Diagnosis: Medcan
“What’s that?” asked Dr. Julia Carroll, Medcan’s director of dermatology. She was meeting with a client, Geoffrey Belisle, a 41-year-old investment advisor visiting the clinic for some routine mole-mapping, when she noticed a spot on Mr. Belisle’s chest.
“Oh that?” said Mr. Belisle. “I’ve seen three different dermatologists about it—they said it was just eczema.”
“Eczema?” asked Dr. Carroll. “Hmmm. Can you tell me a little more about it?”
Mr. Belisle had first noticed the small patch of red skin when he was 16. At first it was less than an inch square, the size of a dime. It itched a little. Once he noticed it spreading he made an appointment with a dermatologist, but the doctor dismissed it as common eczema, a chronic skin condition that can flare up into itchy, red patches. Over the years he’d seen two other dermatologists about it. They’d indulged him with prescriptions, then assured him it was nothing to worry about. The trouble, Mr. Belisle told Dr. Carroll, was that the patch—now a two-square-inch area of oozing, cracked skin—had been really itchy lately.
“You know, I’m not sure that’s eczema,” Dr. Carroll said. Naturally curious, Dr. Carroll had become a doctor in part to indulge her fascination with the human body. Mr. Belisle’s red mark was something that piqued her curiousity. The patch had flaky skin on it, like eczema, but a closer examination revealed that it exhibited other, more concerning factors, such as a tough, slightly thicker quality. It could also have been psoriasis—but if it was, the prescriptions other dermatologists had already prescribed Mr. Belisle should have cleared that up.
“Do you mind if I have someone else look at it?” Dr. Carroll asked. She called in her colleague, Dr. Paul Cohen. What struck Mr. Belisle was the way Dr. Carroll didn’t say anything to Dr. Cohen. She simply showed the other doctor the spot, and asked what he thought it was. “You want someone to have fresh eyes,” Dr. Carroll says. “I wanted someone to look at it with a fresh perspective.” Without any coaching, Dr. Cohen agreed—Mr. Belisle’s spot could be something more serious than eczema.
That was enough for Dr. Carroll. She froze the skin on Mr. Belisle’s chest and sliced off a small bit of the reddened skin for analysis.
“Right away,” recalls Mr. Belisle, “I thanked her. I said, ‘you’re the first person who took this seriously.’ I could just feel her tenacity—she wasn’t going to stop until she found out for certain what it was.”
Mr. Belisle returned to Medcan for a follow-up appointment in the last week of June. “So what have we got?” he asked when he saw Dr. Carroll.
"Well... It's not eczema after all,” Dr. Carroll said. “It's actually cancer—which is somewhat surprising based on how long you've had this thing.”
In fact, it was a type of non-Hodgkin lymphoma called a cutaneous T-cell lymphoma—a rare form called a Woringer-Kolopp pagetoid reticulosis, which typically appears on an extremity, such as an arm or a leg. The lymphoma isn’t skin cancer. Rather, it’s a cancer of the body’s lymphatic system, a part of the immune system.
Medcan found one of the few dermatologists who specialize in cutaneous T-cell lymphoma, a Dr. Scott Walsh at Toronto’s Sunnybrook Hospital, who confirmed the diagnosis. Mr. Belisle learned he was only the 470th person to be diagnosed with cutaneous T-cell lymphoma at Sunnybrook—and the hospital had the world’s largest population of patients for that particular form of cancer. Further testing, such as a full CT scan of Mr. Belisle’s lymph nodes, revealed that the lymphoma remained a stage-1 cancer: It hadn’t spread to other parts of the body. Somehow, for 25 years, Mr. Belisle had held off his rare form of cancer. Friends joked with him. “How’d you keep it at bay for so long? What do you eat? And can I get some?”
The next step for Mr. Belisle was radiation treatment, which happened in September. Once a day for 10 days, Mr. Belisle visited Sunnybrook Hospital to have the lymphoma blasted with radiation for 60 seconds. The lymphoma has shrunk markedly since the treatment finished. Soon, it will disappear—leaving Mr. Belisle without the cancerous lesion he’s had for a quarter century.
Mr. Belisle’s story has a moral for Dr. Carroll. It’s about the diagnostic importance of a fresh set of eyes: it never hurts to get a second opinion. There’s a lesson for Mr. Belisle, too. “Everywhere else I went, the dermatologist just glanced at the spot and dismissed it,” he said. “They basically gave me a pat on my head and sent me on my way. Dr. Carroll was absolutely different. After that first appointment with Dr. Carroll, I went home to my wife and said, I finally found someone who’s going to figure this thing out. The biggest difference, to me? Dr. Carroll listened.”