Vol. 14 No. 2
Fall 2004

Combining art and science, the anaplastology program at Huntsman Cancer Institute offers anatomical restoration—and hope—to those with cancer.

Growing up on a wheat farm near Shelby, Mont., just south of the Canadian border, Lloyd McLean spent a lot of time outside in the sun. He gave up farming years ago, but not his work outdoors. He now makes a living as a cartographer, mapping out areas of exploration for the oil and gas industry.

All that time in the sun eventually caught up with McLean. A few years ago, he noticed a suspicious-looking sore on his left ear. He eventually went to a doctor who gave him the bad news: basal cell carcinoma, a common form of skin cancer. At that point, McLean says he elected to take a wait-and-see approach—until he was told some months later that his cancer had spread.

The surgery to remove the cancer proved difficult because it included removal of the left ear. McLean says the surgery—and the bandages and dressings he had to wear to cover its effects—had a terrible psychological impact on him. “People would walk by and stare—you know, do a double take,” he says. A year later, another sore on his cheek brought him to the University of Utah dermatology clinic, where Glen Bowen MD’90 performed Mohs micrographic surgery, removing the cancer and a small portion of tissue.

The Truth about Melanoma

· Skin cancer can strike at any age, but occurs most frequently in older people.

· Much of the damage that leads to skin cancer occurs in young children and adolescents.

· If treated early, skin cancer is usually curable.

Then some good news: McLean learned of a new program just getting under way at The Huntsman Cancer Institute at the U called anaplastology—the art and science of creating an artificial substitute for a missing or malformed part of the face or body.

For those with disfiguring cancer, there are several options to consider. Depending on the aggressiveness of the cancer, a patient could decide on reconstructive surgery, or a combination of surgery and prosthesis. Surgical reconstruction is often the treatment of choice. However, when multiple procedures are required, patients often choose prosthetic restoration to avoid additional surgeries. Anaplastology can also offer the patient a more predictable outcome in terms of aesthetic appearance.

For McLean, who had spent a year without a left ear, a facial prosthesis seemed to be the best option. Paul Tanner, a U of U student who was working with Bowen at the time, replaced McLean’s ear with a completely natural-looking prosthesis. Today, McLean reports that he’s happy, adding, with a laugh, “and so are the people who have to look at me.”

Types of Skin Cancer

Basal cell carcinoma
The most common form, primarily caused by cumulative exposure to sunlight. It can destroy the skin tissue of noses, ears, eyelids, lips, and other areas. It is usually not life threatening unless it goes untreated for a long period of time.

Squamous cell carcinoma
The second most common skin cancer usually occurs in areas that have been overexposed to the sun. Ordinarily, this type of cancer grows slowly, but it can be aggressive and life threatening.

The deadliest form of skin cancer, melanoma has reached epidemic proportions worldwide. If removed before it invades the lower layers of skin, it is almost 100 percent curable. If it invades the body and travels to other organs, however, it is hard to treat and frequently fatal. Melanoma can occur in parts of the body that have never been exposed to the sun.

Tanner is part of an elite group. There are 161 members of the American Anaplastology Association worldwide, 109 of whom reside in the United States. Tanner became interested in the field six years ago when a relative had an ear removed due to melanoma and received a prosthesis at M.D. Anderson Cancer Center in Houston, Texas. “That’s when I first became acquainted with facial prosthetics,” he says. Because there is no formal undergraduate program for anaplastology in the country, he was allowed to design his own course of study, which combined art and science, with classes in art, biology, materials science, and health education.

Now a senior, Tanner will graduate with a Bachelor of University Studies degree in anaplastology from the School of Medicine. He couldn’t have picked a better time or place for his work. The anaplastology department at HCI recently got a much-needed boost. The Huntsman Cancer Hospital, located adjacent to HCI, was formally dedicated in June and is the department’s new home—the most comprehensive prosthetics lab in the state. Patients can now have both oncology and prosthetic treatment without leaving the state-of-the-art facility.

More important than a new home, the program now has a new director: Gillian Duncan, who comes to HCI from her private practice in Minnesota with more than 20 years of international experience making facial prosthetics for patients referred from the Mayo Clinic, the University of Minnesota, insurance companies, and many doctors in private practice.

Duncan, who has a master’s degree in medical illustration, gained a vast amount of knowledge and clinical experience early in her career operating an “epithetic” clinic in Germany. Some of her patients were World War II veterans, including many who had lived for years with a disfiguring injury. Duncan was there, fitting patients with “epitheses” (the international term for facial prostheses), when the Berlin Wall came down. During the hours spent with patients, creating their facial prostheses, “I learned European history firsthand from patients who had been in the military or who were civilians and injured in the war,” says Duncan. “It was a unique experience. I do this work because of my love of art, science, and ‘a good story!’ It’s great to be doing something you love and that really helps someone else.”

The Huntsman Cancer Institute, home to the anaplastology program, celebrated the opening of the Huntsman Cancer Hospital this summer.

Fast facts about the new Huntsman Cancer Hospital:

· Located at the Huntsman Cancer Institute

· Project cost: $100 million

· Provides all oncology in-and-out patient care

· Connected to existing institute by glass walkways

· 276,344 square feet

· 50 private inpatient beds

· 4 operating rooms

· First full-field digital mammography unit in the Intermountain West

· First combined PECT/CT imaging unit in the Intermountain West

· Prosthetics lab

· Full-service retail pharmacy

· Styling salon exclusively for patients’ use

· Family-oriented amenities, including business area with Internet access, chapel, and the Point Bistro

The facial prosthesis is made through a careful examination of a person’s anatomy, skin color, and texture. Using minute amounts of different colors mixed into silicone, prosthetic noses, ears, eyes, and, in some cases, larger sections of the face are realistically detailed down to tiny veins and age-appropriate wrinkles. Orbital prostheses are meticulously finished with special attention to the lashes and eyebrows. Once completed, the prosthesis is carefully fitted and held securely in place with clips or magnets, or by using a small amount of adhesive around the thin, soft, silicone edge.

Cancer treatment can be long and sometimes painful, but can also restore a person’s hope. In contrast to the treatment itself, which can take weeks, months, or years, creating a facial prosthesis usually takes just a few appointments. Duncan says the biggest challenge is not the size or location of the prosthesis but the patients’ acceptance of it—whether it provides them with a sense of self-confidence and predictability about how they perceive themselves and how others see them. “This work can make an incredible change in people’s lives after the trauma they’ve been through,” she says.A facial prosthesis offers patients and their families a return to normalcy, something Duncan never forgets when talking to those she is treating. “We’re at the end of the medical continuum where whatever happened to them has hopefully been resolved,” she says. “Now we are there to offer a successful prosthetic restoration that helps the patient look in the mirror and not only accept but like what they see. That’s quality of life.”

In McLean’s case, the prosthetic ear has meant renewed self-confidence. The change has been dramatic. “It gave me some peace of mind that I wasn’t revolting. It got rid of the double takes. People used to walk by and stare, and that doesn’t happen anymore,” he says.

As cancer survival rates increase, so does the need for prostheses, which keeps Duncan and Tanner busy. Both say they love their work—especially the reaction from individuals like Lloyd McLean, who has not only regained a piece of himself but also the peace of mind once lost to disease.

—Remi Barron is a writer in the University’s Marketing & Communications Office.

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