Historically Speaking: The Quest to Understand Skin Cancer

The 20th-century surgeon Frederic Mohs made a key breakthrough in treating a disease first described in ancient Greece.

The Wall Street Journal

June 30, 2022

July 1 marks the 20th anniversary of the death of Dr. Frederic Mohs, the Wisconsin surgeon who revolutionized the treatment of skin cancer, the most common form of cancer in the U.S. Before Mohs achieved his breakthrough in 1936, the best available treatment was drastic surgery without even the certainty of a cure.

Skin cancer is by no means a new illness or confined to one part of the world; paleopathologists have found evidence of it in the skeletons of 2,400- year-old Peruvian mummies. But it wasn’t recognized as a distinct cancer by ancient physicians. Hippocrates in the 5th century B.C. came the closest, noting the existence of deadly “black tumors (melas oma) with metastasis.” He was almost certainly describing malignant melanoma, a skin cancer that spreads quickly, as opposed to the other two main types, basal cell and squamous cell carcinoma.

ILLUSTRATION: THOMAS FUCHS

After Hippocrates, nearly 2,000 years elapsed before earnest discussions about black metastasizing tumors began to appear in medical writings. The first surgical removal of a melanoma took place in London in 1787. The surgeon involved, a Scotsman named John Hunter, was mystified by the large squishy thing he had removed from his patient’s jaw, calling it a “cancerous fungus excrescence.”

The “fungoid disease,” as some referred to skin cancer, yielded up its secrets by slow degrees. In 1806 René Laënnec, the inventor of the stethoscope, published a paper in France on the metastatic properties of “La Melanose.” Two decades later, Arthur Jacob in Ireland identified basal cell carcinoma, which was initially referred to as “rodent ulcer” because the ragged edges of the tumors looked as though they had been gnawed by a mouse.

By the beginning of the 20th century, doctors had become increasingly adept at identifying skin cancers in animals as well as humans, making the lack of treatment options all the more frustrating. In 1933, Mohs was a 23-year-old medical student assisting on cancer research in rats when he noticed the destructive effect of zinc chloride on malignant tissue. Excited by its potential, within three years he had developed a zinc chloride paste and a technique for using it on cancerous lesions.

He initially described it as “chemosurgery” since the cancer was removed layer by layer. The results for his patients, all of whom were either inmates of the local prison or the mental health hospital, were astounding. Even so, his method was so novel that the Dane County Medical Association in Wisconsin accused him of quackery and tried to revoke his medical license.

Mohs continued to encounter stiff resistance until the early 1940s, when the Quislings, a prominent Wisconsin family, turned to him out of sheer desperation. Their son, Abe, had a lemon-sized tumor on his neck which other doctors had declared to be inoperable and fatal. His recovery silenced Mohs’s critics, although the doubters remained an obstacle for several more decades. Nowadays, a modern version of ”Mohs surgery,” using a scalpel instead of a paste, is the gold standard for treating many forms of skin cancer.

Historically Speaking: Plagues From the Animal Kingdom

The coronavirus is just the latest of many deadly diseases to cross over to human beings from other species.

February 6, 2020

The Wall Street Journal

Earlier this week, the still-rising death toll in mainland China from the coronavirus surpassed the 349 fatalities recorded during the 2003 SARS epidemic. Although both viruses are believed to have originated in bats, they don’t behave in the same way. SARS spread slowly, but its mortality rate was 9.6%, compared with about 2% for the swift-moving coronavirus.

A scientist examines Ötzi, a 5,300-year-old mummy discovered in the Tyrolean Alps in 1991.
PHOTO: EURAC/MARION LAFOGLER

Statistics tell only one part of the story, however. Advances in the genetic sequencing of diseases have revealed that a vast hinterland of growth and adaptation precedes the appearance of a new disease. Cancer, for example, predates human beings themselves: Last year scientists announced that they had discovered traces of bone cancer in the fossil of a 240-million-year-old shell-less turtle from the Triassic period. This easily surpasses the oldest example of human cancer, which was found in a 1.7 million-year-old toe bone in South Africa. The findings confirm that even though cancer has all kinds of modern triggers such as radiation poisoning, asbestos and smoking, the disease is deeply rooted in our evolutionary past.

Unlike cancer, the majority of human diseases are zoonotic, meaning that they are passed between animals and people by viruses, fungi, parasites or bacteria. The rise of agriculture around 10,000 years ago, which forced humans into close contact with animals, was probably the single greatest factor behind the spread of infectious disease.

Rabies was one of the earliest diseases to be recognized as having an animal origin. The law code of Eshnunna, a Mesopotamian city that flourished around 2000 B.C., mandated harsh punishments against owners of mad dogs that bit people. Lyme disease was only identified by scientists in 1975, but it too was an ancient scourge. Ötzi, the 5,300-year-old mummy who was discovered in the Tyrolean Alps with cracked ribs and an arrow wound in his shoulder, was an unlucky fellow even before he was killed. DNA sequencing in 2010 revealed that while he was alive, Ötzi was lactose intolerant, had clogged arteries and suffered from Lyme disease.

Smallpox, which was eradicated by the World Health Organization in 1979, had been one of the most feared diseases for most of human history, with a mortality rate of 30%. Those who survived were often left with severe scarring; the telltale lesions of smallpox have been identified on the mummy of Pharaoh Ramesses V, who died in 1145 B.C. The disease is caused by the variola virus, which is thought to have crossed over to human beings from an animal, likely a rodent, in prehistoric times.

Although it can’t be proved for certain, it is likely that smallpox was behind the terrible plague that killed 20% of the Athenian population in 430 B.C. The historian Thucydides, who lived through it, described the agony of those infected with red pustules, the dead bodies piled high in the temples and the scars left on the survivors. He also noticed that those who did survive acquired immunity to the disease.

Thucydides’s observation turned out to be the key to one of humanity’s greatest weapons against infectious disease, vaccination. But apart from smallpox, the only eradication programs to have made some progress have been against viruses transmitted from human to human, such as polio and measles. Meanwhile, since the 1970s more than 40 new infectious diseases have emerged from the animal realm, including HIV, swine flu and Zika. And those are just the ones we know about.

WSJ Historically Speaking: A Risky Skin Game: Tans, Fashion and Cancer

ILLUSTRATION: THOMAS FUCHS

ILLUSTRATION: THOMAS FUCHS

The suntan was born as a fashion accessory in France in 1923—or so legend has it. The French like to claim Coco Chanel started the trend after she turned an accidental sunburn into a fashion statement while sailing with her lover, the duke of Westminster.

But the Americans have an equal shot at the title with Gerald and Sara Murphy, wealthy expatriates who fell in love with the French Riviera and established themselves in Cap D’Antibes the same year. A glittering roster visited them there, from Picasso to the American writer John Dos Passos, helping to turn the sleepy backwater into a glamorous destination. Continue reading…