Cutting Edge Cancer Care
Dr. Lilker specializes in Foot Care in the Cancer Patient. He is the preferred Foot Doctor for Memorial Sloan Kettering Cancer Center in New York City.
Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies.
Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments.
Research & Publications:
Published: November 2018 – Journal of the American Podiatric Medical Association (JAPMA)
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Mario E Lacouture MD, David J Kopsky MD, Raphael Lilker DPM, Fiona Damstra MD, Mecheline HM van der Linden PhD, Azael Freites-Martinez MD, Mischa PM Nagel. “Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors”
Published: May 2024 – Journal of the American Podiatric Medical Association (JAPMA)
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Ivan R. Bristow PhD, Raphael Lilker DPM, “Microwave Energy for the Treatment of Painful Intractable Plantar Keratosis”
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Background: Plantar keratoma are common hyperkeratinized, deep-seated lesions, often located on weightbearing areas of the foot. Such lesions are frequently associated with pain and disability. Intractable plantar keratomata (IPK) are highly recurrent and, in most patients, require regular, palliative treatment visits with a significant impact on patient time, cost, and quality of life.
Methods: We undertook a retrospective chart review of 9 patients (with a total of 21 lesions) who underwent a minimum of two treatments using microwave therapy to their IPK. Pain levels were assessed at each of their treatments using a 10-point scale and patients were invited for review for follow-up in the following year. A total of seven patients undertook four treatments and were included in the final analysis.
Results: Mean baseline pain scores significantly dropped with each subsequent treatment, equating to a 90.4% mean reduction in pain between the first and fourth visits, with 71.4% of patients reporting a zero-pain rating at their final treatment visit.
Conclusions: The use of microwave therapy has been shown to be effective in producing significant and prolonged pain reduction in a cohort of patients with painful IPK.
Published: September 2018 - Cancer Rehabilitation, 2nd Edition, Principles and Practice, Edited by: Stubblefield, Michael D., MD.
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Monica Dhawan MD , Mischa PM Nagel, Raphael Lilker DPM, Mario E Lacouture MD. "Chapter 38: Dermatologic Complications of Cancer and Their Treatment"
Published: August 2025 - Cancer Rehabilitation, 3rd Edition, Principles and Practice, Edited by: Stubblefield, Michael D., MD.
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Ian W. Tattersall MD, PhD, Raphael Lilker DPM, and Mario E. Lacouture MD. "Chapter 38: Dermatologic Complications of Cancer and Its Treatment"
Abstract
This chapter discusses the dermatologic toxicities of anticancer therapies and mainly focuses on three adverse events: hand–foot syndrome (HFS), hand–foot skin reaction (HFSR), and paronychia. HFS is a well-documented reversible adverse effect of many chemotherapeutic therapies, causing a wide variety of cutaneous symptoms ranging from erythema, dysesthesia, pain, and desquamation of the palms and soles, to impairing daily activities of living. HFSR is a painful hyperkeratotic and blistering eruption of the palms and soles caused by anti-vascular endothelial growth factor receptor (VEGFR) multitargeted tyrosine kinase inhibitors and is clinically and likely mechanistically distinct from HFS. Paronychia is the inflammation of the nail folds, often associated with pain and predisposition to infection and development of pyogenic granuloma-like vascular growths. In cancer therapy, paronychia is most often caused by treatment with epidermal growth factor receptor (EGFR) inhibitors. There are a variety of palliative therapies that can reduce the severity of HFS, HFSR, and paronychia, potentially avoiding the need for dose interruption or modification and improving the outcomes of patients suffering from treatment-related skin and nail toxicity.
In Progress:
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Mischa PM Nagel, Monica Dhawan MD, Raphael Lilker DPM, Christine B. Boers-Doets MD. “Therapeutic footwear improves the functional mobility and quality of life of patients with chemotherapy-induced hand-foot syndrome:
Results of a pilot study”