Multidisciplinary Cancer Care

Complex skin cancers often require expertise that extends beyond any single medical specialty. A multidisciplinary approach to cancer care brings together specialists from dermatology, oncology, surgery, radiation therapy, and pathology to develop coordinated treatment plans. This collaborative model ensures that patients with advanced, rare, or recurrent skin cancers receive comprehensive care that addresses all aspects of their condition.

The Multidisciplinary Approach

Multidisciplinary cancer care is founded on the principle that complex cases benefit from the collective expertise of multiple specialists working together. Rather than a patient being managed by a single physician in isolation, a team of professionals contributes specialized knowledge to develop an integrated treatment strategy. This approach is associated with improved outcomes, more thorough staging, and better coordination of sequential or concurrent therapies.

Case conferences, in which the multidisciplinary team reviews imaging, pathology, and clinical findings together, form the cornerstone of this approach. These discussions enable consensus-based decision-making and ensure that all treatment options are considered before a plan is finalized.

When Multidisciplinary Care Is Needed

While many skin cancers are effectively managed through standard surgical excision, certain clinical scenarios warrant a multidisciplinary approach. These include:

• Advanced melanoma, including cases with regional lymph node involvement or distant metastatic disease
• High-risk squamous cell carcinoma with perineural invasion, lymphovascular invasion, or involvement of deep structures
• Rare cutaneous malignancies such as Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous lymphoma
• Recurrent skin cancers that have not responded to standard treatment
• Cancers in anatomically challenging locations where reconstruction requires specialized surgical expertise
• Metastatic or locally advanced disease requiring systemic therapy, immunotherapy, or radiation

Collaborative Specialties

The composition of the multidisciplinary team is tailored to the specific needs of each case. The following specialists may be involved in the management of complex skin cancers:

• Dermatologist: initial diagnosis, staging, dermoscopic assessment, and ongoing skin surveillance
• Dermatopathologist: histopathological analysis, immunohistochemistry, and molecular testing
• Surgical oncologist: wide local excision, sentinel lymph node biopsy, and lymph node dissection
• Medical oncologist: systemic therapies including immunotherapy, targeted therapy, and chemotherapy
• Radiation oncologist: adjuvant or definitive radiation therapy for selected cases
• Plastic and reconstructive surgeon: complex wound closure, flap reconstruction, and aesthetic outcomes

Treatment Planning

Treatment planning in the multidisciplinary setting involves a systematic review of all available diagnostic information, including histopathology, imaging studies, and clinical staging. The team discusses the merits of various treatment approaches and reaches a consensus on the optimal plan for each patient.

For advanced melanoma, treatment planning may include consideration of sentinel lymph node biopsy, adjuvant immunotherapy with checkpoint inhibitors, targeted therapy for BRAF-mutant tumours, or radiation therapy for specific indications. For high-risk squamous cell carcinoma, the discussion may encompass wide excision versus Mohs surgery, the role of adjuvant radiation, and the potential need for systemic therapy in metastatic cases.

The resulting treatment plan is communicated clearly to the patient, with each team member's role and the sequencing of interventions outlined in detail.

Patient-Centred Coordination

Effective multidisciplinary care requires seamless coordination to minimize delays and reduce the burden on patients. Appointments with multiple specialists are coordinated whenever possible, and communication between team members ensures that each step of the treatment plan proceeds in a timely and organized manner.

Throughout the process, the patient remains at the centre of all decision-making. Treatment options, potential side effects, expected outcomes, and follow-up requirements are discussed thoroughly, ensuring that patients are informed participants in their care.

At the Centre for Medical and Surgical Dermatology, Dr. Maksym Breslavets collaborates with a network of specialists to provide multidisciplinary care for patients with complex skin cancers. From initial diagnosis through treatment planning and long-term surveillance, a coordinated approach is taken to ensure that each patient receives the most appropriate and comprehensive management for their condition.