Top Docs Q&A: Thomas Kupper

Massachusetts has an alarmingly high number of melanoma cases. Kupper explains why this cancer is on the rise.

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area. 

Name: Thomas Kupper

Hospital Affiliations: Brigham and Women’s Hospital, Dana-Farber Cancer Institute

Title: Chairman of department of dermatology at Brigham and Women’s Hospital; Director of cutaneous oncology at Dana-Farber/Brigham and Women’s Cancer Center.

Field: Dermatology

Specialty: Cutaneous lymphomas, melanoma, other skin cancers

Thomas Kupper is a dermatologist who specializes in skin cancers and rare, high-risk skin diseases. He is also the principal investigator for the Harvard Skin Disease Research Center and the Specialized Program of Research Excellence (SPORE) in Skin Cancer, which is a five-year, $14.25 million research initiative funded by the National Cancer Institute.

Why did you first chose Dermatology?

I was doing research involving immunology of the skin, and I became extremely interested in the skin as a host defense organ. From there, it was sort of a natural progression to then go into dermatology.

What do you love most about the field?

It’s a field where you see a wide variety of different disorders. At the Brigham, we tend to do a lot of highly specialized, high-risk dermatology. We work with diseases that are pretty uncommon, but can be pretty devastating and lethal to the patients.

You have played a central role in forming the dermatology department at Brigham. What has this been like for you?

I got to the Brigham in ‘92, and started research in dermatology, which at the time was through the division of medicine. Then in ‘94 we received the NIH grant that funded the Harvard Skin Disease Research Center. In ‘95 I took over as Chief of Dermatology. It wasn’t till 2000 though that we became a freestanding department of the hospital. I was just three years out of residency, so to actually build a research division and take over the clinical division was initially very daunting.

The Harvard Skin Disease Research Center receives approximately seven million dollars in NIH funding annually. How does this work?    

It’s really been because of the people that we’ve been able to recruit. We have some really outstanding investigators, and they are also a very eclectic group; We have dermatologists, a hematologist oncologist, a pediatric rheumatologist, etc. We try to find the best people doing the best research, give them the right environment, and then just set them loose.

In the time that you’ve been practicing how have you seen the field change?

About 10 years ago now, we figured out that the skin is actually full of resting T cells, and that there’s about twice as many T cells in the skin as there are in your blood. At the time that information was kind of startling. In Cutaneous T cell lymphoma, these T cells becomes malignant and they grow in the other areas of the skin. Often we’ll see patients diagnosed with psoriasis, when they actually have this lymphoma. Therefore, this knowledge has been really important to diagnosing and treating this form of cancer.

What are the latest advancements in the field now?

We are continuing to learn more about these T cells. We are finding through a variety of clinical observations, and studies using animal models, that these cells may really important for host defense in the body. We always thought of immunology as a field that involves the blood, lymph nodes, and the organs, but now we are finding that a lot of the action that protects your body against infections is done in the skin.

Statistics from the National Cancer Institute suggest that melanoma rates are increasing. Why do you think this is? 

The incidence of skin cancer is rising in part because of changes in population demographics. So as the baby boomers reach their 60s and 70s, the rate of skin cancer is going to increase dramatically. I also think people have more leisure time now, so they’ve been doing more outdoor activities and have been exposed to more ultraviolet light.

What do you hope to see for the future of Dermatology?

Overall, I think the future of dermatology will be very much focused on the detection and prevention of skin cancer. Because people typically develop skin cancer when they are older, we are now uniquely prepared to diagnose and treat these cancers really early on.

What advice would you give regarding skin cancer prevention that people don’t typically hear?

A lot of skin cancers, particularly early melanomas, are found by partners and spouses. Yes, it’s always good to go to the dermatologist, but every now and again have your partner look your skin over. If they see anything that  looks funny, different, or concerning then they should call the dermatologist.

What do you love most about practicing in Boston?

The great thing about practicing in Boston and working at Dana-Farber is you really are working with some of the most talented doctors, nurses, and support staff in the country. Together we help patients who are really among the sickest. Being able to help them get better is a real privilege.