UofMHealthBlogs.org » mCancerTalk: Cancer Care

BRCA Gene Mutations and Cancer

Mark Pearlman, MD — Fri, 17 May 2013 14:05:59 +0000

BRCA gene mutations have been in the news this week since Angelina Jolie announced she has the BRCA1 gene mutation and opted to have a bilateral mastectomy to reduce her risks of developing breast cancer. She became aware of her risk because her mother developed breast cancer in her mid-40s and died at age 56. What exactly are the so-called breast cancer genes and who should be tested to see if they are a carrier?

Two genes, BRCA1 and BRCA2, if mutated are known to dramatically increase a woman’s risk of developing breast and ovarian cancer. Men can also carry these genes, and if they have a gene mutation, which also puts them at risk for developing breast and other cancers, though their breast cancer risk is not nearly as much as in women. These mutations are so-called germline mutations, that is, they are acquired at conception from either their mother or father. If a parent has a BRCA gene mutation, each child has a 50 percent likelihood of acquiring that mutation. Each year, a group called the National Comprehensive Cancer Network, reviews the latest research and develops the guidelines of who should be tested for these gene mutations. Current guidelines recommend screenings for:

women and men who have a strong family history of breast and/or ovarian cancer on either the maternal or paternal side of their family
women and men who developed breast cancer, particularly bilateral breast cancer, at a young age (under age 50)
women who developed ovarian cancer at a young age
women who have men in the family with breast cancer

The screening is a simple blood test, but it is expensive (around $4,000) and, due to patent restrictions, is performed by only one lab in the United States. For that reason, we must conserve resources and only test those individuals who meet the testing criteria.

Individuals who carry the BRCA1 gene mutation have a 60% to 85% chance of developing breast cancer and an approximately 40% chance of developing ovarian cancer. Those with the BRCA2 gene have 40% to 60% chance of developing breast cancer and about a 20% chance of developing ovarian cancer. After learning you have one of these gene mutations, there are several decisions to make.

At a minimum, women with BRCA gene mutations should undergo aggressive surveillance. This typically consists of an annual mammogram and breast MRI starting at age 25. This allows us to detect breast cancers sooner, if it does develop, at an early and more treatable stage. Like Ms. Jolie, some patients choose the risk-reduction bilateral mastectomy and breast reconstruction, which reduces their risk of developing breast cancer by 93%. However, there is no data currently that compares the mortality rate of those who choose bilateral mastectomy versus those who opt for aggressive screening.

Unfortunately, we currently do not have reliable surveillance methods for early diagnosis of ovarian cancer that are as effective as mammograms and breast MRI are for breast cancer. For women who have the BRCA1 or BRCA2 gene mutation, we do recommend removal of their ovaries and fallopian tubes after they are done having children, typically between the ages of 35 and 40.

If you feel you may be at an increased risk for carrying one of these genes, it’s important to discuss your family history with your healthcare provider. He or she can recommend a course of action. For those who find they have either the BRCA1 and BRCA2 gene, the University of Michigan Comprehensive Cancer Center has a wealth of resources to help you understand your options.

Additional Resources:

Breast and Ovarian Cancer Risk Evaluation
Gynecologic Care for Breast Cancer Patients and BRCA Gene Mutation Carriers
Blog post: Cancer risk and genetic testing for BRCA1 and BRCA2 (by Kara Milliron, MS, CGC)
CNN Opinion Article: When Removing Breasts is Not the Answer (by Sara Hawley, MD)

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Mark Pearlman, MD, is vice chair and service chief in the Department of Obstetrics and Gynecology at the University of Michigan Von Voigtlander Women’s Hospital. He also holds an appointment as professor in the Department of Surgery and is associate chief of clinical affairs for the University of Michigan Hospitals and Health Centers. Dr. Pearlman is a member of the surgical staff of U-M’s Breast Care Center, with particular expertise in the management of gynecologic care for women with increased genetic risks for breast and ovarian cancer, gynecologic care of women with breast cancer, as well as the management of benign breast disease.

The University of Michigan’s Women’s Von Voigtlander Women’s Hospital is a leader women’s health care. Consistently ranked among the America’s top gynecology programs by U.S. News & World Report, U-M is committed to unsurpassed patient care.

The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan for cancer patient care. Seventeen multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.

Simple lifestyle changes that help prevent cancer

Beth Johnson, Thrive editor — Thu, 16 May 2013 11:21:16 +0000

In today’s age of fad diets and infomercials promoting the latest exercise craze, it’s easy to see that weight is a health concern. Besides making you feel more confident and look better, achieving a healthy weight can help reduce your cancer risk. Simple changes to your lifestyle can help you reach a healthy weight, make a huge impact on your health and help prevent cancer.

What is a healthy weight?

A healthy weight is defined as a body mass index (BMI) between 18.5 and 25. If you’re not sure of your BMI, use this easy-to-use calculator.

Exercise guidelines have been set at 150 minutes of moderate activity a week. This boils down to only 30 minutes of exercise, 5 days a week, which can be done in blocks of as little as 10 minutes.

Can’t I just take a pill?

A general multivitamin and mineral supplement does still have its place, as some research suggests it has benefit in certain situations, such as men over 50 years of age with a history of cancer. To be on the safe side, only take dietary supplements if recommended by your physician.

To drink or not to drink?

Although alcohol has been shown to have some benefits for heart health, when it comes to cancer the question to drink or abstain remains unclear. Many cancers including breast and esophageal cancer have been linked to alcohol intake.

The current recommendation is moderation: no more than 1 drink for women or 2 drinks for men per day (1 drink is equivalent to 12 ounces of beer, 5 ounces of wine or 1 1/2 ounces of liquor).

Pick an area you can improve and make the change! Even making just one change can reduce your cancer risk.

Learn more about cancer and nutrition in Thrive.

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Thrive magazine is a quarterly publication of the U-M Comprehensive Cancer Center, offering inspirational patient stories, news and information on programs and services, tips on coping and living with cancer and more. Find Thrive in the Cancer Center or online.

Watch your noggin: when cancer strikes the brain

Kim Zapor, RN, BSN, OCN, CBCN, U-M Cancer AnswerLine — Tue, 14 May 2013 19:07:12 +0000

Kim Zapor, RN, BSN, OCN, CBCN, is one of four oncology nurses with the U-M Cancer AnswerLine™

“Watch your noggin!” I can remember as a child my mother saying this, usually after I had toppled off something that inflicted some bumps and bruises to my head. The brain inside is complex. Speaking, moving, feeling, balance, memory and emotions are just a few of the numerous tasks we automatically expect from this amazing organ. When cancer strikes the brain, it can be especially frightening and life-altering.

Brain tumors can be both benign (non-cancerous) and malignant (cancerous). A person’s risk of developing cancer of the brain is less than 1%. Brain tumors are slightly more common in males than females and the second most common cancer in children. They can occur at any age, but occur more frequently in children and older adults.

Other than previous radiation exposure, there is no lifestyle or environmental cause for brain tumors. Factors that have been investigated, but NOT proven are:

Cell phone use

Aspartame (sugar substitute)

Electromagnetic fields from power lines

How do you know when cancer strikes the brain? Signs and symptoms of brain tumors include:

Seizures

Trouble speaking

A change of mood such as depression

A change in personality

Weakness or paralysis in a part of the body

Changes in vision, hearing, or other senses

Headache

Nausea

Vomiting

What’s being done in research?

Doctors and researchers are exploring better ways to diagnose and treat brain tumors, which include:

Biomarkers – tests that can find a brain tumor before symptoms occur (usually tested from blood samples)

Studying the genetics of the tumor – several genes have been identified already

Tumor vaccines

Targeted therapies – targets cancer growth at the protein or gene level

Improving imaging techniques – helpful in monitoring effectiveness of treatment and tumor recurrence

Blood-brain barrier – developing techniques that allow chemotherapy and other drugs to pass through this natural barrier and enhance the effectiveness of treatment

Refining surgical and radiation therapies

How you can support brain tumor research

U-M Cancer Center: Make a Gift

Brain tumor information on treatment and diagnosis

American Cancer Society: Brain & Spinal Cord Tumors

U-M Health System: Pediatric brain tumors

The National Cancer Institute: Brain Tumor

Cancer.Net: Brain Tumors

Support for patients and families

American Brain Tumor Association

National Brain Tumor Society

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The Cancer AnswerLine™ is a dedicated phone line at the Comprehensive Cancer Center that is staffed by oncology nurses five days a week, 8 a.m. – 5:30 p.m. at 800-865-1125. They have a combined 105 years of experience helping patients and their families who have questions about cancer.

Stem cell research and treatment for cancer

Annette Schork, RN, BSN, OCN, CBCN, Cancer AnswerLine — Thu, 09 May 2013 12:57:01 +0000

As a Cancer AnswerLine nurse, I’m often asked by a caller, “Can I have treatment for my cancer with stem cells? I have read that U-M is involved with stem cell research.” This simple question has a very complex answer.

All of the blood cells in your body start out as young (immature) cells called hematopoietic, (or blood-forming), stem cells.

Stem cells mostly live in the bone marrow (the spongy center of certain bones), where they divide to make new blood cells. Once blood cells are mature they leave the bone marrow and enter the bloodstream. A small number of stem cells also get into the bloodstream. These are called peripheral blood stem cells.

One type of “stem cell treatment” is a stem cell transplant, which restores the stem cells when the bone marrow has been destroyed by disease, chemotherapy, or radiation. Depending on the source of the stem cells, this procedure may be called a bone marrow transplant, a peripheral blood stem cell transplant, or a cord blood transplant. Bone marrow transplants are a type of adult stem cell-based therapy that has been in widespread clinical use for more than 40 years. Stem cell transplants can benefit people with a variety of both cancerous and non-cancerous diseases.

The University of Michigan is involved in four types of stem cell research: embryonic, adult, cancer and reprogrammed cells (known as iPS cells).

What is an embryonic stem cell?

Embryonic stem cells exist only at the earliest stages of embryonic development and are capable of making any cell type in the body. Under the right conditions, these cells retain the ability to divide and make copies of themselves indefinitely. Because they can give rise to any type of cell in the body, researchers believe embryonic stem cells offer great potential for developing new ways to treat disease.

What is an adult stem cell?

Adult stem cells are present in everyone — adults, children, newborn infants, and even developing fetuses. Adult stem cells are more limited and specialized than embryonic stem cells. They have the ability to make just one or two kinds of tissue, such as blood cells, immune system cells, brain cells or muscle cells. Adult stem cells also have a more limited capacity to replace themselves than do embryonic stem cells.

What is a cancer stem cell?

Cancer stem cells are the small number of cells within a tumor that are capable of generating a new tumor. This means these are the cells actually fueling cancer’s growth and spread. These cells are resistant to current chemotherapy and radiation treatments, which may explain why cancer often comes back after initial treatment.

What is an iPS (induced pluripotent stem) cell?

iPS cells are adult cells reprogrammed to behave like embryonic stem cells. While iPS cells are an exciting discovery for advancing stem cell research and an understanding of the biology, these cells could never be used in patients because they are made by using viruses to reprogram the adult cells. This process predisposes the cells to cancer.

The U-M Center for Stem Cell Biology’s main goal is to determine the fundamental mechanisms that regulate stem cell function. That knowledge, in turn, provides new insights into the origins of disease and suggests new approaches to disease treatment. Most of the work involves adult stem cells — including blood-forming and nervous system stem cells — but human embryonic stem cells also are studied. Currently, no cancer therapies are available based on this work.

At the U-M Comprehensive Cancer Center, we believe treatments designed to target and destroy cancer stem cells will revolutionize how we treat cancer. If these stem cells were eliminated, the cancer would be unable to grow and spread to other locations in the body. In addition to robust laboratory research to understand these cells, the Cancer Center is offering several clinical trials to assess treatments designed to target cancer stem cells.

Visit umclinicalstudies.org to search for a clinical trial or discuss this option with your oncologist. If you have further questions, please call the Cancer AnswerLine for assistance at 1-800-865-1125.

Additional Resources:

U-M Bone Marrow Transplant Program

U-M Cancer Stem Cell Research

University of Michigan, Stem Cell Research

American Association for Cancer Research

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Veiled nutrition: Skin cancer precautions can result in vitamin D deficiency

Tue, 07 May 2013 13:15:50 +0000

Spring is here and so is the sun, which is great for our spirits after a long, dreary winter, but not for our skin. Up to 90% of non-melanoma skin cancers and 65% of melanomas are associated with exposure to UV radiation from the sun. May 1^st marks the start of Skin Cancer Awareness month so while you’re enjoying the outdoors, protect yourself from skin cancer by seeking shade during midday hours (10 am-4pm), wearing protective clothing, hats and sunglasses, and using sunscreen (SPF 15 or greater). But did you know these precautions can result in a vitamin D deficiency?

While taking these precautions is recommended as the best prevention against skin cancer, they decrease the body’s ability to produce vitamin D for itself. For this reason, effort needs to be made to get the recommended 600-800 IU of vitamin D from food or a supplement. Meeting your estimated daily needs for vitamin D is important because vitamin D plays many roles in the body from optimizing bone health to reducing inflammation. Current research is showing that vitamin D might play a role in the prevention and treatment of various cancers, type 1 and 2 diabetes, hypertension, fatigue and other medical conditions. Specifically in cancer, vitamin D plays a role in programmed cell death, as well as other cellular processes, which could explain why higher vitamin D levels have been associated with decreased cancer risk.

While consuming foods rich in vitamin D (see table 1) is recommended, it can be difficult to get enough from diet alone. Vitamin D supplementation may be needed. When choosing a vitamin D supplement, make sure to buy a product that meets the United States Pharmacopeia (USP) standards and avoid taking more than the recommended amount of vitamin D unless specified by your physician.

Vitamin D Content of Food	IUs per serving*	Percent DV**
Swordfish, cooked, 3 ounces	566	94
Salmon (sockeye), cooked, 3 ounces	447	75
Tuna fish, canned in water, drained, 3 ounces	154	26
Orange juice fortified with vitamin D, 1 cup	137	23
Milk, nonfat, reduced fat and whole vitamin D-fortified, 1 cup	115-124	19-21
Yogurt, fortified with vitamin D, 6 ounces	80	13
Margarine, fortified, 1 tablespoon	60	10
Sardines, canned in oil, drained, 2 sardines	46	8
Liver, beef, cooked, 3 ounces	42	11
Egg, 1 large (vitamin D is found in yolk)	41	7
Ready to eat cereal, fortified with vitamin D, 3/4-1 cup	40	7
Cheese, Swiss, 1 ounce	6	1

* IUs = International Units. ** DV = Daily Value.

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Registered dietitians who are specially trained in the field of oncology nutrition provide cancer nutrition services at the Comprehensive Cancer Center. They focus on assessing the individual dietary and nutrition needs of each patient and providing practical, scientifically sound assistance.

Make rehabilitation a part of cancer care and survivorship

Beth Johnson, Thrive editor — Sat, 04 May 2013 12:38:28 +0000

The U-M Comprehensive Cancer Center has spent nearly a decade developing programs and services to help patients with rehabilitation. We sat down with Patty Clark, M.S.N., R.N., director of the Cancer Center’s Adult Survivorship Program, to talk about the broad scope of rehabilitation and how it should be a routine part of your cancer care and survivorship.

Q: What do we mean by “rehabilitation?”

With rehabilitation, we try to help people with cancer function at their optimum levels in life based on any limits that may have resulted from their cancer diagnosis or treatment. Cancer rehabilitation addresses physical, social, emotional and work-related changes and helps each person set achievable goals to maximize his or her ability to carry on with life.

Q: Why has rehabilitation become a major issue in cancer care?

Cancer rehabilitation has been an objective of cancer care since the National Cancer Act in 1971. I think we are seeing more about it in the media because more and more people are living with cancer. Cancer survivors want to live like anyone else. They want to be active in their families, at work, at church and in the pursuit of their interests, just like they did before their diagnosis. However, successful cancer treatment may result in some changes, limitations perhaps, and people with cancer need help overcoming these as much as possible.

Read more about rehabilitation in the Spring 2013 issue of Thrive.

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Here’s looking at you: checking to detect skin cancer

Susan L. Daron, RN, BSN, OCN, Cancer AnswerLine — Thu, 02 May 2013 13:34:52 +0000

Susan Daron, RN, BSN, OCN, is one of four oncology registered nurses at the Cancer AnswerLine™

As warm weather approaches and we shed our wool pants and winter jackets for shorts and tank tops, people often ask what they can do to protect their skin. While limiting sun exposure, wearing sunglasses, and applying sunscreen are common sense, there is something else you can do monthly that could your life. It is called a skin check, and doing this can detect skin cancer.

Doing a skin check involves carefully examining all of the skin on your body. Start at your scalp and go all the way down to the soles of your feet and between your toes. During a skin check, don’t leave any area of skin unexamined. Some parts such as your back and neck are difficulty to see, so you may want to ask a partner or spouse to help. Just because the sun’s rays may not reach some areas such as the genitals doesn’t mean you can skip them. Women should examine the skin under their breasts and men should check their scrotal area.

The Skin Cancer Foundation provides step-by-step instructions for completing a head to toe skin examination.

So, how to know if a spot or bump is worrying? Here are some general guidelines from the American Cancer Society about what might be suspicious:

Shape is uneven, irregular, with no clear borders

Color is not the same throughout

Becomes itchy, tender, or bleeds

Does not heal

Larger than the size of a pencil eraser

Does not look like your other freckles/moles

Once you get into the habit of performing skin checks, you will be more attuned to your own skin and notice any changes such as the ones mentioned above. If you have any concerns about your skin findings, be sure to get in touch with a dermatologist or your healthcare provider.

The University of Michigan Health System has developed a free app that can help with the process. It is called UMSkinCheck and can help you set reminders for monthly skin checks, direct you on how to complete a skin check, and monitor any skin changes via photo catalogs. You can find details and download the app here.

Learn more about checks to detect skin cancer:

U-M Health System: Skin Cancer Prevention

Skin Cancer Foundation

American Academy of Dermatology

The American Cancer Society: Skin Cancer Prevention and Early Detection

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Coping with a brain tumor diagnosis

Annette Schork, RN, BSN, OCN, CBCN, Cancer AnswerLine — Tue, 30 Apr 2013 19:27:29 +0000

Valerie Harper, the actress best known for playing Rhoda Morgenstern on “The Mary Tyler Moore Show” and her own spinoff, “Rhoda,” has been diagnosed with terminal brain cancer. Although Valerie Harper’s tumor is incurable, this isn’t the scenario for everyone who is coping with a brain tumor. There is hope, innovation and support available for those with brain and spinal cord tumors at the U-M Comprehensive Cancer Center.

Brain Tumor 101

Every year in the United States, about 23,000 people are diagnosed with cancer that began in or next to the brain. These are called primary brain cancers. Another 100,000 people are diagnosed with cancer in the brain or spinal cord that spread (metastasized) from another place in the body. These are called secondary brain cancers.

Some brain tumors grow slowly and may become quite large before causing symptoms. Others may grow quickly and cause a sudden onset of symptoms. While most types of primary brain cancer may spread within the brain, few spread beyond the brain. Because the skull is rigid, there is no room for the tumor to expand, so brain tumors may press on parts of the brain that control movement, speech, sight or other vital functions. Sometimes a seizure is the first symptom.

Most Common Symptoms

Headaches

Seizures

Problems caused by damage to specific brain regions. This can include weakness on one side, loss of feeling on one side, problems seeing and word-finding difficulty.

Changes in mental function

Treatment

For nearly all brain tumors, surgical removal is commonly recommended provided this can be done safely. Radiation, chemotherapy, steroid treatment and clinical trials may be offered too.

The U-M Neuro-Oncology Clinic emphasizes compassionate care, personalized attention, and involvement of the patients in decision-making to help preserve the patient’s quality of life.

What happens after treatment is over?

When treatment is completed, most patients are monitored for tumor recurrence on a regular basis with MRI or CT scans. Scans are typically done on a three-month, six-month, or yearly basis, depending on the tumor type.

There is always research going on to learn as much as we can about brain and spinal cord tumors. Scientists are looking for causes and ways to prevent these tumors, and doctors are working to improve treatments.

Whether you are a patient or caregiver, one of the first things you may choose to do is gather information and find out how to get support. Many people finding that talking with others in a similar situation can help with the stress and sometimes provide useful insights. Our Support Group, which has been meeting for more than 15 years, provides a supportive setting for such discussion.

If you wish to consider coming or if you have questions about the support group, please call our nurses at: 734-647-8906.

Living with a brain tumor

Continue some type of exercise. For many of our patients, a program of exercise walking is helpful, no matter what the distance.

Eat a fairly healthy balanced diet that includes some protein and some vegetables.

Many brain tumor patients experience constipation, sometimes worsened by medications. Consider a high fiber diet, extra fruits and vegetables, a natural over-the-counter stool softener.

Do you have questions about brain cancer? Call the Cancer AnswerLine™ at 800-865-1125.

Additional Resources

U-M Brain Tumor Information Guide

U-M Brain Tumor Research Fund

American Brain Tumor Association

National Brain Tumor Society

What’s New in Brain Tumors in Adults Research?

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The Cancer AnswerLine ™ is a dedicated phone line at the Comprehensive Cancer Center that is staffed by oncology nurses five days a week, 8 a.m. – 5:30 p.m. at 800-865-1125. They have a combined 105 years of experience helping patients and their families who have questions about cancer.

Best of distractions: Places

mCancerPartner — Sat, 27 Apr 2013 14:00:24 +0000

Cancer care comes with a lot of down-time and time to think. We’ve been asking our Facebook friends to share their favorite distractions, including books, movies and now places. Here are suggestions for the BEST of distractions: places that can offer a mini-vacation from the cares that come with cancer.

Our Facebook friends recommend:

Diane: To deal with the anxiety of cancer, I learned the importance of taking time to relax. I often take a small sketch pad, find a quiet room with a view and draw for a bit. Losing myself in the activity has an incredibly calming effect. Sometimes the view is from my window at work. At other times it will be a view of nature from home or even in my car, parked by the side of a country road.

Shelli: Oddly I escape during treatment, surgeries, biopsies or anything that scares or worries me in my own mind by singing “Toes” by the Zac Brown Band to myself. I just picture myself on a beach doing anything but and push through it. I’ve done this since my first biopsy.

Stephen: A walk in the woods (best if after a summer rain) or out on the water, either fishing, or a slow paddle in my kayak. If I’m unable to do these activities during treatment I set them at the top of my “to do “list which makes them a goal to reach …if that makes sense …

TLC: On an average day, I either distract my thoughts by sewing (if the pain is tolerable) or kick back and watch the birds play at the feeders outside. When possible, I love to go to our garden (all raised beds to accommodate my bone mets) and just by getting my hands dirty in the soil, tending to my plants, and relaxing on the garden patio, surrounded by nature – I am at peace and able to feel “normal” again.

Editor’s suggestions for the best of distractions:

Magic carpet ride: Let guided imagery serve as your magic carpet, taking you to enchanted lands – all through the power of your imagination. Get started with our audio library of guided imagery exercises.

Summer attractions from Google maps: Here is a roundup of fun places throughout the United States, and each link produces Google’s ‘street view’ so that you can tour a zoo, explore Diamond Head Crater Park near Honolulu, jostle through a carnival’s crowd, walk a golf course and more – without ever leaving your home. If you are uncertain about how Google’s ‘street view’ works, check out this resource.

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The Cancer Center’s Guided Imagery program teaches a gentle but powerful technique that focuses and directs the imagination. Research demonstrates its positive impact on health, creativity and performance. Guided Imagery is part of the Cancer Center’s Complementary Therapies Program.

Repairing the nose after skin cancer in just one step

mCancerPartner — Thu, 25 Apr 2013 20:28:19 +0000

Jeffrey S. Moyer, M.D.

The skin cancer growing on Carolyn Bohlmann’s nose was not a very aggressive variety. But it was deep and located right on her nostril. The tricky part was not so much removing it – MOHS surgery, the procedure Bohlmann had, is a fairly common outpatient procedure.

The tricky part would be reconstructing her nostril so that it didn’t lift up or droop down. It’s an important cosmetic issue, but it’s also critical for breathing.

Bohlmann opted for a new reconstruction technique her surgeon, Jeffrey Moyer, M.D., was offering at the University of Michigan Comprehensive Cancer Center. Moyer removed some cartilage from behind Bohlmann’s ear and skin from her shoulder and shaped it to create a new nostril in the place where the tumor had been growing.

Dr. Moyer, an associate professor of otolaryngology, and his colleagues recently reported on the first 20 patients to undergo this new procedure. Here, he explains what they learned and how it gives people with skin cancer on the nose another option.

mCancer Partner: Why is reconstructing the nostril more challenging than reconstructing other parts of the body?

Dr. Moyer: The nose is a fairly complicated area to reconstruct. To maintain both the aesthetic and the functional aspects, you have to maintain a three-dimensional structure. This means you can’t just use skin – you need something with structure to prevent the nostril from collapsing or pulling up.

mCancer Partner: So what traditionally have you done to reconstruct the nostril?

Dr. Moyer: Ear cartilage works well, but you also need a blood supply, which we get from skin on the forehead or cheek. That creates a skin flap that stays on for about three weeks, allowing the blood vessels to grow. Then we go back in to separate out the skin flap. That means the patient needs to come back for a second procedure.

mCancer Partner: How does your new technique differ?

Dr. Moyer: We demonstrated that we can put the cartilage in without the blood supply, which saves patients from that second procedure – but still maintains the ability to breathe and a good cosmetic result. We do these cheek flaps just because we need the blood supply, but we don’t need the tissue. It turns out you don’t need the blood supply either.

mCancer Partner: Why is this important for patients?

Dr. Moyer: This technique is a single procedure, so it could save people a lot of effort and time. The last thing people want to do is return to the OR. It allows us to spare people multiple surgeries or a scar that dominates the cheek. The cheek flap is still a slightly better cosmetic result, but the incremental benefit may not be worth it for some patients. The ability to do something less but still get the same quality of results is important.

Specialists at the U-M Comprehensive Cancer Center continue to offer this reconstruction technique. For information, call the Cancer AnswerLine at 800-865-1125.

Learn more about repairing the nose after skin cancer:

U-M Comprehensive Cancer Center Press Release: Repairing the nose after skin cancer in just one step

U-M Department of Dermatology: Surgical Dermatology: FAQ

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Jeffrey S. Moyer, M.D.

The U-M Dermatology Cutaneous Surgery & Oncology Program is a leader in Mohs surgery, which has been available at U-M since 1955. U-M’s fellowship-trained Mohs surgeons receive extensive post-graduate training in both Mohs surgery and complex reconstruction. They perform approximately 3,500 of these surgeries per year and are experts in their field.