Five Questions With: Dr. Thomas Ruenger

"Once more people are covered by insurance, my hope is that they will seek help for skin problems earlier."

Dr. Thomas Ruenger was recently named chairman of dermatology at Roger Williams Medical Center. He is also professor of dermatology at Boston University.
Following his graduation from the Medical School of Christian-Albrecht University (Kiel, Germany), Ruenger completed a postdoctoral fellowship in the Laboratory of Molecular Carcinogenesis at the National Cancer Institute in Bethesda, MD. He completed residency training in both Dermatology and Allergology at the Julius-Maximilian University (Würzburg, Germany), where he also received his PhD equivalent degree (“Habilitation”). He is an internationally recognized expert in photobiology and photodermatology. His clinical interests include phototherapy, photodermatology, psoriasis, melanoma, cutaneous lymphona, and general medical dermatology. He has also worked on skin aging, scleroderma, and wound healing. Dr. Ruenger has published 89 peer-reviewed original manuscripts, reviews, commentaries, and book chapters, is the recipient of several academic, scientific, and teaching awards, and has served on the editorial board of four prestigious journals in dermatology and photobiology. Currently, he is Editor-in-Chief of the journal Photodermatology, Photoimmunology & Photomedicine and serves on several committees of the Society for Investigative Dermatology, the American Academy of Dermatology, and the Photomedicine Society.

PBN: What ways is health care reform changing the practice of dermatology?
RUENGER:
Once more people are covered by insurance, my hope is that they will seek help for skin problems earlier. This is important for the early detection and treatment of skin cancers, which safes lives. The good news is that there has also been increased focus from insurers and others on prevention and screening. In some cases, however, obstacles like high co-payments still exist that prevent people from seeking care early when skin cancers are curable and treatable with less invasive and less expensive therapies.

PBN: How good of a job do primary care physicians do directing patients to dermatologists, generally?
RUENGER:
Physicians in the community usually do very well in referring patients appropriately. Most medical schools do not provide extensive teaching in dermatology and many primary care physicians therefore don’t feel confident enough to diagnose and treat basic skin problems. In order to correct at least some of these shortcomings and to train these important first physician contacts for skin problems, we often have primary care and medicine residents rotate with us in our dermatology clinics. There are not enough dermatologists to treat all patients with skin problems, and we welcome the concept of appropriately trained primary care physicians more actively managing basic skin problems.
Sometimes though, patients with skin problems are not referred to dermatologists but other specialists. Dermatologists are the best trained to perform surgery on the skin. Many autoimmune-diseases manifest on the skin – often only on the skin – and dermatologists should be managing those. When appropriate, we look forward to collaborating with other medical specialists in an interdisciplinary fashion to treat advanced skin cancers, autoimmune diseases, and other conditions.
I believe in a comprehensive clinical approach to academic dermatology with a focus on the medical aspects of the specialty. My concept for the Dermatology Department at Roger Williams Medical Center is to take advantage of the excellent services represented in the other clinical departments at RWMC and foster an interdisciplinary approach to patient care.

PBN: You’re new in town. What would you say about the state of Rhode Islanders’ skin?
RUENGER:
Rhode Island brings together a high percentage of people with fair skin and a beach and ocean culture. This has resulted in one of the highest skin cancer rates in the country, including malignant melanoma. Physicians in our state must continue to increase awareness about the dangers of sun exposure and spread their knowledge about the best methods of sun protection. Other seasons have their challenges too. Like all New Englanders, Rhode Islanders face harsh winters, which can lead to frostbite and dry skin.

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PBN: How much money can early detection of skin cancers save – and how many lives?
RUENGER:
A lot! And that applies to both melanoma and non-melanoma skin cancers. Almost all skin cancers can be cured when detected early enough. The annual cost of treating melanomas is approximately $2.5 billion in the United States alone. Forty percent of that cost is for treatment of advanced melanoma. With that, approximately $1 billion could be saved every year if melanomas were detected and treated early before spreading. Almost 10,000 people died of melanoma last year. Most of these deaths could have been prevented by early detection.
Every year, 3.5 million nonmelanoma skin cancers are diagnosed. While not as deadly as melanoma, they are more common and are still responsible for 4,000 –10,000 deaths every year. Sadly, most are preventable.

PBN: Will suntans ever go out of fashion – do you see your role as fighting that battle to some extent?
RUENGER:
I am very hopeful. Tanning only became a fashion in the 20th century, and it is just that – a fashion. Knowledge about the dangers of tanning has been spreading. Many legislatures are addressing the particular dangers of artificial tanning devices in tanning parlors. It is clear that tanning beds are increasing melanoma risks and therefore killing many Americans. From the public health efforts to reduce smoking-related morbidity and mortality, we know that knowledge alone does not change behavior immediately. Still, education is an important step. In addition, anti-tobacco efforts teach us that change in behavior is possible. And aren´t deep, dark-brown tans already out of fashion? And at the same time, undamaged skin is already gaining recognition again as “beautiful.”
Do I see my role in fighting the battle against suntans? Absolutely! Most of my academic interests and pursuits have been in the fields of photobiology and photodermatology, areas of research that study effects of sunlight on human cells and skin. It is fulfilling to know that my contributions to educating others about the effects of solar ultraviolet light on the skin is helping prevent suffering and deaths from skin cancers.

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