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Oncology

Leaders from Northwell’s Cancer Institute and its Center for Genomic Medicine celebrate the opening of the Molecular Diagnostic Laboratory. From left to right, Joseph Castagnaro, Jeff Boyd, Dwayne Breining, Richard Barakat, Naima Loayza, Anna Razumova, Angelo Carbone, Rita Mercieca and Kathryn Cashin. Photo courtesy of Northwell Health

By Daniel Dunaief

Northwell Health Cancer Institute and its Center for Genomic Medicine opened a Molecular Diagnostics Laboratory, which will reduce the cost of testing and shorten the time to get test results for cancer tests.

At a cost of $3.2 million, the 2,800 square foot facility will use next generation sequencing to provide tumor and patient genomic profiling and to assist in testing for biomarkers and determining the choice of cancer therapy.

The MDL, which is using the space Northwell Health Labs owned, will offer an array of tests in a phased approach. It is starting with a set of single gene tests to inform precision therapies for lung, melanoma, pancreatic, and colorectal cancer, which can be conducted in 24 to 72 hours.

“We like to get cancer therapy started as soon as possible for patients with metastatic disease,” said Jeff Boyd, vice president and chief scientific officer and director of the Northwell Health Cancer Institute’s Center for Genomic Medicine. When Northwell sent out similar tests to for-profit centers, the results, depending on the test, could take weeks.

The MDL is performing these tests on patients with advanced stage disease and/or recurrent diseases, which increases the need to generate results quickly.

“That makes a huge difference for the ordering oncologist and, most especially and importantly to the patient,” said Boyd. “The sooner they can get on precision therapeutics to treat the disease, the better. Outcomes will reflect wait time until you get therapy.”

Northwell treats more New York residents for cancer than any provider in the state, according to the Statewide Planning and Research Cooperative System, inpatient and ambulatory surgery data. 

The center, which is located in Lake Success, started conducting tests several weeks ago.

The lab is using high-end DNA sequencing to extract and define the genomic details of each tumor. Each patient tumor is different, which affects decisions about the best possible treatment.

“When the diagnosis isn’t totally clear to the pathology team, the genetics of the cancer will often inform the diagnosis,” said Boyd. Some patients with the same type of tumor will respond differently to radiation.

The lab is offering four single-gene tests: EGF for non-small cell lung cancer, BRAF for melanoma, KRAS for colorectal, pancreatic and lung cancers, and BRAF/NRAS for melanoma.The MDL plans to offer a 161-gene NGS panel for solid malignancies, a 45-gene NGS panel for hematologic malignancies, and MSI-H, a genetic test that reveals whether tumors will respond to immunotherapy.

Long road

Northwell recruited Boyd to start a molecular diagnostic lab four years ago. He started working in February of 2020, a month before the pandemic caused local, state, national and worldwide disruption.

While he has other responsibilities, Boyd suggested that his “primary reason” for joining Northwell was to “create and direct a Center for Genomic Medicine.”

Northwell conducted extensive physical renovation of the core lab facility that houses the MDL. Northwell also hired six people for the MDL, which includes a lab director, a lab manager, two certified lab technicians, a director of bioinformatics and an LIMS administrator.

In addition, New York State Department of Health had to certify the tests. Northwell is working through certification for additional tests.

Patients don’t need to go to the Lake Success facility to benefit from the services offered by the lab.The cost to patients for these tests is less than it would be for a for profit lab, Boyd said.

“We are a non profit and all we’re looking for is the sustainability of the lab infrastructure,” he added.

At this point, the lab isn’t conducting any germ line testing to determine if there are genetic predispositions to various cancers.

“That might be one of those tests we role out in the future,” Boyd said.

For Boyd, who earned a PhD in toxicology and biochemistry from North Carolina State University in Raleigh, the work is particularly rewarding.

To see his job “impact care tomorrow” based on a particular genetic alteration, “it doesn’t get much better than that for an individual with my background and profession,” he said.

People should go through several bottles of sunscreen in one season. Using an ounce of sunscreen is ideal, as companies measure the SPF of a sunscreen by applying that amount of sunscreen to the body. Photo by Giselle Barkley

A little dab here and a little dab there. That’s usually how people apply sunscreen to their skin, according to Dr. Michael Dannenberg of Dermatology Associates of Huntington, chief of dermatology at Huntington Hospital. But with around one in five people developing skin cancer on their scalp, a dab of sunscreen isn’t enough.

Skin cancer is one of the most prevalent cancers in America, and cases for scalp cancer have increased in the past several years. While those who don’t have hair may be more prone to getting scalp cancer in comparison to those with hair, anyone can develop any form of skin cancer on this area of their body.

Squamous cell and basal cell carcinoma are common for those who are frequently exposed to the sun and those who are losing hair. Melanoma can also develop on the scalp. In 1935, one in 1,500 people developed melanoma, but the rate has since increased. Now, one in 50 people have a lifetime risk of developing melanoma.

According to Dr. Tara Huston, a surgeon in the Melanoma Management Team for Stony Brook Medicine, there will be 74,000 new cases this year of melanoma in the United States alone. Huston also said that this form of skin cancer usually requires a surgeon’s attention, as it calls for “a larger excision margin than either basal or squamous cell skin cancer.”

Huston and her team help patients with various forms of skin cancer. While dermatologists treat skin cancers like melanoma if caught early, people with more advanced stages of skin cancer may need surgery and additional treatment to recover. A patient’s lymph nodes are also examined. Lymph nodes are responsible for the drainage of certain parts of the skin. Doctors can further repair issues found from examining the nodes associated with the cancer in that area.

Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian
Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian

Although skin cancer of the scalp is not difficult to detect, Dr. Dannenberg says it can be missed because it is on the head. Lesions can vary based on the form of skin cancer on the scalp. Yet, it is easy to detect, especially when people receive frequent haircuts. According to Dannenberg, his office receives countless referrals from barbers and hairstylists who may find a cancerous lesion on their client’s heads.

Huston agreed with Dannenberg regarding the role of barbers and hairstylists, as a number of skin cancer lesions are identified by these professionals.

Squamous cell carcinoma appears in dull, red, rough and scaly lesions, while basal cell carcinoma appears as raised, pink and wax-like bumps that can bleed. Melanoma on the scalp appears as it would on any other part of the body — irregularly shaped, dark-colored lesions.

While sunscreen is more often associated with skin protection, dermatologists like Dannenberg also recommend protective clothing and hats. Cloth hats allow the wearer’s head to breathe while protecting the scalp. Hats with a three and a half inch or more rim offer the best protection, as they cover the head while protecting the ears and other parts of the face or neck. While people can also use straw hats, the hats should be densely woven and not allow sun to penetrate. Hats as well as sunscreen and protective clothing should be used together to provide people with the best form of sun protection.

“Nobody is completely compulsive about putting on that hat every moment they walk out the door,” Dannenberg said. “Likewise, even for people [who] are using sunscreens, people tend not to use enough of it and they don’t reapply it as often as necessary.”

One ounce of sunscreen might be hard to hold without dripping down the side of someone’s hand, but it is the amount of sunscreen people should use on their entire body. Dannenberg also says that sunscreens usually last for about three hours before people need to reapply.

Since few people follow the directions when applying sunscreen, Dannenberg as well as the American Academy of Dermatology recommend people use sunscreens with at least SPF 30. Using sunscreens with higher SPF counts means that people can under apply and still get some degree of sun and ultraviolet radiation protection.

Huston said individuals who don’t want to wear sunscreen or those with a history of tanning should seek a dermatologist and schedule appointments at least once a year to conduct a full body skin examination.

According to Huston, operating on areas of the head like the ears, nose, eyelids, lips and scalp is difficult because of the surrounding tissue.

“Reconstruction of a 2 cm defect on the nose may require multiple stages/surgeries in order to optimize the aesthetic result,” Huston said in an e-mail interview.

While some patients need skin grafts upon the removal of a cancerous lesion, Huston said, “incisions on the scalp can lead to alopecia, or hair loss along the incision line, if it stretches, and can be very upsetting to patients.”

Both Huston and Dannenberg emphasized the importance of protecting the skin and skin cancer education. Dannenberg hopes that the rates of skin cancer will decrease if people are more consistent about protecting their skin with protective attire, sunscreen and hats.

“We’ve been talking to people for years about wearing hats…telling them that as fashion always seems to follow need, that these hats are going to be coming in style,” Dannenberg said. “We’re hoping that over the next 10 or 15 years, we’ll be able to get a drop in the incidences of skin cancer.”