During one of the first ever humanitarian missions to treat skin cancer, Dermatology Prof. Hayes Gladstone traveled to Chile last month and provided free care to more 20 patients.

Since the early 1990s, the hole in the ozone layer has been centered over southern Chile. Combined with the migration of fair-skinned Europeans to the country over the last 200 years, rural poverty and limited access to medical care, this problem has resulted in many severe cases of skin cancer, Gladstone said.

“One in three people in Chile are expected to develop skin cancer, compared to one in five in the United States,” he said in an interview with The Daily.

The issue came to Gladstone’s attention last year when he gave a lecture on epidermolysis bullosa, a condition that causes blister formation, in Palo Alto. Francis Palisson, a pediatric dermatologist from Chile and the nation’s leading expert on the disease, spoke to Gladstone following the talk.

Palisson told him that he wanted to bring Mohs Micrographic surgery, a highly effective skin cancer treatment, to Chile. Shortly thereafter, Gladstone assembled a team of eight surgeons from various university medical centers and two registered nurses, including Stanford’s Judy Elkayam.

In the course of one week, the team was able to treat 20 Chileans ranging from nine to 80 years old.

“It was really great for all the country,” Palisson said in an interview with The Daily. “They make surgery very, very good for the poorest of people.”

If it hadn’t been for the team’s intervention, many of these people may have died, Gladstone told the Stanford News Service. The only treatment offered by Chilean physicians would have involved extensive and disfiguring surgeries.

Many of the Chileans they met called the doctors on the team “gifts from God,” Elkayam said in an interview with The Daily.

There is a two-tiered health system in Chile: there are private hospitals for the wealthy, but most people must seek care at poorly-funded public hospitals. Because the public facilities lacked the proper equipment, the team performed their surgeries at the private Clinica Alemana.

Mohs Micrographic treatment, now recognized as the most effective skin cancer treatment in the world, is a fairly new development. The technique offers surgeons microscopic control, allowing them to remove multiple thin, horizontal layers of cells and view the entire border of the cancer. It has a 99 percent cure rate for primary lesions, compared to traditional surgeries’ 90 percent cure rate. It also leaves the smallest possible scar, which is especially desirable for patients suffering from facial skin cancer.

The lack of skin cancer awareness among Chileans is another major problem, Gladstone said.

“Only a small part of the population is educated about the problems of skin cancer,” he said.

Chilean newspapers regularly report on the hole in the ozone layer, and a few include information on ultraviolet radiation levels. Even so, most people still do not wear sun block, he added.

While Santiago does not receive as much unfiltered solar radiation as cities further south like Punta Arenas, its residents are still at great risk because the warmer temperatures cause them to wear less clothing and expose their skin more often, according to the Web site of the Ozone Hole, a nonprofit environmental group.

To address this problem, the medical team also taught courses on the Mohs procedure and facial reconstruction to Chilean doctors and nurses.

Gladstone said he hopes to return to Chile next year and perform at least 100 surgeries. He is also trying to set up a fellowship at Stanford and other leading academic dermasurgery institutions for Chilean doctors to learn the most advanced treatments and procedures.

“The long term solution is for them to do it and not us,” Gladstone said.