The first clinical program dedicated to the care of cancer patients, with an initial focus on dermatologic events resulting from targeted therapies was established in Northwestern University in 2006 [2]. Soon thereafter, it expanded into caring for skin conditions resulting from cytotoxic agents, radiation therapy, and sequelae from treatment in survivors. Starting an oncodermatology practice requires knowledge of oncologic drugs and their mechanism of action, types of cancer and staging, quality of life tools, and adverse event grading as per the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI- CTCAE). In 2006, the Multinational Association of Supportive Care (MASCC) established the Skin Toxicity Study Group and proposed an EGFR inhibitor grading scale to improve the sensitivity and specificity of reported dermatologic adverse events, the MASCC EGFRI Skin Toxicity Tool (MESTT). Hitherto, institutions across the country and the world have developed dermatology clinics with a focus on oncologic patients, described as supportive oncodermatology formally in 2011 [3]. The growing study of dermatologic events is reflected in the number of publications on this topic (Supplemental Figure 1). The establishment of dermatologists as an integral component of cancer care has shown increased diagnostic accuracy [4] and decreased need for antineoplastic dose modifications as a result of skin toxicities, prolonged survival [5], and consistent dosing of antineoplastic therapy [6].
In an effort to ascertain the extent and expansion of supportive oncodermatology across institutions in the US, public data and a survey to program directors in the Association of Professors of Dermatology (APD) was utilized to identify the presence of oncodermatologists. Profiles of dermatology faculty at National Comprehensive Cancer Network (NCCN) institutions (https://www.nccn.org/), and 144 dermatology programs (non-NCCN) were identified through key terms in faculty profiles such as “skin toxicities for anticancer therapy” and “oncodermatology”, and the number of oncodermatologists at each program was recorded.
We found that of 31 NCCN institutions, 84% (26/31) listed oncodermatologists, and of the 144 dermatology programs (non-NCCN), 9% (13/144) listed oncodermatologists. Of 118 program directors surveyed, 38 (32% response rate) responded, with 36 programs having oncodermatologists on staff (31%). After accounting for overlap of programs that were on both the survey and website search, we identified 52 total programs (26 NCCN, 26 non-NCCN, Fig. 2 of the ESM and xref to the supplementary.) with oncodermatologists. The average number of faculty with oncodermatology indication was 4 for NCCN institutions (range: 1–18) and 2 for non-NCCN dermatology programs (range: 1–6). Study limitations include the use of public data, and responsiveness to the survey. In summary, oncodermatology has expanded from 1 institution to 52 institutions (Supplemental Table 1) in a span of 15 years, with oncodermatologists developing new niches within the field focusing on pediatric, hematology/inpatients, restorative procedures [7], and skin of color patients. This growing presence and interest in dermatologic events have been made possible by key elements critical towards the establishment of an oncodermatology clinical program (Table 1).
Table 1.
Key concepts for developing a supportive oncodermatology program.
| Developing a patient population | Supportive oncodermatology programs typically have an affiliation with a cancer center for a steady referral base from oncologists. Proximity to a cancer center facilitates convenience for patients and oncologists with dermatologists, especially when acute consultation for a dermatologic adverse event is necessary. |
| Proximity to a cancer center | |
| Rapport with oncologists | |
| Patient education resources | |
| Assessment of dermatologic adverse events | Supportive oncodermatologists should have a strong foundation in cancer types and how mechanisms of drugs can cause dermatologic adverse events. Standardized adverse event grading tools such as the NCI-CTCAE2 and MASCC EGFRI Skin Toxicity Tool3 are available. For patient reported outcome measures, SkinDex294 and DLQI5 are some of the tools that have been developed and used. |
| Types of cancer and staging | |
| Knowledge of oncologic drugs | |
| Adverse event grading | |
| Quality of life measures | |
| Treatment of dermatologic adverse events | Some dermatologic adverse events such as hand-foot syndrome have well established treatments, while rarer manifestations may require review of case series and/or reports in the literature for successful management. Supportive oncodermatologists can use the Oncodermatology Society listserv6 for feedback from other clinicians who may have expertise in treating certain conditions. |
| Evidence based practices | |
| Review of the literature | |
| Using professional networks |
Email membership@oncodermatologysociety.org to use the Oncodermatology Society listserv.
The formation of the Oncodermatology Society (oncodermatologysociety.org) and the European Task Force “Dermatology for cancer patients” (linked to the European Academy of Dermatology and Venereology), aims to bridge the knowledge gap and enhance collaboration between oncodermatologists towards research. The number of clinical trials in oncodermatology continues to expand, addressing mechanistic, quality of life, and therapeutic aspects of oncodermatology (Supplemental Table 2). Taken as a whole, it is expected that this subspeciality will be present in all dermatology programs and practices that provide care to cancer patients and survivors, all of which would result in improved dermatologic health and optimal cancer care.
Supplementary Material
Figure 1.
Geographic location of institutions with Oncodermatologists in NCCN centers and academic dermatology programs.
Funding:
No external funding was used in preparation of this manuscript.
Footnotes
To the editor: The increasing number and efficacy of cancer treatments has transformed the field of oncology. Prolonged survival across most solid and hematologic tumors as well as the introduction of systemic therapies with novel mechanisms of action, i.e. targeted blockade of oncogenic pathways and immune checkpoint inhibition, have underscored the importance of dermatologic adverse events and the need to address these untoward reactions as critical for optimal cancer care. Surveys of oncology practices revealed that despite dermatologic AEs frequently leading to anticancer agent dose modification or interruption, less than 8% of oncologists refer to dermatology. Reasons for the dearth of dermatologic involvement included time for an evaluation, additional costs, and oncologists’ lack of knowledge of dermatologists with expertise and interest in oncology [1].
Conflicts of Interest:
Dr. Anadkat has served as a consultant for ImClone, Bristol Myers Squibb, AstraZeneca, Therakos, Aspire Bariatrics, Biogen, Amgen, Veloce, Adgero, Eli Lilly, Abbvie, Boehringer-Ingelheim, Innovaderm, UCB Biopharma, Novocure, OnQuality, and Springworks. Dr. Anadkat has served as a Principal Investigator for Novartis, Boehringer-Ingelheim, Lutris, OnQuality, UCB Biopharma, InflamRx, Eli Lilly, InCyte, Abbvie, AnaptysBio, Hana Biosciences, Xoma, Veloce, Biogen, Xbiotech, and Chemocentryx.
Dr. Choi has a consultant role with OnQuality, Regeneron, Parexel, Azitra, La Roche-Posay Pharmaceuticals, and PraHealthSciences. Dr. Choi has served as a consultant for Biotest AG, Keratin Biosciences, Bristol Meyers Squibb, Novartis, Array Biopharma, and Kyowa Kirin International. Dr. Choi has served as a Principal Investigator for OnQuality, InCyte, and Veloce.
Dr. Jung has a consultant role at Regeneron and Sanofi.
Dr. Lacouture has a consultant role with Johnson and Johnson, Novocure, QED, Bicara, Janssen, Novartis, F. Hoffmann-La Roche AG, EMD Serono, Astrazeneca, Innovaderm, Deciphera, DFB, Azitra, Kintara, RBC/La Roche Posay, Trifecta, Varsona, Genentech, Loxo, Seattle Genetics, Lutris, OnQuality, Azitra, Roche, Oncoderm, NCODA, Apricity. Dr. Lacouture also receives research funding from Lutris, Paxman, Novocure, J&J, US Biotest, OQL, Novartis and AZ.
Dr. LeBoeuf is a consultant and has received honoraria from Bayer, Seattle Genetics, Sanofi, Silverback and Synox Therapeutics.
Dr. Markova has a consultant role with Alira Health, Blueprint Medicines, and receives research funding from Amryt Pharma and Incyte Corp.
Dr. Noor has a consultant role with Kyowa Kirin.
Dr. Sibaud has received consulting fees from Amgen, Bristol Myers Squibb, Pierre Fabre, Bayer. Dr. Sibaud has received honoraria for lectures from Bristol Myers Squibb, Pierre Fabre, Novartis, and Incyte. Dr. Sibaud participates on a data safety monitoring board for Bristol Myers Squibb.
Dr. Rossi has served as a consultant for: Almirall, Mavig, Dynamed, Canfield Scientific, Allergan Inc, Biofrontera, MD, Lam Therapeutics, Regeneron, Cutera, Skinfix, L’oreal.
Dr. Rossi has received research funding from Regen, LeoPharma, Biofrontera. Dr. Rossi serves on the editorial boards for Lasers in Surgery and Medicine, Cutis, Journal of the American Academy of Dermatology (JAAD), and Dermatologic Surgery.
Alexander Bang and Dr. Gordon declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.
Declarations
Ethics Approval: Not applicable.
Consent to participate: Not applicable.
Consent for publication: Not applicable.
Availability of data and material: Data of the supporting information is available upon request from the authors and a directory of oncodermatologists is available on oncodermatologysociety.org.
Code availability: Not applicable.
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