Even as a child, Kristin Skinner loved medicine and longed to understand what caused normal cells to transform themselves into deadly cancers.

While for most people that natural predisposition might reasonably suggest a career as a physician, Skinner vehemently rejected the very notion at first-at one point declaring to her family that she would become a surgeon "over my dead body."

But in the end, the lure of the same profession that won over her father, uncle and two of her three sisters proved too much to resist, says Skinner, an M.D. and assistant professor of surgery in the Keck School of Medicine of USC.

"I grew up in a medical family and saw my first surgery when I was 6. I remember going on rounds with my father and meeting his patients-it was just fascinating to me," she says. Even so, she begrudged all the times her father worked late or on weekends: "He wasn't around much and that left an impression on me that medicine was something I didn't want to do.

"As I grew older, I fought being a doctor for a long time," she says, partly because it seemed that being a physician meant you were never able to get away from work, or get away from being a physician.

But when she took a biology class at the University of Rochester in New York, her eagerness to investigate the mysteries underlying the roots of cancer development overwhelmed her reluctance to enter the field of medicine.

"In college I became fascinated with genetics-so much so that I had these weird dreams about when cells became cancer," she says.

That burning interest led her to an internship during her freshman year in the lab of the late Charles Huggins-a renowned surgical oncologist at the University of Chicago whose research on prostate and breast cancers would earn him a Nobel Prize for Medicine in 1996.

"I was interested in cancer research long before I was interested in medicine as a career. But finally, I told my mom, 'Don't tell dad, but I think I'm going to become a doctor.' She laughed and said, 'I think he already knows it,'" Skinner says.

In 1988, Skinner received her medical degree from the Johns Hopkins University School of Medicine and by 1995 had completed her internship and residency in general surgery at UCLA.

"It turned out I liked surgery better than anything else. So, given my interest in oncology, it was obvious to me that I would become a cancer surgeon," she says.

Of course, surgeons run in her family. Her father, David Skinner, M.D., is a well-known surgeon in Chicago and New York, where he was chief executive officer of New York Hospital and led the merger with Presbyterian Hospital. Her uncle is Donald Skinner, M.D., USC professor and chair of urology and holder of the Hanson-White Chair in Medical Research.

But in addition to surgery, Kristin Skinner has also chosen to do basic research into the causes and treatments of cancer-a move that surprised some of her peers, who suggested that the different disciplines were strictly an either-or proposition.

"All along, people told me you can do research or be a surgeon, but you can't do both. I said, 'Why?' and just did it," she says. "That's still unusual. I'm pretty much the only one in my department who does both."

Peter W. Laird, Ph.D., assistant professor of surgery, biochemistry and molecular biology, who mentored Skinner for three years, says he agrees that her mix of talents is rare. "What's most striking to me is that she is an active clinician who has an exceptional level of interest in basic research and the molecular mechanisms underlying cancer. A lot of clinicians are interested in science but very few are able to incorporate research in their day-to-day activities. She combines these two very demanding tasks: she can think like a scientist and perform like a surgeon," he says.

In a typical week, Skinner sees patients on Tuesday mornings and Thursday afternoons, performs surgeries on Fridays and spends the rest of her time in the laboratory.

Although Skinner says she tries to divide her time equally between working in the lab and seeing patients, whenever time is short and something must give, the patients always win out. "Real people always come first and I get a huge amount of satisfaction from treating patients."

She says that the mix of lab and clinical work is extraordinarily fulfilling. "Without research, ultimately you can't do anything more for patients 10 years down the road than you can today. But only doing research doesn't help anyone here and now. Seeing patients provides immediate gratification."

In the lab, Skinner's work focuses on DNA methylation-a process through which DNA becomes modified in areas responsible for turning genes on and off in a cell.

"That's important because many of these genes are tumor-suppressor genes. This is interesting to cancer researchers because the change is reversible. We study it because we think it can be a target for therapy and also because it may be one of the earliest changes that can eventually lead to cancer," she says.

To help support her research, Skinner recently received grants of $708,000 from the National Institutes of Health to study DNA methylation as a marker for breast cancer risk; $250,000 from the Susan G. Komen Breast Cancer Foundation to examine DNA methylation in ductal carcinoma in situ, a common, localized form of breast cancer, and $330,000 from the American Cancer Society to perform research in DNA methylation in esophageal cancer.

She notes, "If methylation precedes other changes by a long period of time, it may also serve as a marker for increased cancer risk, giving patients an early warning signal that could help save their lives. Basically, the work I do in the lab focuses on things that can be translated quickly to the clinical side and to the patient."

Skinner says she is thrilled to be working in a field that is exploding with new findings, new research and new drugs to fight cancer. "There's so much change coming so fast. A few years ago, you might see an occasional article in a journal on DNA methylation, but now you can't pick up a journal without seeing several articles about it."

She adds, "There's just been exponential growth in the number of oncogenes [genes that promote cancers] and tumor surpressors. When I was starting out oncogenes were just being discovered."

Interestingly, the dreams that Skinner had in college about malfunctioning genes and cancer presaged the later discovery of oncogenes. "A year after they were discovered I was telling people, 'I used to dream about these things,' and people said, 'Sure you did,'" Skinner says.

Keck School of Medicine Dean Stephen J. Ryan praises Skinner as "an excellent role model. It's impressive to note that while serving as a busy faculty member in the Department of Surgery, she has been able to achieve the gold standard for her research. Receiving support from organizations such as the NIH and the Komen Foundation simply underscores her innovation as a researcher and clinician."

Skinner says that although her work is important, it is not everything to her. She enjoys cooking, working with her church group and gardening as ways to unwind. Skinner notes that-as she learned from her father as a child-the hours can be long.

But for those rare moments when that starts to weigh on her mind, she has a gentle reminder hanging on her office wall that helps the stress evaporate.

"I have a picture of a cabin out in the woods in Alaska that will be my retirement home. It's just there to remind me that when times get hard," she says, "I can always get away."