An NCI-designated Comprehensive Cancer Center
By Robert Young | May 22, 2018
Joshua Singer | City of Hope Joshua Singer and his wife Helen
Joshua Singer thought it was just a rash on his forehead, a couple of raised, red, itchy spots that he noticed back in 2012. They were annoying and unwelcome but not really concerning. But when they started spreading over his forehead and down to his nose and neck, it was time to get checked out.
Singer visited several dermatologists and cancer specialists over the next two years, and his frustration was growing. No one could give him a definitive diagnosis.      
“Luckily, the rash was never debilitating,” Singer said. “My life didn’t change dramatically, but no one could tell me exactly what it was, although some of the doctors suspected a rare skin cancer called cutaneous T cell lymphoma (CTCL). I received a variety of treatments with minimal results, and my wife Helen and I grew more frustrated and anxious.”
Then Singer discovered a website dedicated to CTCL. After doing some research on the disease, he read about Christiane Querfeld, M.D., Ph.D., a renowned dermatologist who specializes in the study and treatment of cutaneous lymphoma at City of Hope. He was encouraged to learn that Querfeld, chief of the Division of Dermatology at the cancer center, had expertise and resources not available elsewhere. 
So Singer sent his records ahead and booked an appointment with Querfeld. It was a decision that might well have saved his life.
“Dr. Querfeld examined me, ordered the highly specialized testing needed to confirm CTCL, and scheduled another appointment for two weeks later,” said Singer, 61, a resident of San Luis Obispo, California.  “She explained that the testing came back positive for CTCL, and she spent hours with me and my wife, explaining everything. Oddly, this was all a great relief.”
They discussed staging, prognosis, standard treatment options, experimental protocols and more. Singer discovered he had treatment options — and lots of hope.     
The caring and helpfulness of Dr. Querfeld and her staff, along with volunteers and everyone else at City of Hope, is unbelievable and in complete contrast to much of our experience elsewhere,” he said. “We never feel like a ‘number’ and that is hugely important.”

Advanced skin cancer research

A rare, slow-growing form of skin cancer, cutaneous lymphoma affects about 40,000 to 60,000 people in the U.S., usually those in their 60s and 70s. It takes on various forms, including the type of CTCL that Singer contracted, mycosis fungoides.
“There’s no cure for cutaneous lymphoma, but it can be confined to the skin if it’s caught early,” Querfeld said. “In those cases, patients can live a fairly normal life span. More advanced cases develop red nodules that can spread to internal organs. No one knows what causes it. It doesn’t run in families and, unlike other skin cancers like melanoma, exposure to sun isn’t a factor.”  
Rare forms of cancer like CTCL can be especially difficult to treat, but Querfeld devotes herself to research, conducting clinical trials and developing immunotherapy protocols for cutaneous lymphoma — basically prodding a person’s healthy cells to attack and kill malignant cells.
Immunotherapy is a very promising development in the treatment of cancer, stimulating the body to heal itself without the often debilitating side effects of chemo and radiation therapy, Querfeld said.   
“Tumors develop mechanisms to escape from a person’s immune system, which normally would kill cancer cells,” Querfeld said. “That’s how tumors continue to grow and spread without the immune system attacking them. But immunotherapy reverses that and puts good cells to work killing cancer.”
Singer was fortunate that his CTCL was caught at an early stage, greatly improving his prognosis. He and Querfeld decided on a series of treatment options: low-dose radiation, a topical form of chemotherapy, and finally an experimental immunotherapy serum injected directly into his lesions.  
“We put Joshua into two clinical trials,” Querfeld said. “The second has produced an excellent result.”

A new lease on life

Singer says the injections worked wonders. “My initial and current prognosis is good. I’m still early-stage,” he said. ”None of the treatments have had harmful side effects, and I look pretty normal, but with most of one eyebrow and one sideburn missing, partly from chemo, partly from CTCL. Some forehead redness has popped up of late, but Dr. Querfeld is working on what we’ll try next.”
Now that he has Querfeld and a team of experts working to keep his CTCL in check, Singer’s able to enjoy all that his retired lifestyle has to offer. When he’s not closely following Wall Street’s roller-coaster ride, he and Helen carve out time for exercise, travel and volunteering in the community. He’s a regular golfer; she practices yoga.    
Today Singer considers himself “in pretty good shape,” and gives all credit to City of Hope —  especially Querfeld and her staff.
“We love Christiane Querfeld and so many others that are part of City of Hope’s patient care,” he said. “She is brilliant, gutsy, caring, funny and incredibly hard-working. We feel that we know them all, and that they know and care about us. We respect them and their dedication.” 

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