Today, he’s a bit more cautious about how much time he spends in the sun. In the past three years, Randy has had two basal cell carcinoma skin cancers removed from his face, the first requiring significant reconstruction due to the lesion’s proximity to the left side of his nose and eye socket.

Randy said he didn’t think too much about the initial spot at first. When it grew more noticeable, he asked his primary care physician about it. According to Randy, his family medicine physician, Karalee Bessinger, M.D., at Norton Community Medical Associates primary care in Carrollton, Kentucky, referred him to a dermatologist in LaGrange, Kentucky. That doctor wanted to refer him to a facility in Louisville, Kentucky, because of the lesion’s location and the intricate surgery it would take to remove it.

Not one for city traffic, Randy sought another opinion, turning to Jonathan Hanson, M.D., otolaryngologist (ear, nose and throat specialist) with Norton King’s Daughters’ Health in Madison, Indiana. Dr. Hanson met Randy in January 2022 and assured him that he could remove the lesion and provide any necessary reconstruction.

“The art of facial reconstructive surgery takes into account a lot of factors,” said Dr. Hanson, adding that about 15% of his practice includes skin cancer removals on the face, ears, head and neck. “Elasticity of the skin varies from the nose to the cheek to the eye. It’s also important to factor in the shape and location of a patient’s natural skin lines and contours. The goal is to meet surgical needs while minimizing any noticeable incisions when healing is complete.”

During Randy’s first surgery, Dr. Hanson opened a large flap on the left side of Randy’s face, following the natural skin lines under his eye to the edge of his mouth. After fully removing the cancerous lesion, he carefully stitched the seam back together using the natural skin folds along his cheek and eye. Today, you would never know Randy underwent significant facial surgery.

“He’s a fabulous doctor,” Randy said. “He told me exactly what he was going to do and followed up with everything he said he was going to do.”

In May 2024, Randy returned to Dr. Hanson for a second area of concern: an elongated bump just below his right eye. A less extensive surgery was needed, and Dr. Hanson again developed a plan of action and executed it perfectly.

“One reason I enjoy the work is the creativity,” Dr. Hanson said. “Every face and every person is unique. There’s no cookbook or recipe.”

After a life spent farming, working at a factory and serving his country in the Army, Randy relishes his slower pace. He enjoys being home, spending time in his self-proclaimed man cave and watching car racing on television. He and his wife, Carolyn, still live on a 60-acre farm outside Carrollton, near family and friends.

These days on the farm, one thing is different. If you see Randy outside mowing or working on a project, he’s wearing a straw hat. It’s a small price to pay to help keep the sun off his face.

“The earlier we find skin cancers, the better,” Dr. Hanson said. “The smaller they are, we get much better results. It’s easy to ignore them. Any spot that is raised or pigmented or grows or changes needs to be reviewed by a family provider. If they think it’s suspicious, the patient can be referred for follow-up.”

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Depending on how much the cutaneous T-cell lymphoma has spread, the thickness of the lesions and the patient’s baseline skin color, narrowband UVB light and similar treatments have been shown to be as much as 90% effective. Remissions have lasted as long as a year after light treatment.

Norton Cancer Institute has developed a multidisciplinary team to help diagnose and treat this rare type of lymphoma.

Patients with cutaneous T-cell lymphoma typically develop red, scaly — often itchy — patches on the skin, called plaques. The symptoms can be similar to eczema or psoriasis, often resulting in delayed diagnosis.

Cutaneous lymphoma is a rare subtype of non-Hodgkin lymphoma. The cancer cells start in white blood cells (lymphocytes).

For most people, the lymphoma grows slowly and is very treatable. In a small number of patients, the cutaneous T-cell lymphoma can spread to form tumors, and involve lymph nodes, blood and internal organs.

Cutaneous T-cell lymphoma UVB treatment

Jae Y. Jung, M.D., Ph.D., with Norton Cancer Institute and the only oncologic dermatologist in Louisville and Southern Indiana, administers the treatments as patients stand in front of a panel of UVB-emitting light bulbs for several minutes. Patients wear goggles to protect their eyes.

Two or three treatments a week for a few months can reduce redness and scaling, flatten plaques and suspend development of new plaques.

“We’ve seen excellent results when UVB light is delivered consistently over time,” Dr. Jung said. “We select the very narrow UVB band of light to avoid increasing skin cancer risk and burning.”

Sunlight carries an elevated skin cancer risk and can’t deliver the consistent therapy needed to get cutaneous lymphoma to respond. Similarly, tanning beds aren’t a substitute for UVB treatments because they also increase the risk of skin cancer, especially over the long term of treatment that cutaneous lymphoma requires.

Dr. Jung has established a close working relationship with Joseph J. Maly, M.D., medical oncologist with Norton Cancer Institute. Dr. Maly has specific training and experience using immunotherapy, chemotherapy or a combination to treat complicated T-cell lymphoma.

Dr. Maly’s work has made national and global clinical trial efforts available to qualifying patients in Louisville and Southern Indiana.

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Completion is planned for February 2020, with two downtown campus locations getting a makeover.

Norton Cancer Institute – Downtown (676 S. Floyd St.)

• New clinics will serve patients with urgent care needs related to cancer, hepatitis C and sickle cell disease.
• Advanced radiation therapy services will continue to anchor the first floor.
• New multidisciplinary care space will be created for the Head, Neck and Skin Cancer Program and Comprehensive Lung Center.
• Current skin cancer resources will be expanded to include innovative new technology.
• A state-of-the-art oncology pharmacy and an expanded chemotherapy and infusion suite are being added to the third floor.

Norton Cancer Institute Women’s Cancer Center (234 E. Gray St.)

• The new women’s center on the first floor will include offices for gynecologic oncologist Lynn Parker, M.D. along with six large gynecologic oncology exam rooms.
• A new expressive art and music therapy suite will be located on the first floor.
• Offices for Norton Cancer Institute’s research program will occupy part of the second floor.
• A new central call and scheduling center, plus space for the financial services team, will be on floors five and six.
• Additional plans include a multidisciplinary breast health clinic led by medical oncologist Laila S. Agrawal, M.D.
• A designated pull-in valet area will facilitate quick service for those visiting for outpatient blood tests.

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Lymphomas are cancers of the immune system, which generally arise in lymph nodes and other lymphatic tissue.  The immune system consists of white blood cells, the spleen, lymph nodes and other areas throughout the body.

“In many ways, our skin can be considered our largest immune organ,” said Jae Jung, M.D., oncologic dermatologist with Norton Cancer Institute. “It is designed to defend constantly against viruses, bacteria, and other microbes. When the special immune cells that reside in the skin become cancerous, it can lead to cutaneous lymphoma, a rare type of skin cancer.”

Signs and symptoms of skin lymphoma

Often there are signs and symptoms of skin lymphoma that can be seen or felt. A skin exam by a medical provider helps determine the severity of the cancer. Some of the signs that may be seen or felt on the skin include:

• Patches: may be flat or elevated
• Plaque: can be elevated lesions or a deep thickening of the skin
• Tumor: a solid or rounded lesion greater than 1 centimeter in diameter that has spread deep into the skin
• Erythroderma: widespread, intense reddening of the skin
• Hypopigmentation: patches on the skin that are lighter than your skin tone
• Granulomatous slack skin: loose skin, especially in the body folds
• Pagetoid reticulosis: usually appears as a scaly plaque on the extremities such as the hands or feet
• Leonine facies: extreme thickening of the skin on the face

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Treatment options for skin lymphoma

There are a variety of treatment options for skin lymphoma that may be used alone or in combination with other treatments. These include:

• Medications that are applied directly to the skin
• Radiation treatment
• Chemotherapy
• Immunotherapy, which uses a person’s immune system to fight cancer
• Clinical trials for new treatments

While the signs and symptoms of skin lymphoma may be noticed quickly, they can resemble other conditions; so, diagnosis is done through a skin biopsy, a procedure where a sample of your skin tissue is removed and viewed under a microscope, or other lab tests.

Always discuss unusual skin issues with your doctor.

“The best treatment of cutaneous lymphomas is complex, involving both skin-directed therapies (applied directly to the skin) and systemic therapies (treatment that travels throughout the body),” Dr. Jung said. “Ideally, patients should be treated in a multidisciplinary clinic that includes medical oncology, radiation oncology, dermatology, rehabilitation and social services. Fortunately, most cutaneous lymphomas progress slowly and can be treated conservatively with lasting remissions. Although prognosis for patients with aggressive and widespread disease historically has been very poor, new targeted and immune-directed therapies are extremely promising.”

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Jae Jung, M.D., Norton Cancer Institute, is melding ancient knowledge with new technology to heal hard-to-treat wounds. Dr. Jung, Kentucky’s only oncologic dermatologist, calls maggots “the real stars of this success story.”

Maggot debridement therapy (MDT) uses medical-grade, germ-free larvae to treat serious skin and soft tissue wounds. Typically, MDT is used for lesions that fail to respond to traditional treatments.

“Credible research supports the use of maggot therapy,” Dr. Jung said. “New advanced technology and bandaging applications have improved its effectiveness and made it easier to use.”

World’s “smallest surgeons”

Medicinal maggots have been called “the world’s smallest surgeons” because they can precisely debride wounds without damaging surrounding healthy tissue. They secrete enzymes that break down dead tissue and help kill bacteria.

Their work helps stimulate growth of healthy new connective tissue and microscopic blood vessels. This is a critical step in the body’s ability to heal wounds.

Maggot debridement has been described from antiquity across many cultures. Its therapeutic use in the United States dates to the Civil War. In 2003, the U.S. Food and Drug Administration began regulating the use of medicinal maggots.

Saving limbs and lives

Judith Beumler, 73, knows firsthand about the benefits of MDT. She struggled for nearly a year with a 3-inch ulcer on her ankle that started from a medicine reaction.

“I hurt from my ankle to my knee. I couldn’t sleep. I needed help,” Judith said.

After seeing other providers, Judith was referred to Dr. Jung, who specializes in treating complicated cases. Dr. Jung had used MDT successfully to treat nonhealing ulcers related to graft-versus-host disease, a potentially fatal immune response sometimes seen in recipients of tissue or bone marrow transplants. She also had used it to treat ulcers related to radiation treatment and poor blood flow.

When Dr. Jung first recommended maggot therapy, Judith and her daughter cringed and said, “What?”

Then they weighed the options: Lidocaine shots and painful debridement every 10 days over numerous visits versus a one-time 48-hour application of maggots. Both agreed to try MDT.

“I was in horrible pain, and we were desperate,” Judith said.

Dr. Jung said Judith’s response is common.

“At first patients are grossed out, as you would expect, but they’re so fed up with the ulcer they just want something that will help,” she said.

On a Wednesday, Dr. Jung applied what looked like tiny white strings to Judith’s ankle inside a specially designed bandage. She said that while the treatment is not painful, it could cause some discomfort.

For the first 24 hours, Judith felt nothing. Late on day two, she felt something. By Friday morning, as she headed to Dr. Jung’s office to get the treatment removed, she admitted the sensation became a bit unnerving.

The good news is Judith’s ulcer responded remarkably well to MDT. She had to wear pressure stockings for some time, and she sees Dr. Jung for periodic wound checks — but she is thrilled with her outcome.

To Dr. Jung’s knowledge, she is the only provider in the area offering MDT. This unique therapy, while still uncommon in modern health care, offers hope for people with chronic nonhealing wounds.

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