Donald L. Morton, MD, transformed the management of melanoma and breast cancer by introducing the sentinel node biopsy, giving surgeons an accurate roadmap for treatment, and sparing generations of cancer patients from the morbidity associated with unnecessary surgery. Throughout his distinguished career, his work and discoveries have profoundly changed the treatment of cancer. Dr. Morton died on January 10, 2014, in Santa Monica, California. He was 79.
Overcoming Poverty
Dr. Morton was born in 1934 in Richwood, West Virginia, a small coal-mining town tucked away in the Appalachians. The son of a coal miner, Dr. Morton grew up dirt poor during the Great Depression, reared in a house built by his father that had no electricity or indoor plumbing. He tended pigs, cows, and chickens in the morning before school, and then again after school. “Only after all my chores were done could I do my homework by the light of a kerosene lamp,” noted Dr. Morton in an interview with Innovations, a publication of the John Wayne Cancer Institute.
Dr. Morton’s self-determination and a supportive mother overcame the limitations imposed by poverty. His searing intellect was seen early on, and following high school he enrolled in Berea College in Kentucky, which provided free education to qualified students from poor families. After graduating from Berea, Dr. Morton completed his undergraduate education at the University of California, Berkeley, in 1955 and then received his medical degree from the University of California, San Francisco (UCSF), in 1958.
Early Career
Dr. Morton interned at UCSF Medical Center and began a surgical residency in general surgery, which was put on hold by a fellowship grant at the National Cancer Institute (NCI). Following his fellowship, Dr. Morton completed his surgical residency at UCSF Medical Center, after which he returned to the NCI in 1960 to serve as senior surgeon in the surgery branch.
He eventually became the head of NCI’s tumor immunology section. During this period, Dr. Morton’s lifelong interest in surgical oncology and melanoma began to bloom. Also at the NCI, Dr. Morton’s observations of spontaneous remissions in melanoma sparked his interest in immunotherapy, which would become a central line of inquiry during his career.
In 1971, Dr. Morton assumed the role of Professor and Chief of the Division of Surgical Oncology, UCLA School of Medicine. At that time, surgical oncology was not yet recognized as a specialty within general surgery. Dr. Morton’s work changed the approach to melanoma surgery by introducing cutaneous lymphoscintigraphy to identify the regional lymphatic basin receiving drainage from a primary cutaneous melanoma.
During the late 1970s, Dr. Morton further refined lymphatic mapping, defining the sentinel lymph node as the first tumor-draining node, leading to the development of the sentinel lymph node biopsy, which has become the standard of care for patients with early-stage malignant melanoma and breast cancer. It is widely accepted that the sentinel node concept saves the U.S. health-care system about $3.8 billion per year in unnecessary procedures and their subsequent harms.
Groundbreaking Research
Dr. Morton’s early interest in immunotherapy led to his pioneering work with intratumoral bacille Calmétte-Guerin (BCG) for nonspecific melanoma immunotherapy, the first successful application of immunotherapy in metastatic cancer. His studies also laid the foundation for the use of intravesical BCG in superficial bladder cancer, which became the first U.S. Food and Drug Administration–approved cancer immunotherapy.
During this period of groundbreaking research, Dr. Morton also became known as being one of the last physicians to treat the Hollywood icon John Wayne, who died in 1979 of stomach cancer. Dr. Morton—who slightly resembled Wayne in his stature and rugged good looks—became quite close to the famous actor. In later interviews, Dr. Morton would remark about Wayne’s dignity in dealing with his terminal condition.
In 1981, with the help of the Wayne family, Dr. Morton established the John Wayne Cancer Clinic at UCLA. Ten years later, seeking more space for patients and research, Dr. Morton, along with John Wayne’s eldest son, Michael Wayne, moved to St. John’s Health Center, founding the John Wayne Cancer Institute.
Valued Mentor
In a 2011 editorial in the Journal of Surgical Oncology, former ASCO Executive Vice President, Charles M. Balch, MD, of Johns Hopkins University wrote, “Donald Morton is truly a legend in surgical oncology, an icon as a surgical investigator, a pioneer in melanoma, a valued mentor, an authentic role model, and a cherished friend.”
“I’m proud that about 80% of those I’ve trained are now deans or department chairs and are widely distributed throughout the country. They will continue to make contributions to cancer long after I’m gone,” Dr. Morton said during his interview in Innovations.
Dedication to Patients
Dr. Morton’s scientific contributions to the field of oncology will endure as a living legacy, carried on by generations of future doctors. That said, his groundbreaking research work in the lab did not separate him from cancer patients; it brought him closer to them.
His dedication to patients was best captured during an interview in the Los Angeles Daily News, when he said, “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.”
Reference
1. Kloos RT, et al: Ernest L. Mazzaferri, MD, MACP (1936-2013). Thyroid 23:917-923, 2013.
Adapted from The Columbus Dispatch, May 19, 2013.
