DEPARTMENT OF DERMATOLOGY
Brief history
The Department of Dermatology is composed of an outpatient and an inpatient unit.
The so called onco-dermatological profile, specialised in skin cancer has a tradition of almost 50 years going back in the history of the National Institute of Oncology. The available statistics show that an increasing number of patients suffering from various types of skin cancer register at our Department from all over the country.
The growing number of patients reflects the worldwide tendency that incidence of malignant skin cancer and melanoma continuously increases among the white population in the last decades.
Outpatient care, appointments
While a total of 710 malignant melanoma, i.e. pigment cell tumour were diagnosed and treated at the National Institute of Oncology between the years 1958-68, a total of 952 patients were diagnosed with melanoma just between 2010-2011. In recent years malignant melanoma has been diagnosed in 6-700 patients per year, nevertheless majority of the patients were cured in an early stage.
Annually 15.000 patients visit our outpatient department. In addition to melanoma the highest percentage of cancer patients have basal cell carcinoma, basalioma, squamous cell carcinoma and spinalioma. Metastasis of basal cell carcinoma is very rare just as the lymph node and internal organ metastasis of squamous cell carcinoma; generally patients are cured by surgical treatment.
Since 2011 the Outpatient Unit of the Dermatology Department is located at Ground Floor in the newly built Building 8/A with 4 consulting rooms. The Inpatient Unit is located on the 2nd Floor of the building.
Patients need to have an appointment to be registered at the Department. We kindly ask our new patients to do not adhere to a specific physician so that misunderstandings and delays can be avoided. Appointments can be requested by phone 224-8600/ext. 2600 or personally at the Patient’s Admission Office (Budapest XII., Kékgolyó u. 13). We provide appointments for our patients who are currently undergoing treatment. If the appointment given is not appropriate for some reason it is possible to see the treating physician without an appointment during the physician’s consultation hours after prior consultation via telephone (ext. 2600).
Naturally the ideal case would be that patients would have a referral from their general practitioner, a dermatologist or from another specialist when they visit our Department for the first time, as in many cases patients applying for examination may not know whether they need to be treated at the national institute or not. We provide our outpatient services as detailed above, because our aim is to treat everyone whose tumour makes it necessary to be treated at the Institute. To this end we kindly ask our patients to wait patiently.
In urgent cases we kindly ask you to bring an emergency referral from your GP indicating the diagnosis. We can give you an appointment based on this referral. Requesting an appointment is mandatory.
Inpatient Unit
Some of our patients need inpatient care. The patient who are admitted to the Inpatient Unit receive chemotherapy, immunotherapy, radiation therapy or other therapies for which hospitalization is required. The onco-dermatology department has hospital rooms with one, two or three beds and bathrooms; a total of 26 beds. The new, modern building meets all requirements aesthetically as well as in terms of equipment.
Staff
Head of Department: Prof. Dr. Gabriella LISZKAY Ph.D., Med. Habil., dermatologist, clinical oncologist
Physicians:
- Dr. Tímea BALATONI - Dermatologist - Clinical Oncologist, Head Physician, Deputy Head of Department
- Dr. Fanni BARANYI – Physician assistant
- Dr. Kata CZIRBESZ – Oncologist
- Dr. Tímea DANYI – Physician assistant
- Dr. Franciska GESZTI – Dermatologist (part-time employee)
- Dr. Eleonóra IMRÉDI – Dermatologist trainee
- Dr. Mihály Tamás KISPÁL – Physician assistant
- Dr. Krisztina MELEGH – Dermatologist trainee
- Dr. Gitta PÁNCZÉL – Dermatologist, Senior lecturer
- Dr. Zsuzsanna CSELLÁR – Dermatologist - Clinical Oncologyist, Head Physician (part-time employee)
- Dr. János HUNYADI – Dermatologist - Clinical Immunologist, DSc. (part-time employee)
- Dr. Mária VARGA – Head Physician (volunteer/part-time employee)
- Dr. Iringó Ágnes OTTÓ – Dermatologist (part-time employee), Ph.D.
Psychologist:
- Péter KOVÁCS
Nurses:
- Ilona KÁRPÁTI – Head nurse
- Kitti BALOGH
- Andrea BÁNÁTI
- Janka KOVÁCS – Nurse assistant in vocational nurse training
- Ildikó NAGY
- Erika SZABÓ
- Magdolna TŐZSÉR-BÍRÓ
Assistants (Health care professionals):
- Miklós ZOLTÁNNÉ – Senior assistant
- Katalin SÁRKÖZINÉ KUNYOVSZKY – Deputy Senior assistant
- Erika SCHRÓTH
- Györgyi JANKOVITS
- Marianna CZENÉNÉ KAPÁS
Administrators:
- Tímea KOÓS
- Edina Eszter ORAVECZNÉ PUSKÁS
- Anikó HORVÁTH
Professional profile
Our task is to provide the highest quality care for patients suffering from different skin tumours.
We are in cooperation with all departments of our national Institute both in practical work related to patients and in scientific work. New diagnostic and therapeutic methods are introduced into clinical practice at the Department. Our professional experiences are published in journals, books and book extracts. The Department participated in several international drug trials; clinical trials are currently being conducted related to new substances. International articles have been written on the based on these clinical trials of which we are co-authors.
In accordance with our national institutional functions the Department participates in the training of medical students; moreover physicians working at the Department hold lectures at the University of Pécs and at the University of Medicine, Pharmacy, Science and Technology of Târgu Mureș on the topic of skin tumours. The education of graduates is provided by the Department in the form of thesis supervision. Medical students are being welcomed during summer and semester internship. As an accredited training site we provide theoretical and practical education for dermatologist and oncologist candidates. According to our extensive international relations we regularly hold training courses with the participation of keynotes (Stockholm Karolinska Institute, IPRI, Bergamo Azienda Ospedaliera Papa Giovanni XXIII).
An international immunotherapy conference titled “Give Life a Chance through Cancer Immunotherapy” was organised in cooperation between the “Hungarian Fulbright Alumni and Hungarian American Fulbright Commission” and the National Institute of Oncology with outstanding success. Our physicians regularly give presentations at national and international conferences on their research activities, they also publish in academic journals.
The characteristics and processes of dermatological care
The inpatient and outpatient units of the Department of Dermatology provides care for patients with skin tumours in close cooperation as one unit. The Department considers the diagnosis of all skin based lesions suspected to be tumorous as well as the set up and implementation of appropriate treatment plans its main function.
Preliminary diagnosis is of crucial importance in dermatological oncology. The majority of dermatological tumours are located in a prominently visible location. Skin tumours are particularly prevalent on the face. Early and correct diagnosis makes the complete recovery possible for patients post-op.
In the majority of cases the diagnosis can be made with certainty by the analysis of lesions performed either by a simple visual inspection with the naked eye or with using dermatoscope (a special magnifying device).
In the case of a benign tumour the patient is informed both in orally and in writing about the nature of their lesion and further treatment, if needed. In the case that malignancy is suspected the patient is enrolled in treatment, which means the surgical removal of the lesion in most cases. In possession of the histological findings the treatment plan is determined by a multidisciplinary team (MDT) which consist of the following: a dermatologist, a clinical oncologist, a surgeon, a head & neck surgeon, a radiotherapist, a pathologist and an imaging diagnostician. The MDT’s decision based on the data the treating physician provides, when the patient’s examination is not required. If needed patient examination is performed at the MDT session. The decision is reached according to the high quality international and national professional protocols as well as evidence-based medicine. The therapeutic plan is proposed by the treating physician. The MDT sessions are led by Prof. Dr. Gabriella Liszkay, Department Head of the Department of Dermatology. The MDT meets every Thursday in Ground Floor of Building 8/A at 14:00. The patients discussed at these sessions are referred to the MDT by the physicians of the Department of Dermatology.
The National Institute of Oncology offers a number of therapeutic treatment options at the Department, which are performed according to the patient’s needs at any given time. These treatment options are the following: general surgery, reconstructive surgery, sentinel lymph node biopsy as well as radiotherapy and chemotherapy.
Interferon immunotherapy
Interferon immunotherapy is administered to patient who underwent surgery and are currently cancer-free in order to prevent the development of metastasis. Its most typical adverse effects are flu-like symptoms. The treatment is set up at the inpatient unit of the Department and continued at home via self-injection.
Targeted therapy for melanoma
For a long time, the only treatment option available to melanoma patients were chemotherapy. Through the advancement of molecular pathology, the BRAF-mutation, a tumour genetic deviation which plays a pivotal part in the development of melanoma was successfully detected.
The first targeted therapy drug has been registered in America since 2011. Since then it has also been registered in Europe, thus becoming available for patients in Hungary as well. The BRAF-mutation can be detected in about half of all detected tumours, resulting in therapeutic response to the dugs administered in the majority of patients. If the drug is combined with MEK-inhibitor, which is a drug effective on the same transmission path both the percentage of therapeutic response rate and survival increase.
At our Institute we have every means to detect BRAF-mutation, yet we perform tests on other mutations responsible for the development of melanoma, if there is clinical therapeutic indication for them to be performed. Naturally these tests do not pose financial obligations to the patients as nowadays these tests are essential for treatment planning.
Targeted therapies have special adverse effects, however at the Institute the treatment and prevention of these are part of the daily routine based on the therapeutic experience gained from treating hundreds of patients.
Immunotherapy for melanoma
The role of the immune system in relation to melanoma is in the focus of experimental and practical research for decades. The therapeutic effectiveness of interferon has been demonstrated in the case of cancer-free patients, however until 2011 no immunotherapy prolonging survival existed for metastatic melanoma. The first drug to be effective on immune checkpoints was the anti-CTLA4 ipilimumab.
The therapeutic response rate is low, however 20% of those patients who respond to the treatment survive up to 3+ years. There is no “predictive laboratory marker” to predict its effectiveness. Nowadays the ipilimumab is used mostly in second-line and can be used in first-line treatments in combined immunotherapy administered only to a narrow group of patients as its adverse effects are significant.
After ipilimumab therapy the anti-PD1 (programmed cell death) immunotherapy was adopted both in the USA and in Europe. The PD1 inhibitors have a higher response rate than ipilimumab therapy and are at least 3 times more efficient. The autoimmune adverse effects occur quite frequently but they are less severe than those of the previously mentioned therapy. Both therapies are available in Hungarian centres, such as our national centre. Long-term survival can be achieved in advanced metastatic melanoma with the help of the new therapeutic modalities, especially if the metastases are detected in time
Chemotherapy
While nowadays chemotherapy is less likely to be administered for melanoma as new pharmaceuticals are available, it still has a prominent role in the treatment of melanoma. In some cases, chemotherapy proves to be more effective than the so-called modern therapies.
For melanoma chemotherapy is administered as a 1-, 3- or 5-day treatment.
This treatment often requires inpatient stay. The treatments administered for melanoma usually have few adverse effects. In the majority of therapies hair loss does not occur. The patient is informed in detail about the expected adverse effects.
Special diagnostic and treatment methods for melanoma
The Sentinel Lymph Node Technique was a revolutionary step forward in the surgery of melanoma that was developed three decades ago. Using this technique, the primary tumour is removed and at the same time or a few weeks later the lymphatic system is mapped. The lymph vessels leading from the tumour to the lymph nodes are also identified with the help of a small surgery. During the histological examination of the tissue sample even microscopic tumour involvements become detectable. This is important in terms of the prognosis as well. Furthermore, by the application of this method the number of melanoma patients whose remaining lymph nodes should also be removed can be narrowed down.
For the early detection of metastases in addition to physical examination and other imaging tests in certain indications a PET / CT scan is a precise testing method for which the physicians at our Department refer patients to if needed.
In the case of brain metastasis, a consultation of neurosurgeons and radiotherapists decide on the feasibility of performing the so-called stereotactic radiosurgery (SRS). During the surgery the metastasis is targeted with gamma-rays without having to cut in the skull, protecting the surrounding brain tissue. The procedure is carried out jointly by the National Institute of Clinical Neurosciences (Országos Idegtudományi Intézet) and the Department of Radiotherapy of the National Institute of Oncology.
A new treatment option for treating metastases in the internal organs is the CyberKnife, a special radiation therapy, which can substitute surgery in some cases.
In the case of liver metastases, it is possible to treat the liver with selective chemotherapy via the artery supplying the organ. The method makes it possible for the cytotoxic agent to reach a higher concentration in the affected organs thus lower doses are sufficient, and the adverse effects are fewer. In case of a single metastasis, there is also a possibility to occlude the vein supplying the tumour. The tumours on the extremities can be treated in a similar way.
In recent years a new treatment option is electrochemotherapy in case of multiple metastatic or non-operable tumours of the skin. During electrochemotherapy the cell membranes become temporarily permeable with the help of short high voltage current pulses. In this way several molecules can be introduced directly into the cell, e.g., chemotherapeutic medications (electrochemotherapy). Many chemotherapeutic products have lipophilic characteristics and therefore can pass through the cell membrane, but electroporation significantly increase medicine concentration in the tumorous cell, thereby increasing cytotoxicity. Such substances include bleomycin, cis- and carboplatin. In the case of these medications increased cytotoxicity has been documented both in vitro and in clinical studies. The efficacy of electrochemotherapy has been confirmed in several cutaneous tumour clinical trials as well as during the treatment of cutaneous metastases in internal organs.
Psychological care at the Department of Onco-dermatology
In accordance with international guidelines there is a psychologist working at the Department of Onco-dermatology. Patient care is organized according to the multidisciplinary approach, therefore patient care is realised by the joint teamwork of the physicians, the nurses and the psychologist.
A szorongás gyakori kísérője az onkológiai kezeléseknek, de és a kórházba kerülésnek (hospitalizáció) szintén jól ismert velejárója. A depresszió diagnózisához szakember szükséges. A lehangoltság mellett, alvási zavarok, a testsúly változásai, fáradékonyság, kedvetlenség is kísérhetik a betegséget. A pszichológiai problémák nem egyik napról a másikra alakulnak ki, ezért különösen fontos lehet a hozzátartozókkal való kapcsolattartás is.
The psychological assessment is done parallel to the patient’s admission to the Department. The assessment is performed by questionnaires used in international practice, which have also been validated in Hungarian patient groups. In respect of the current psychological state of the patient it is important to take into account the psychological adverse effects associated with treatments, since the intensification of said symptoms often cause the interruption of the therapy and may worsen the patient's overall quality of life as well.
Anxiety is a frequently inherent to oncological treatments and a well-known factor in hospitalization. The diagnosis of depression can only be given by a psychologist. In addition to being lethargic, the patient may have trouble sleeping and may experience weight changes, tiredness, as well as listlessness. Psychological problems do not develop from one day to another, therefore contact with relatives may be of special importance.
The different medical treatments may indicate a difference in psychological support. All care provided is tailored specifically to the needs of each patient. Therefore, the support provided for the management of mental health problems and for the bio-psychosocial balance is unique to each patient.
At our Department patients can ask for help from not just their treating physicians but also from well-educated and dedicated psychologists who specialise in melanoma and whose scientific work is also recognised internationally.
