Last March, just as New York City was entering lockdown, Colleen Regan was confronting a health crisis of her own. A few days before hospitals were forced to cancel elective surgeries to free up beds for the surge of patients with COVID-19, Regan had been diagnosed with a rare type of melanoma, a deadly skin cancer. She wondered how she would manage her illness amid a pandemic that made something as simple as leaving the house a potentially life-threatening event.
One year earlier, Regan, then 58, noticed an itchy blemish beneath her right eye, a seemingly innocuous pink spot. She consulted two dermatologists, both of whom dismissed the scaly patch as a skin infection and prescribed topical antibiotics. But when the itching persisted, Regan grew increasingly concerned. She knew she couldn’t wait for the pandemic to pass to find out the cause, so she consulted a third dermatologist, Tracey Liebman, MD.
Dr. Liebman saw things differently. The pink coloring beneath Regan’s eye made her suspect a rare type of skin cancer called amelanotic melanoma. “It’s easy to miss because it doesn’t have the pigment or other features that patients might typically associate with melanoma,” explains Dr. Liebman, assistant professor of dermatology in NYU Langone Health’s Ronald O. Perelman Department of Dermatology. “It can be pinkish.”
On March 9, a biopsy confirmed Dr. Liebman’s suspicion. About 1 in 50 people will develop melanoma in their lifetime. Less than 5 percent of those cases will be amelanotic, or without pigment. The rare cancer is no deadlier than conventional melanoma, but fewer people survive because it’s often overlooked or misdiagnosed.
Dr. Liebman’s ability to discern what others had missed reflects NYU Langone’s long-standing expertise in melanoma research and care. Its dermatologists developed one of the first skin cancer treatment programs in New York City more than 30 years ago and even established the main criteria for detecting melanoma, popularized with the mnemonic ABCDE.
“Dr. Liebman was the first doctor who listened to me,” recalls Regan. “She’s the only one who would do a biopsy.”
Within a few days, Regan was sitting across from eye surgeon Irina Belinsky, MD, an oculoplastic specialist and director of ocular oncology at NYU Langone’s Department of Ophthalmology. Like Dr. Liebman, Dr. Belinsky brought specialized knowledge to the case. She is one of a few surgeons in the nation dually trained in oculoplastic surgery and ocular oncology. With her elite expertise, she was accustomed to difficult cases, but Regan’s was unlike anything she had ever encountered. “Melanoma of the eye is rare,” notes Dr. Belinsky, “and amelanotic melanoma is rarer still. The location alone makes it extraordinarily complex.”
“Melanoma in the eye is rare, and amelanotic melanoma is rarer still. The location alone makes it extraordinarily complex.”
—Irina Belinsky, MD
During multiple exploratory procedures to determine the extent of the cancer, Dr. Belinsky discovered a malignancy “rolling out like an invisible carpet.” The melanoma, it turned out, had spread along the skin of her entire lower eyelid, onto the mucous membrane (conjunctiva) that lines the inside of the eyelid and white part of the eye, and even the skin of her upper eyelid. Worse still, it extended into her tear canal, the conduit for tears flowing from the eye to the sinus. “That was a big problem because if the cancer cells spread beyond the canal, the chance of surgically clearing the cancer would be slim, and Colleen’s overall prognosis would be poor,” says Dr. Belinsky. “It was a very sneaky melanoma that got into all of the little nooks and crannies.”
There was no doubt that Regan would need more surgery. The only question was how to do it amidst the shutdown. By late March, national guidelines had recommended postponing surgeries for three months, including those for melanoma. But Dr. Belinsky knew Regan couldn’t afford the delay. She successfully petitioned for an exemption and created a plan to work around the staffing limitations. “Olga Whyte, our ophthalmology nurse, came in every other day with little notice, as the positive biopsy results kept coming in, to assist me with ongoing procedures,” recalls Dr. Belinsky. “I personally walked the tissue specimens down the street to the pathology lab.” She would sit shoulder-to-shoulder with dermatologist Shane A. Meehan, MD, director of NYU Langone’s Section of Dermatopathology, peering down a microscope at Regan’s tissue samples.
After 11 procedures in the office and 5 surgeries in the operating room, the cancer was still encroaching. So Dr. Belinsky consulted the Tumor Board at Perlmutter Cancer Center, which includes a multidisciplinary group of physicians who convene to troubleshoot challenging cases. Dr. Belinsky remembers asking herself, “Is my patient going to lose her eye so we can clear the cancer? Is continuing with surgery the right thing, or should we think about other treatments, like radiation or topical chemotherapy?”
Dr. Belinsky’s methodical approach quickly earned her patient’s trust. “Dr. Belinsky had enough confidence to consult with other specialists,” Regan says. “She’s that intelligent. I was afraid, but being in her care made it so much easier.”
Ultimately, Dr. Belinsky pressed on with a surgical approach. She treated the surface of Regan’s eye with cryotherapy and removed the tear canal. Then, she teamed up with colleague John A. Carucci, MD, PhD, director of dermatologic surgery, to remove any remaining cancer from the surrounding skin.
Regan would go on to have three major reconstructive surgeries to rebuild the periocular tissue and eyelids, all at the peak of the pandemic.
“In ocular oncology, our goals are to preserve life first, save the eye, and if at all possible, save vision,” says Dr. Belinsky. “For now, our team has achieved all three goals for Colleen, and we will continue to fight for her. She’s an unforgettable patient. She does everything we ask of her. She’s strong and never loses her positivity.”
Today, Regan is back to work as a legal assistant. In her downtime, she rides her bike and enjoys taking long walks, grateful that she can still take in the scenic views. “What NYU Langone has done for me has been unbelievable,” she says. “They saved my life.”