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A team of University of Arizona physicians is collaborating with a medical team in Colombia to facilitate the establishment of an effective multidisciplinary cutaneous oncology program and to initiate collaborative projects in the field of melanoma.
Representatives of the Colombian National Cancer Institute invited University of Arizona Cancer Center physician-scientists to a three-day conference in Bogota in April attended by about 100 clinicians and researchers to discuss ways to establish a multidisciplinary approach to improve the outcomes of patients treated for melanoma at their institution.
The UACC’s multidisciplinary disease-site clinics bring together a team of medical, surgical and radiation oncologists and pathologists to focus on individual cancer cases to develop treatment plans.
Clara Curiel, MD, director of the UACC’s pigmented lesion clinic and co-director of the Cutaneous Oncology Program (COP) in the Skin Cancer Institute, co-chaired the conference. Accompanying her to Colombia were surgeon James Warneke, MD, division chief of surgical oncology in the UA’s Department of Surgery; and Keliegh Culpepper, MD, a dermatopathologist member of the COP. Lee Cranmer, MD, PhD, director of the UACC’s melanoma/sarcoma program, participated by videoconference from Tucson.
Dr. Curiel said among the challenges their Colombian counterparts face include the advanced stage at presentation for a significant proportion of the melanoma cases referred to their NCI. In addition, the team in Colombia was interested in establishing a consistent and reliable sentinel lymph node technique for head and neck melanomas. They have been performing sentinel lymph node mapping for other nodal sites but needed an additional technical training to establish the head and neck procedure.
Close to 65 percent of the melanoma cases seen by the Colombian physicians represent acral lentiginous melanomas, compared to just 2 percent of US patients. A significant proportion of these patients present with advanced local or metastatic disease, she said.
Dr. Curiel said the Colombian oncologists are eager to understand the mutagenic profile of the melanoma patients seen in the high-risk national program. The UACC will perform a pilot DNA sequencing on a small sample of the patients to begin to characterize genetic profiles.
“We want to understand how melanomas in other countries are genetically characterized with the hope to then consider a targeted and more effective therapeutic approach,” she said.
Dr. Curiel said once the genetic sequencing has been analyzed, the oncologists can with the pharmaceutical firms to develop clinical studies geared toward the specific biological profile observed in certain countries.
In return, the US physicians were impressed with the improvisation and quality of sentinel nodal localization performed by the nuclear medicine group in Colombia. Dr. Warneke is looking forward to having the teams at the UACC and Colombia exchange their technical approach.
While in Colombia, Dr. Warneke worked side-by-side in an operating room with his counterparts on complex melanoma cases and guided his fellow surgeons on head and neck sentinel lymph nodes techniques.
“If you spark collaboration between different specialties you are already enhancing clinical care outcomes for the patients,” Dr. Curiel said of the UACC multidisciplinary clinic approach.
Dr. Curiel said this collaborative work with the Colombian NCI could be extended to the UA Cancer Center’s Skin Cancer Institute and the Cancer Health Disparities Institute.
Pictured from left to right: Alvaro Acosta De Hart, MD/Dermatologist (conference chair), Clara Curiel-Lewandrowski, MD/Dermatologist (conference co-chair), Oscar García, MD/Surgical Oncology, James Warneke, MD/Surgical Oncology, Keliegh Culpepper, MD/ Dermatopathology, Natalia Olaya, MD/Dermatopathology
July 3, 2012