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Multidisciplinary Cutaneous Oncology Programs


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Multidisciplinary
Cutaneous Oncology Programs






The Department of Dermatology, along with the Ireland Cancer Center of University Hospitals, the Case School of Medicine, and the Cleveland Veterans Affairs Medical Center have developed special programs to deal with the cross-disciplinary needs of patients with skin cancers. The Cutaneous Lymphoma and Melanoma Programs assist in the diagnosis and treatment of patients with melanoma and lymphoma, or benign conditions which appear very similar. Achieving optimal outcomes for patients with skin cancers require complex coordination of rapidly evolving standards of care by personnel from multiple specialties. These programs provide the type of cross-specialty care and care-path development that is required for optimum patient benefit and efficient delivery of services for patients with high-risk cancers occurring in the skin. Weekly tumor boards staffed by physicians of different specialties, nurses, and program staff allow rapid decision-making based on pathologic, clinical and lab data, and consensus management recommendations.

 

Multidisciplinary Cutaneous Lymphoma Program

The Cutaneous Lymphoma Program assists in the diagnosis and treatment of patients with lymphoma or benign conditions which appear very similar. Cutaneous lymphoma is a serious disease which is difficult to diagnose and treat, and requires multiple specialists. Therefore, we have assembled a multidisciplinary team with internationally recognized expertise in patient-centered care and research in cutaneous lymphoma. Our team members have made advances in the area, including basic causes, new diagnostic methods, clinical evaluation, advanced therapeutics, and measurement of patient benefit.

Patients are identified by physician referral to the Cutaneous Lymphoma Program. Comprehensive history, exam, photos, skin biopsies, blood tests, imaging studies, immunophenotyping and gene rearrangement clonality tests are obtained as necessary. All the information is presented at the bi-weekly Interdisciplinary Cutaneous Lymphoma Conference. At this conference, physicians from Dermatology, Pathology, Hematology/Oncology, and Radiation Oncology assemble to reach a consensus regarding the best care for the patient, using constantly updated carepaths.

Options include conventional therapies administered by the referring physician or new investigational treatments. At a follow-up visit, the consensus recommendations, in consultation with the referring physician, are discussed with the patient and a management plan is initiated. Although therapeutic options change as new clinical trials become available, the current and upcoming treatments that we have available are as follows:

  • Targretin
  • Nitrogen Mustard
  • PUVA
  • UVB
  • Photopheresis
  • Electron Beam Radiation Therapy
  • Orthovoltage Radiation Therapy
  • Interferon-alpha
  • BCNU
  • IL-2 Fusion Toxin

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Multidisciplinary Melanoma Program

Melanoma can spread very rapidly and is the most deadly form of skin cancer. Although it is less common than other types of skin cancer, the rate of melanoma is steadily increasing. It is the leading cause of death from skin disease. In the United States, 1 in 85 people will develop melanoma at some point in their life. The risk of developing melanoma increases with age, but nonetheless the disease frequently affects young, otherwise healthy people. Melanoma is the number one cause of cancer death in women aged 25 - 30.

Achieving optimal outcomes for patients with melanoma requires complex coordination of rapidly evolving standards of care by personnel from multiple specialties. The Multidisciplinary Melanoma Program was assembled to coordinate interdisciplinary care for patients with melanoma and to advance on patient-centered research on melanoma. Patients can be referred to any of our members for consultation and entry into the program and includes a visit post-conference to discuss recommendations made by the program. The multidisciplinary team meets bi-monthly in a patient management conference to reach consensus on histologic diagnosis and stage. The ability to obtain a “second opinion” by an entire panel of experts results in state-of-the-art management recommendations. These incorporate constantly updated care paths and clinical trials of advanced therapies.

Although therapeutic options change as new clinical trials become available, the current and upcoming diagnostic methods and treatments that we have available are as follows:

  • PET Scanning
  • Sentinel Lymph Node Biopsy
  • 06BG and BCNU
  • Termozolomide
  • Ganglioside Vaccination vs. Interferon
  • GMCSF and Immunization
  • Molecular Diagnostic

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