Tributes Flow for Sentinel Lymph Node Biopsy Inventor Donald Morton, MD

Kate Johnson

January 23, 2014

An icon in surgical oncology passed away this week. Donald Morton, MD, who died from heart failure at the age of 79 years, is credited with changing the direction of cancer treatment by mapping the course of malignant melanoma with his identification of the sentinel lymph node. He also pioneered the development of cancer vaccines.

"It's a huge loss in the cancer world," Anton Bilchik, MD, PhD, told Medscape Medical News. Dr. Bilchik is chief of medicine at the John Wayne Cancer Institute in Santa Monica, California, an institution founded and previously headed by Dr. Morton, who was recently chief of the melanoma program.

Dr. Donald Morton

"He was a giant in the field," said Armando E. Giuliano, MD, professor of surgery and associate director of the Samuel Oschin Comprehensive Cancer Center at Cedars-Sinai in Los Angeles, also speaking in an interview.

Both Dr. Bilchik and Dr. Giuliano worked alongside Dr. Morton for many years.

"He was still working and funded by the National Cancer Institute up until the end," said Dr. Giuliano. "He continued to see patients and operate until quite recently. He was loved by his patients."

"He was one of the pioneers of modern cancer research," said Dr. Bilchik. "The [sentinel lymph node] technique that he discovered for melanoma, and which he published in the New England Journal of Medicine, has become the standard of care for the treatment of melanoma around the world, and has saved many people unnecessary lymph node dissections. That concept was then applied to breast cancer, and the first sentinel lymph node procedure for breast cancer was done at the John Wayne Cancer Institute. That, too, became the standard of care for the management of early breast cancer, and now many women around the world have not had to undergo unnecessary lymph node dissections because of that. So his work has really had a tremendous impact on the management of melanoma and breast cancer, and has been applied to improving staging for colon cancer, stomach cancer, and esophageal cancer."

Dr. Morton was also a major contributor to immunotherapy in cancer, said Dr. Giuliano. "His intravesicalar injections of metastatic melanoma to the bladder led the way for BCG treatment of bladder cancer — the first FDA-approved form of cancer immunotherapy. His work on cancer vaccines led to NIH funding for a large prospective randomized trial of an antimelanoma vaccine, which he developed. Dr. Morton was also a pioneer in limb-salvage surgery for soft tissue sarcoma and pulmonary resection for solid tumor metastases."

Teaching and sharing his knowledge was a central preoccupation for Dr. Morton, who, over the course of his career, trained more than 140 surgical fellows.

"There are few people in the world who have trained as many people in cancer as he has," said Dr. Bilchik. "More than 80% of those fellows are now leaders in surgery or cancer research. Many of them are deans, heads of departments, or chairs."

At the same time, Dr. Morton had an extraordinary ability to strike a personal rapport with his patients.

"Many surgeons will operate on a patient, maybe see them postoperatively, and then they'll get followed by their internist or oncologist. But he made a point of following every one of his patients and had a personal relationship with every one of his patients. Many patients would see him who he'd operated on 30 or 40 years ago," said Dr. Bilchik.

An obituary published in the Los Angeles Daily News quotes Dr. Morton as saying that "cancer patients are the nicest patients in the world. I truly believe there is a genetic link between kindness and those who are diagnosed with cancer.... After all of these years, I still cannot help but get emotionally involved with my patients and their situations. It is truly rewarding when a patient with a fatal diagnosis is still alive after 5 years but it is crushing when I lose a patient because in essence I am losing a friend."

As reported in the Los Angeles Times, Dr. Morton was born from humble roots — he grew up in a home without electricity or running water. His unlikely rise through medical school began with free enrollment for disadvantaged students.

Dr. Morton is survived by his wife, 5 children, 8 grandchildren, a brother, and a sister. A private funeral will take place on February 8.


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