The Skin & Kidney Cancer Program at Smilow Cancer Hospital brings together an extensive, multidisciplinary team to diagnose, treat, and care for patients with all types of skin cancers, including melanoma, as well as kidney cancers. Established over 30 years ago, our program includes experts in surgery, medical oncology, dermatology, urology, pathology, dermatopathology, radiology, genetics, and radiation oncology. Members of the team are national and international leaders in clinical and laboratory research focusing on improving treatment and outcomes for our patients. From patients who present with an early-stage diagnosis or more complex, metastatic disease, our team is prepared to provide each patient with the most comprehensive and cutting-edge treatment available.
Each patient’s care is reviewed by our multidisciplinary care team to develop a personalized treatment plan. Clinical trials are also available to patients through Yale Cancer Center, bringing the latest treatment options to our clinics to benefit patients. Our doctors are at the forefront of melanoma and kidney cancer treatment and research, including novel immunotherapy approaches and the genetic characterization of kidney cancers.
Smilow Cancer Hospital places great emphasis on taking care of all of our patients’ needs through a network of supportive care services. Nurses with dedicated knowledge and skills care for our patients through the continuum of their treatment. Patients and their families also have access to social workers to provide psychosocial support, as well as pastoral support, nutritional counseling, physical therapy, palliative care, and integrative medicine.
After the initial diagnosis—and depending on the presentation of the disease—each patient is evaluated by our dermatologists, surgeons, urologists, and/or medical oncologists.
For some presentations of melanoma and other skin cancers, particularly in the early stages in which disease has not spread beyond the primary site or lymph nodes close to the primary site, surgery may the preferred initial treatment.
Specialized surgical expertise is essential for the management of melanoma and other skin cancers, which can occur on any skin site and even in areas not exposed to the sun. Some skin cancers appear in delicate areas such as the face, nose, ear, or hand and often require the expertise of a plastic surgeon. For certain regions of the body, our team collaborates with other highly trained surgical subspecialties, including thoracic surgery and neurosurgery. To care for kidney cancer, we work closely with oncologists and urologic surgeons.
In the early stages of melanoma, pathology results from the tumor will determine the risk of developing metastases (spread to distant organs) in the future. If the results indicate a high risk for melanoma metastases, treatments are available to reduce the risk and possibly prevent or delay melanoma recurrence. Adjuvant therapies (or therapies given after surgery) include immunotherapies and targeted therapies for tumors with a specific mutation in the protein called BRAF.
Special Types of Melanoma
Melanoma is also known to develop in areas of the body other than the skin. Ocular melanoma is the most common eye tumor in adults. Care is managed through the Ocular Oncology Program at Smilow Cancer Hospital, in collaboration with the Smilow Cancer Hospital Skin and Kidney Cancer Program.
Mucosal melanoma is found in the mucosal surfaces of the body which line nasal passages, the anus, vagina, and other areas. With this diagnosis, patients are often first seen by head and neck, gastrointestinal, or gynecologic surgeons. With both diagnoses, our Skin and Kidney Cancer Program experts provide input and manage subsequent post-surgical and follow-up care for melanoma patients.
One of the major complications of advanced melanoma is spread of disease to the brain. The disease and treatment of the disease can have important neurologic consequences. Management of disease in the brain requires a highly skilled and experienced team. To care for these patients, we have assembled a multidisciplinary group of expert medical oncologists, neurosurgeons, neuroradiologists, and radiation oncologists to form the Brain Metastasis Program. The team meets weekly to design optimal treatment regimens and effectively manage the neurologic consequences of the disease and its treatment.
Other Types of Skin Cancer
Merkel cell carcinoma is a rare, but aggressive, form of skin cancer. The general surgical approach is similar to that of melanoma, in which a wide excision and sentinel lymph node biopsy are performed. Our radiation therapy expert also sees Merkel cell patients as part of our multidisciplinary care approach, along with our medical oncologists. Advanced squamous cell and basal cell carcinomas that are not treatable with surgery alone are also treated by our medical oncologists in collaboration with our radiation therapy expert.
Hereditary Kidney Cancer information
The hereditary kidney cancer section of the Skin & Kidney Cancer Program was specifically designed to assist the unmet needs of those patients with less common forms or unusual presentations of kidney cancer, as well as to assist their community physicians who may be less familiar with genetic testing and the specifics of clinical management.
Our comprehensive program is designed to evaluate and treat the following types of patients:
Patients with early onset kidney tumors (presenting at age 45 or less)
Patients with bilateral or multifocal kidney tumors
Patients with significant family history [one (1 ̊) relative, or two (2 ̊) relatives] with kidney tumors
Personal or family history of other cancers including tumors of the pancreas, uterus, thyroid, breast, brain/spine, adrenal gland, and melanoma
Associated dermatologic skin conditions with or without a family history of kidney cancer such as fibrofolliculomas, leiomyomas, angiofibromas, etc.
The program contains a team of experts within Yale New Haven Hospital and Smilow Cancer Hospital focused on managing cancer patients. This includes clinicians in their field with a specific interest in treating hereditary cancer syndromes. As part of our program, we have experienced genetic counselors, a clinical geneticist familiar with next-generation testing, a molecular diagnostic team, and a partnership with the Cancer Genetics & Prevention Program.
Besides performing genetic testing for known kidney cancer genes using in-house CLIA-certified genetic labs, our team also is interested in novel gene discovery. By using next generating sequencing techniques, we expect to find new causes that contribute to familial cancer predisposition, some of them with therapeutic implications.
Our team’s expertise in the management of complex forms of kidney cancer has recently led to a special designation by the VHL Family Alliance as one of eight Comprehensive Clinical Care Centers for hereditary kidney cancer. This designation highlights our commitment and ability to manage highly complex kidney cancer conditions. The Program Director also serves as one of three members on the Kidney Cancer team for the NCI Physician’s Desk Query Cancer Genetics Editorial Board. This group continually updates NCI's website to provide the public with the latest management strategies for hereditary kidney cancer.
Additionally, our molecular diagnostics team developed CLIA-certified methods for tumor characterization (PCR and FISH), specifically designed to identify acquired genetic events found in tumors in young adults. This ensures we will remain at the forefront in understanding and treating genetic causes of kidney cancer disease.
Our Skin and Kidney Cancer Program has a long history of recognized and groundbreaking laboratory and clinical research into the causes and treatment of melanoma and other skin cancers. Patients with advanced or metastatic melanoma and kidney cancer have access to numerous clinical trials at Smilow Cancer Hospital including novel immunotherapy and targeted molecular therapy regimens. Additionally, patients who are no longer eligible for melanoma or kidney cancer-specific studies may be eligible for therapies through our Phase I Clinical Trial Program.
The Yale SPORE (Specialized Programs of Research Excellence) in Skin Cancer is the result of a grant awarded by the NIH National Cancer Institute to improve risk assessment, measures for diagnosis and prognosis, and therapies for patients with melanoma. As only one of five sites in the Unites States to receive a SPORE grant focused on skin cancer, Yale is in the unique position of being able to prioritize skin cancer research through several research projects and a career development program.
Yale Cancer Center is also home to several leading research laboratories, which study the genetics and cellular changes that result in melanoma. Yale researchers developed several mouse models that are used worldwide to study how melanoma forms and progresses, to test new melanoma therapies, and to see how the immune system can be stimulated to fight melanoma.