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Northside Hospital Program Focuses Resources on 
Deadliest Skin Cancer




Surgical oncologist Jonathan Lee, M.D., left The Cancer Institute of New Jersey last year to join the Northside Hospital medical staff and launch Northside Hospital Melanoma Program in August 2012 as Program Director. With Northside Hospital’s appointment as a National Cancer Institute’s Community Cancer Center, it's clear that Dr. Lee's dedication and that of the program's staff are paying off.

Most skin cancers are basal cell carcinoma and squamous cell carcinoma, which are relatively uncomplicated to treat when caught early. However, melanoma has a tragically disproportionate impact relative to its incidence. Although melanoma accounts for less than 5% of skin cancers, it is responsible for approximately 80% of skin cancer deaths, Dr. Lee points out.

The American Cancer Society estimates 77,000 new melanomas will be diagnosed in the United States in 2013. About 9,500 people are expected to die of the disease this year.

“One of the dangers of melanoma is it can spread to other parts of the body by the hematogenous route or by the lymphatic route,” Dr. Lee says. “Melanoma is a completely different beast from more common forms of skin cancer. With melanoma, there’s a higher risk of metastasis to other parts of the body.”

That adds enormous significance to Northside Hospital’s appointment as one of the National Cancer Institute’s Community Cancer Centers. The appointment indicates Northside Hospital has specialists who use the most innovative, leading-edge and science-based treatments for melanoma. That includes lymphoscintigraphy — or lymphatic mapping — and sentinel lymph node biopsy, which provide accurate staging with minimal morbidity.

Mapping Cancer

Lymphoscintigraphy, a type of nuclear medicine procedure, uses radiotracer agents to determine lymphatic drainage patterns. It can be used to identify the sentinel lymph node, so called because it is the first node to receive lymphatic drainage from a tumor. In treating melanoma, lymphatic mapping and sentinel lymph node biopsy allow for a less invasive procedure with fewer side effects.

“Classically, when we talk about surgical therapy of cancer, we would resect the tumor itself along with a margin of normal tissue and remove all the lymph nodes from the tumor-draining lymphatic area at the same time,” Dr. Lee says. “That particular process has finally evolved so we don’t have to remove all the lymph nodes. By using lymphatic mapping and sentinel lymph node biopsy, we’re able to identify potentially cancer-containing regional lymph nodes with a high level of accuracy. After performing a sentinel lymph node biopsy, if that particular lymph node does contain cancer, there’s some likelihood other lymph nodes in the same lymphatic area might also contain cancer. In that case, further therapies can be offered to improve the patient’s outcome. These may include surgery, radiation and/or systemic therapy. Lymphatic mapping and sentinel lymph node biopsy provide a way of staging patients’ cancer with minimal morbidity.”

Clinical Trials to Serve Advanced-Stage Patients

Clinical trials in the new melanoma program will focus on immunotherapy and targeted therapy for specific gene mutations. The program already has one trial open for unresectable Stage 3 and 4 patients whose tumors harbor BRAF mutation.

“We’re also working to provide clinical trials for patients who don’t have the BRAF mutation,” Dr. Lee says. “Our immediate goal is to open up clinical trials for patients with advanced-stage melanoma and give them the opportunity for ongoing care.”

Dr. Lee says survival rates for advanced-stage melanoma patients haven’t changed significantly in the past three decades because effective systemic therapies haven’t existed. However, the advent of promising new drugs has sparked a renewed focus on systemic therapies, he says.

“Everybody’s hopeful and excited that these drugs can be used to enhance patient outcomes,” Dr. Lee says. “They’ve reignited research fervor in developing other drugs in a similar category. I do believe that other new clinical trials on the horizon will increase hope for these patients.”

Navigating the health care system while dealing with the physiological and psychological effects of the potentially life-threatening skin cancer melanoma can be both frightening and bewildering for patients. But Northside Hospital’s new melanoma program strives to make screening, diagnosis, staging, treatment and survivorship for this particularly aggressive form of 
skin cancer as 
efficient and effective as possible.

Clinical care is provided by a multidisciplinary team of medical experts, including dermatologists, dermatopathologists, medical oncologists, surgical oncologists, radiation oncologists, interventional radiologists and plastic surgeons, who consult with one another about the optimal care plan for each patient.

An Advocate for Patients

Dr. Lee is particularly enthused about one member of the newly assembled medical team — the nurse navigator. As both patient advocate and educator, the nurse navigator partners with physicians to coordinate treatment plans, offers trusted support to patients and their families, provides tips for dealing with treatment, assists with insurance and financial issues, and facilitates support groups — all with the ultimate goal of improving care and outcomes.

  • For three consecutive years, the Blood and Marrow Transplant Program has ranked No. 1 in the United States for survival rates for matched related and unrelated donors and allogeneic transplants.
  • More cases of breast cancer and gynecologic cancer are diagnosed and treated at Northside Hospital Cancer Institute than at any other hospital in the Southeast.
  • More prostate cancer treatments are performed at Northside Hospital Cancer Institute than at any other Atlanta hospital.

“Cancer care is best delivered in a multidisciplinary fashion, with all specialists involved in coming up with a patient’s evaluation and treatment plans. Patients might need to visit multiple physicians to ensure that a full spectrum of care is delivered. Having a nurse navigator who works with patients to make sure such care gets coordinated and nothing falls through the cracks really helps.”

One of the largest providers of comprehensive cancer services in the Southeast, Northside Hospital has nurse navigators in other programs of its Cancer Institute, but Kathleen Gamblin, R.N., B.S.N., OCN, is the oncology-trained nurse dedicated to the melanoma program.

Dr. Lee notes that Gamblin performs crucial functions to complement the rest of the medical team’s efforts.

“The nurse navigator builds a relationship with patients and makes sure they stick with what we discussed in the multidisciplinary setting,” says Dr. Lee. “Having a navigator participating in active patient management is a significant advantage.”

For more information about the Northside Hospital Melanoma Program, call Dr. Lee at Melanoma Specialists 
of Georgia at (404) 851-6000 or visit www.northside.com/melanoma.


COMMENT ON THIS ARTICLE


1 comment for “Northside Hospital Program Focuses Resources on 
Deadliest Skin Cancer”

  1. Gravatar of beverly haughtonbeverly haughton
    Posted Tuesday, February 18, 2014 at 1:41:57 PM

    I have recently completed 4 Yervoy treatment and am wondering if there is an advancement over this treatment.
    Would be interested in finding out more about advancements with Dr. Lee