Stanford Cancer Center provides special care for cancer-related skin conditions

Steve Greiner lived for nearly a decade with chronic lymphocytic leukemia, a cancer that affects the blood and bone marrow. Over the years, he'd become pretty savvy about the side effects of chemotherapy, radiation, a bone marrow transplant, and drugs taken during clinical trials. 

But this summer, after a long afternoon working outside left nearly his entire body covered with itchy, weeping sores, Greiner had a new challenge. "I've lived far longer than what I expected and I make sure I enjoy every day," he said. "Worrying that something else is going to come along and take you just like that makes you mad, so my biggest fear is something else happening."

To Greiner, those unexplained sores provoked just that kind of worry. But, as he had so many times before, he found quick and understanding help at the Stanford Cancer Center. Responding to a growing awareness that some cancer treatments and certain kinds of cancers trigger skin care issues, the Cancer Center recently incorporated the Supportive Dermato-oncology Clinic into its array of patient care services.

"Even if a cancer-related skin condition is not life-threatening, it can be debilitating to a patient's quality of life. We want to think of ways to protect the skin so patients can continue to do what brings joy to their lives as they are battling cancer," said Bernice Kwong, MD, who organized this new Stanford clinic.

The Supportive Dermato-oncology Clinic is designed to build this new care into a patient's other cancer treatments. That can minimize the need for extra visits. Greiner lives in Tracy, a fair distance from Stanford. "Many of our patients are travelling far," Kwong said, "and many of them are very tired from the therapies they’re going through. We wanted our clinic to be right there in the Cancer Center, to be accessible, to make things more efficient, so people can get this important help and better overall cancer care."

"The skin is something everybody sees and when your entire face erupts in severe acne-like lesions, it's very overwhelming and can make it difficult to carry on throughout the day," Kwong said.

In addition to swift diagnosis and treatment of such skin issues, Kwong has worked with other Stanford Cancer Center specialists to develop new patient education materials about skin problems that might emerge with treatment. 

Kwong recognized what was likely going on with Greiner. It was a well-known phenomenon in other patients with chronic lymphocytic leukemia called exaggerated arthropod bite reaction. It's not fully understood, Kwong said, but it was critical to eliminate other possible issues. "You need to make sure that you’re not missing something," Kwong said. "Is it really just insect bites or is it the chemotherapy or is it the disease flaring?"

Tests confirmed that Greiner's skin was reacting to mosquito bites. That was a huge relief to Greiner's family, said his wife, Christi. "It's great having someone very specialized say, 'Yes, they're mosquito bites, but you're undergoing chemotherapy right now and we have experience with this so we can take care of that for you.' I know when I take Steve to Stanford, that's one day I don't have to worry."

Understanding how much it means to Greiner to be able to in his garden motivated Kwong to come up with a solution that would protect him. She suggested a beekeeper's headgear and insect repellant. "He told us he could tolerate the itch from the bites, but he couldn't tolerate the idea of not going out," Kwong said.

Kwong expects to see this cancer treatment subspecialty expand as more types of cancers are cared for as chronic illnesses. "This Supportive Dermato-oncology Clinic is one of many different subspecialties we call supportive oncology," she said. "Patients really need it and we need to make sure that when the outcome is good from the cancer perspective, that everything else hasn't fallen apart."

Greiner now suits up when he works in the garden. "It's an inconvenience, but I don't have to worry about mosquitoes. To be able to have seen someone so quickly, to squash my fears, I went home happy."