Beth N. McLellan, MD, discusses radiation dermatitis prevention, scalp cooling equity, and the future of personalized oncodermatology in melanoma management.
Advances in oncodermatology are reshaping prevention and management strategies for treatment-related toxicities in melanoma, from radiation dermatitis to chemotherapy-induced alopecia. Emerging research on the skin microbiome, personalized toxicity prediction, and culturally informed supportive care strategies are helping to move the field beyond reactive management toward proactive prevention, according to Beth N. McLellan, MD.
“[In the past, we’ve focused on] treating radiation dermatitis as a skin problem once it develops, and we hope that we can shift the conversation to prevention, so that patients don’t have to deal with it at all,” McLellan said in an interview with OncLive®.
McLellan is a professor in the Department of Medicine (Dermatology) and chief of the Division of Dermatology at the Albert Einstein College of Medicine, Montefiore Einstein Comprehensive Cancer Center in the Bronx, New York, and president, the Oncodermatology Society.
In the interview, McLellan discussed how bacterial decolonization strategies may reduce the severity of radiation dermatitis, why inclusive clinical trial design is essential for equitable scalp cooling outcomes, and how biomarker-driven approaches could transform supportive cancer care in the years ahead.
McLellan: Our work looked at the role of Staphylococcus aureus on the skin in promoting radiation dermatitis and found that patients who had S aureus present in their nose before they started radiation had a higher risk of developing more severe dermatitis. When we used a bacterial decolonization regimen to decrease the S aureus, patients developed less severe dermatitis. That reinforced the [notion] that not only are bacteria there and promoting the inflammation, but that by treating the bacteria, we can prevent this toxicity from happening. It fits in nicely with what we know about bacteria and skin disease. Anything that breaks down the barrier of the skin can let bacteria in and fuel the inflammation that’s happening. I would expect that this is probably happening in other toxicities that we see from cancer treatments, such as eczema. Any rash that’s breaking down that barrier is going to let bacteria get in and drive more inflammation.
One of the great things about using bacterial decolonization for radiation dermatitis or [any other condition] is that it’s widely available. It’s not expensive. It’s usually covered by insurance and often can be purchased over the counter. Our study was done in an underresourced and underserved community, and we showed that they had an easy time getting the medications. Our patients were very [adherent to] the regimen, and we saw no [adverse] effects. That’s one of the real highlights of this regimen. It’s so cheap, easy, and accessible. For implementation, it’s important to get the knowledge out and disseminate it to community practices that may not have a big focus on prophylaxis.
Scalp cooling has been such a glaring example of why it is so important that we have broad representation of diverse patient populations in clinical trials. In the case of scalp cooling, a lot of the research came out of Northern Europe. It’s great research that advanced the field tremendously. However, it was mainly piloted in a mostly Caucasian population. What we found is that in people with more textured, thicker, curlier, kinkier hair, we need to adjust the way that we apply scalp cooling so that we can make sure it’s just as effective as it is in people with other hair types.
In the Bronx, at the Montefiore Einstein Comprehensive Cancer Center, up to 80% of patients we enroll in clinical trials are minorities from underrepresented [communities]. It was a great place to pilot this new methodology, where instead of wetting people’s hair, we work emulsion of water and conditioner through the hair. Then we work with the patient to find the best way to style their hair using things like loose braids or twists or cornrows to try to minimize the volume of the hair against the scalp. [That way] the temperature can get from the cap to the scalp, where it needs to go to be effective.
As of [2026], we were excited to see that scalp cooling is now covered by insurance in New York and in at least 1 other state. We hope to continue to see that type of access spread throughout the country, giving patients access to this treatment so that every patient can have the chance at preserving their hair. It’s an important part of equity in cancer care delivery.
Oncodermatology is such an exciting field because the unanswered questions are constantly changing every time new treatments come to light for cancer that offer exciting new avenues for improving survival and improving patients’ lives. There are new toxicities that we have to adapt to try to treat. The unanswered questions today are probably going to be different than what we have next year. Focusing on more targeted personalized treatment, we see different responses to medications in different people. Being able to predict and tailor [our treatment of] those toxicities as they arise, in a way that treats the patient’s specific inflammatory response to immunotherapy, for example, would really make treatments more effective and more targeted, and preempt toxicities before they arise.
Mentorship is of the utmost importance. We work in a specialty in dermatology where there are a lot of influencers, [there are] a lot of TikToks and media attention to other parts of our specialty. Oncodermatology might be a less-recognized part of what we do as dermatologists, but it’s so important and so impactful for people going through cancer treatment. If trainees and medical students and residents aren’t exposed to this aspect of dermatology, they might not choose it because they don’t know it exists.
It’s been a really rewarding part of my career to be able to mentor students and trainees. In fact, at Montefiore Einstein, we have a new oncodermatologist who joined this past year, who was one of my mentees and medical students. It’s been exciting to have a full-circle moment where she’s joining me now as a partner to take care of patients and to see the impact mentorship can have on young, developing doctors.
Research into personalized approaches to predicting and treating toxicities is hopefully where the future lies. We’ve been trying to pioneer noninvasive ways of doing this. As part of our scalp cooling trial, we’ve been using plucked hairs instead of scalp biopsies and have been able to perform gene expression profiling from those hair follicles. Through that work, we hope to be able to find some biomarkers. The same way that we can use biomarkers to predict a cancer’s behavior, we hope to have biomarkers that could similarly predict individual toxicities that might develop, what treatments might be most helpful, whether scalp cooling is going to work, or whether a patient is going to have long-term alopecia. [We’re hoping to continue to] advance these techniques to study, predict, and treat toxicities.
Melanoma continues to be a very common and deadly type of cancer, despite all the incredible advancements that we’ve seen in treatment options. Many of those treatments we offer at Montefiore Einstein, including tumor infiltrating lymphocyte therapy. But early detection is crucial. One of the things we see in our patient population is a higher incidence of acral melanoma, which can present in the nails and on the hands and feet. This continues to be a type of melanoma that tends to present at later stages and is associated with a higher mortality rate. Many of our patients who are diagnosed with acral melanoma didn’t know that skin cancer could present in their skin type. They thought that certain people of darker skin tones were immune to skin cancer, and they certainly didn’t realize that skin cancer could present as a dark stripe in their nail. Early detection, especially focused on these less common types of melanoma, is important. Seeing a dermatologist for any changes in moles or concerning lesions on the skin remains our best chance of catching things early.
