Surgeons in Abu Dhabi treat rare cancer

Ahmed, a 14-year-old Sudanese boy, is recovering steadily after doctors in the capital save his life by removing a large tumour from his jaw.

Ahmed Ibrahim Mohammed, left, and Dr Robert Lorenz at a press conference at Sheikh Khalifa Medical City in Abu Dhabi.

ABU DHABI // A 14-year-old Sudanese boy is recovering steadily after doctors in Abu Dhabi saved his life by removing a grapefruit-size tumour from his lower jaw. Ahmed Ibrahim Mohammed has a rare immune disorder, xeroderma pigmentosum, that makes him susceptible to developing malignant tumours of the skin as a result of exposure to sunlight. Doctors estimate that the disorder affects one in 200,000 people.

The child's father, Ibrahim Mohammed Ibrahim, struggled for more than two years to find a surgeon in the region who would remove the tumour. In March, surgeons at Sheikh Khalifa Medical City (SKMC), which is managed by the US-based Cleveland Clinic, agreed to perform the very complex and rare procedure. The lower jaw, chin and floor of Ahmed's mouth needed to be removed with the tumour, then rebuilt using bone from his lower leg.

The first major operation lasted more than 18 hours. It was the first surgery of its kind in the UAE. Dr Robert Lorenz, a specialist in head and neck surgery who is affiliated with the Cleveland Clinic and is a surgical consultant at SKMC, performed the operation with the assistance of SKMC staff and visiting doctors. "Most places in the world would not have performed the surgery for him," Dr Lorenz said yesterday. "There are a number of risks, as it is such a complex surgery."

As well as rebuilding the lower jaw, surgeons also had to integrate different tissue types: skin, muscles, arteries, veins and nerves. Dr Lorenz explained that although the cancer that has affected Ahmed was easily treatable, it must be caught early. Ahmed's family noticed the beginnings of the tumour on his lip when the child was eight years old. Ahmed had surgery in Sudan, his family's homeland, but doctors did not succeed in removing all of the tumour, so it grew back.

"They searched for four years to find a place to have the treatment," Dr Lorenz said. "The cancer was curable, but it needed a very big surgery. "Because of the complexity of the surgery, he was refused care because they didn't have the facilities to treat the tumour. "But his father would not accept 'no'. He showed incredible determination on behalf of his son. I have tremendous respect for him."

Because the tumour limited his ability to eat, Ahmed, who lives with his family in Liwa, was malnourished when he arrived at SKMC. And the 18-hour surgery in March was only the first of several operations. Ahmed will have to undergo two or three smaller surgical procedures to rebuild the teeth on the lower jaw and repair some of the scarring. "He has been brave," Dr Lorenz said. "It is a risky surgery, but he has healed very well."

An important risk - but an unlikely outcome - from the surgery was that the "reconstruction completely falls apart", Dr Lorenz said. "He did have an infection afterwards, but we were able to take care of it. One of the risks to the surgery is that someone could develop a very serious infection and potentially die." SEHA, the Abu Dhabi health services company that operates government hospitals in the emirate, is providing all the funding for Ahmed's treatment and aftercare. The company has said that Ahmed can continue to use SKMC's services.

Because ultraviolet radiation from the sun is the primary trigger for the cancers associated with the disorder, Ahmed must stay covered up whenever possible, so he wears a baseball cap and scarf outdoors. And he has been given special training to help spot the early signs of the malignant tumours, which are likely to recur, as early treatment is essential. [e-mail]