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Mission to Chile offers relief to skin cancer victims

Courtesy of Hayes Gladstone

Hayes Gladstone, MD, assistant professor of dermatology, operates on a patient in Chile as part of a team of U.S. medical volunteers that he helped to recruit. In the background is medical center nurse Judy Elkayam, RN.

BY RUTHANN RICHTER

A hole in the Earth's ozone layer has left Chile with some of the highest skin cancer rates in the world. And because of rural poverty and limited access to medical care, the potentially disfiguring disease has become a significant public health problem there.

Hayes B. Gladstone, MD, assistant professor of dermatology, had little idea of the Chileans' desperate circumstances until last month, when he spent a week leading a team of health-care professionals who brought high-tech treatment to patients with these malignant tumors. They performed a series of operations that are relatively routine in the United States but unheard of in Chile. Patients called the visiting doctors and nurses "gifts from God."

Without intervention, the cancers would likely have spread. "Eventually the patients might get treatment but they would have huge, disfiguring surgeries," said Gladstone, who is also director of the Division of Dermatologic Surgery. "We were told that some may never get treatment at all, and some may die."

The trip is believed to be the first humanitarian mission ever by dermatologic surgeons to bring a specialized cancer treatment—Mohs Micrographic Surgery—to a developing country. It emanated from a Stanford talk Gladstone gave last year attended by Francis Palisson, MD, a Chilean pediatric dermatologist and that country's leading expert in the skin disease epidermolysis bullosa.

Palisson was interested in bringing Mohs to Chile, which has had a large influx of northern Europeans over the last 200 years. The combination of a large population of fair-skinned individuals, the Andean altitude and the lack of ozone protection has resulted in a situation where about one in three people is expected to develop skin cancer in his or her lifetime. That compares with one in five in the United States, Gladstone said.

Gladstone assembled a team of eight surgeons from major academic medical centers and two nurses, including Stanford's Judy Elkayam, RN. The group also included a histotechnologist to help prepare medical slides for examination during the Mohs procedure.

The procedure, used primarily in basal cell and squamous cell carcinomas, allows dermatologic surgeons to microscopically examine the entire margin of the specimen, and to precisely map any residual tumor. The cure rate with Mohs is 99 percent, compared to 89 or 90 percent with conventional surgery, in which the surgeon removes the tumor using only visible, clinical margins. In many cases, Mohs surgery also results in a smaller scar, he added.

The team treated 20 Chilean patients who ranged in age from 9 to 80. Most had cancers—visible discolorations—on their eyelid, neck, nose and face. In one case, the surgeons removed a painful, squamous cell tumor about the size of a softball from the scalp of a man in his 50's. These types of tumors can spread to other parts of the body and prove fatal, Gladstone said.

In addition, the dermatologists devoted a half-day to providing laser treatment to youngsters with port wine stains, disfiguring birthmarks caused by blood vessel malformation as well as pigmented birthmarks. All of the procedures were performed at the private Clinica Alemana since the public clinics lacked the necessary equipment for the surgeries, Gladstone said.

The patients were universally grateful for their care. "They were crying and saying thank you and that we were gifts from God," Elkayam said. Some brought precious chocolates and stone carvings as thank-you gifts.

Gladstone and his colleagues provided a three-day course on the Mohs procedure and facial reconstruction to their colleagues in Chile, who also observed the patient procedures through a video hook-up. Gladstone said he hopes to expand the program through yearly, extended visits to Chile, and the establishment of a fellowship at Stanford and other leading academic dermasurgery divisions for a Chilean physician to undergo year-long training in the Mohs technique and facial reconstruction.

Gladstone and his colleagues donated their time and travel expenses for the project, which was sponsored by the nonprofit group The Blade and Light Society, a group founded by Gladstone and a colleague from Northwestern University to help spur humanitarian work and research collaborations among young dermatologic surgeons.