skin cancers. They are studying how antigen-presenting cells are influenced by stress, by the nervous system and by environmental exposures such as ultraviolet radiation from the sun. These studies are aimed at developing novel ways to prevent and treat cancer. This important work is funded by the National Institutes of Health as well as foundations and pharmaceutical companies.

Prevention

From genetics to chemoprevention, clinicians at NewYork-Presbyterian Cancer Centers are exploring ways to prevent melanoma and other forms of skin cancer. For instance, the discovery of mutations in gene p16, the site that may cause melanoma, may prove to be an important factor in prevention. Researchers here are also investigating the use of cyclooxygenase II inhibitors, non-steroidal anti-inflammatory agents, in preventing the growth of basal cell cancers. A National Cancer Institute-funded clinical trial is underway to determine whether prolonged oral administration of this category of drugs to patients who have an inherited tendency to develop large numbers of basal cell skin cancers can reduce the rate at which new skin cancers develop.

In addition, studies are looking at the effect of sunlight exposure on the mechanisms used to control the rate of cell division or cell cycle, which, when uncontrolled, lead to tumor formation. Researchers are also studying the mechanism whereby natural substances isolated from plants can reduce the risk of skin cancer. These studies include extracts of Japanese green tea, resveratrol – a chemical isolated from the skin of red grapes, and cyclopamine a substance found in the corn lilly which can inhibit the development of tumors. Also under investigation at NewYork-Presbyterian/Weill Cornell is the link between sunlight and the suppression of the immune system and its role in helping skin cancers escape immunologic control. This work may lead to new approaches to prevent the development of skin cancer.

Free Melanoma Screening

May is National Melanoma and Skin Cancer Detection Month. Each year, NewYork- Presbyterian Hospital's Department of Dermatology offers free melanoma/skin cancer screenings at three New York City locations. The free screening is part of the Melanoma/Skin Cancer Detection and Prevention Screening initiative sponsored by the American Academy of Dermatology. As with many cancers, early detection can be the key to survival. For more information on the screenings, please call (212) 305-6995 (NewYork-Presbyterian/Columbia), or (212) 746-2000 (NewYork-Presbyterian/Weill Cornell).