Skin Cancer
How to Choose a Doctor and Hospital for Your Treatment
Hospitals and doctors are not all alike…
…they vary in quality due to differences in their training, experience and service. These differences in quality become greater and matter more when you need sophisticated medical care for a complex condition.
A surgeon who performs a complex procedure often, for example, has better success with it than a surgeon who does the same procedure only occasionally. The complication rate, death rate and effectiveness of the same procedure may be many times higher at one hospital than another.
Clearly, the doctor and hospital that you choose have a direct impact on how well you do, especially when you need treatment for a condition as serious as skin cancer.
Skin cancer is the most common form of all cancers in the United States and is increasing at an alarming rate each year. In 1996, an estimated 1 million Americans were diagnosed with skin cancer, up from 300,000 cases in 1977. Although skin cancer is highly curable, it causes approximately 9,000 deaths each year. Three-fourths of these deaths will be caused by the most serious type of skin cancer, called malignant melanoma.
The probability of developing skin cancer in one's lifetime is one in five, and the risk increases with age. Approximately 40 to 50 percent of all Americans age 65 or over will get skin cancer at least once during their lifetime.
Although these are sobering statistics, the total picture is far more positive. Nearly 97 percent of all skin cancer cases are less serious and can almost always be cured when detected and treated early.
You may be reading this brochure because you have been told you are at risk for developing skin cancer, or because you have been diagnosed with skin cancer and are looking for guidance on the best treatments available.
Selecting a doctor and hospital for treatment of skin cancer involves making some difficult and important decisions. No one has more at stake than you; it may be one of the most important decisions of your life.
Carefully consider where to go and what physicians and surgeons are the most qualified to treat skin cancer. Doing comparisons of hospitals and doctors early will better prepare you to make your decision.
How Do You Judge Quality?
Most of us do more research when we buy a car or television than when we choose a doctor or hospital. That may be because we don't know what questions to ask or on what to base our evaluation.
Quality of care can be measured in many different ways, and no universal agreement exists on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use the following six points, or quality indicators, to compare health care providers:
- Credentials
- Experience
- Range of services
- Participation in research and education
- Patient satisfaction
- Outcome
Choosing a doctor or hospital is often influenced by values. You may want to see a doctor who is close to home. You may want a hospital with a specific religious affiliation. But when you need specialized care for skin cancer, you also should consider a doctor's qualifications and a hospital's outcome record. These quality indicators will help you make that kind of evaluation.
Sidebar
A Step-by-Step Guide
This guide helps you choose a doctor and hospital by:
- explaining skin cancer
- identifying risk factors
- describing how skin cancer is diagnosed
- explaining treatments — both surgical and medical therapies
- explaining six points that indicate quality
- providing questions and answers from the Cleveland Clinic that you can use to compare doctors and hospitals
Skin Cancer
The skin is the body's largest organ and is afflicted with cancer more often than any other part of the body. Skin cancer is the uncontrolled growth of abnormal skin cells. While healthy cells grow, divide and replace each other in an orderly way, cancer cells grow and divide in a rapid, haphazard manner. Excess tissue formation from uncontrolled cell growth is called a tumor. Skin tumors are either benign (noncancerous) or malignant (cancerous).
There are three main types of skin cancer. Each type involves a specific kind of cell for which it is named: squamous cell carcinoma, basal cell carcinoma (both referred to as nonmelanoma skin cancers) and melanoma (also called malignant melanoma), made up of pigment cells called melanocytes.
Signs and Symptoms
Not all skin cancers look alike. But the most common warning sign is a change on the skin, either a new growth or change in a previous growth.
Basal cell carcinoma accounts for nearly 90 percent of all skin cancers. It is the least serious type, very slow growing and rarely spreads internally. It usually looks like a smooth, waxy or pearly bump, but can appear as a flat, red and scaly lesion, or an area of whitish hardening of the skin.
Squamous cell carcinoma is also slow growing, but not as slow as basal cell cancer. It can spread to the lymph nodes, which can trap cancer cells and then develop cancer themselves. It can appear as a firm, red nodule, or as a rough, scaly flat lesion that may itch, bleed and become crusty.
Basal cell and squamous cell cancers usually occur on areas of the skin commonly and frequently exposed to the sun, but can occur anywhere.
Melanoma causes 75 percent of all skin cancer-related deaths. When not treated, it can spread to other organs and is difficult to control. It usually has a more irregular appearance than other forms of skin cancer and is usually pigmented or colored. To remember the signs of melanoma, think of ABCD:
Asymmetry: shape of one half does not match the other;
Border: edges are ragged or blurred;
Color: uneven shades of black, brown, tan, as well as white, grey, red or blue;
Diameter: a change in size, larger than 6 millimeters, or the size of a pencil eraser tip.
Be alert to precancerous lesions known as actinic keratoses. These are small scaly spots commonly found on the face and back of hands. They are easily treated but can develop into skin cancer.
What Causes Skin Cancer?
The sun's ultraviolet (UV) radiation is the number one risk factor and cause of skin cancer. UV light from tanning beds or sun lamps is just as harmful. UV exposure during the winter months puts you at the same risk as exposure during the summer. Cumulative sun exposure over many years primarily causes basal cell and squamous cell carcinoma, while episodes of blistering or severe sunburns, usually occurring before age 18, can cause melanoma later in life. Other less common risk factors include repeated X-ray exposure, scars from burns or disease, and exposure to certain compounds such as coal and arsenic.
Who is at Risk?
Anyone can get skin cancer, but the risk is greatest for people with fair or freckled skin that burns easily, light eyes and blond or red hair, and those with a family history of skin cancer. A previous skin cancer puts you at increased risk for developing other skin cancers.
Children are at a particularly vunerable period of their lives since they spend much of their time outdoors. Eighty percent of a person's lifetime sun exposure is acquired by the age of 18.
If you learn you are at risk for skin cancer, start performing skin self-exams on a regular basis. Ask your family doctor or dermatologist the best way to perform a skin self-exam. In general, become familiar with existing growths and be alert to any changes or new growths. Nearly 80 percent of skin cancer cases are detected by either the patient or a family member.
How Skin Cancer is Diagnosed
When your physician detects a growth that looks abnormal, a biopsy is performed. A biopsy is the surgical removal of some or all of an abnormal skin area for microscopic examination by a dermatopathologist. By examining the tissue sample under a microscope, the dermatopathologist can detect subtle but critical differences in cells that provide information such as cellular makeup of a tumor, whether the cancer is localized or has spread, and how quickly it is growing. Accurate input from an experienced dermatopathologist is critical in helping the dermatologist make the correct diagnosis and determine appropriate treatment.
How Skin Cancer is Treated
Most treatment procedures for skin cancer are done on an outpatient basis, either in a physician's office or in an outpatient surgical setting.
Biopsy. Sometimes an excisional biopsy will completely remove the cancer and no further treatment is necessary. Most biopsies, however, remove only part of the tumor and further treatment is required.
Surgery. Most skin cancers can be surgically removed from the skin quickly and easily. Various types of surgical procedures and techniques include:
- Mohs surgery – a highly successful surgical technique used to treat basal cell and squamous cell cancers. (See box at left.)
- Curettage and Electrodesiccation – cancer cells are scooped out, then an electric current is employed to destroy remaining cancer cells and control bleeding.
- Cryosurgery – freezing method using liquid nitrogen to destroy cancer cells.
- Excision – cutting out the visible cancer and a border of surrounding normal tissue.
- Laser surgery – intense beams of light that destroy cancer cells.
- Reconstructive surgery – skin repair, which may be performed after removal of a complex skin cancer lesion to minimize cosmetic complications for the best possible aesthetic (cosmetic) result.
When skin cancer has spread, surgery may not be enough to effectively control the disease, and additional treatments may be used. These include:
- Biological response modifiers – drugs with substances similar to those found in the body that stimulate your own immune system to fight cancer cells.
- Radiation therapy – high-energy X-rays, most often used to treat advanced basal cell and squamous cell cancers. Sometimes radiation therapy may be used as primary treatment in selected cases of basal cell and squamous cell cancers.
- Chemotherapy – chemicals and drugs in the form of a topical, oral or intravenous medication used to destroy cancer cells.
Patients can benefit by participating in clinical trials involving approved or investigational treatments and medications designed to find better ways to treat skin cancer.
Some patients with advanced skin cancer may benefit from support programs, such as counseling and support groups, or hospice or palliative care when the cancer becomes terminal. Check with the medical center you choose to see if they offer support programs.
Sidebar
A Team Approach
Treatment of skin cancer often can involve more than one type of medical specialty, such as the combination of dermatology, plastic surgery, medical oncology and pathology. For this reason, finding a medical center with a multidisciplinary team approach to treating skin cancer is important. In a multidisciplinary environment, team members consult, discuss and agree upon the diagnosis and together determine the most appropriate treatment for each skin cancer patient.
Sidebar
Prevalence, Prevention and Pathology
An alarming 1 million new cases of skin cancer were diagnosed in 1996. Most people do not realize how widespread this disease is, and that anyone can develop it.
Your best defense is to avoid or reduce time spent in the sun, especially during mid-day hours. Other practices include applying sunscreen with an SPF (sun protection factor) of 15 or more every hour; wearing protective clothing and hats; and wearing sunglasses with UV protective lenses.
Pathological examination (biopsy) is the most reliable diagnostic tool to confirm the diagnosis of skin cancer. A dermatopathologist can diagnose the cellular makeup of a tumor and determine its aggressiveness, or if it has spread. Based on careful pathological findings, your dermatologist or dermatologic surgeon can determine the most appropriate treatment for you.
Sidebar
Mohs Surgery is
Treatment of Choice
Mohs surgery is the most effective treatment for basal cell and squamous cell skin cancers. Advantages over other surgical procedures include a higher cure rate for both new (primary) cancers and especially for recurrent skin cancers, and less scarring.
The dermatologic surgeon removes the cancer lesion one thin layer at a time, then microscopically examines each layer and the entire border of the tumor until no further cancer cells are detected. Only the smallest amount of surrounding healthy tissue is removed, leaving a smaller wound. Mohs surgery is especially beneficial when removing lesions on prominent or hard-to-reach areas, such as the face and ears.
Sidebar
Second Opinions
An accurate diagnosis and availability of a full range of treatment options ensure getting the most appropriate care possible for skin cancer. For these reasons, you may want to get a second opinion to confirm your treatment plan when diagnosed with skin cancer. A short delay for a second opinion will not reduce the effectiveness of treatment.
Make sure treatment is based on expert analysis and pathology at an institution experienced in identifying the different types and stages of skin cancer. This ensures the treatment plan determined for you is the most appropriate and beneficial option available.
Where Do You Begin?
Measuring quality in ways that are useful to consumers is a new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But the willingness of providers to give you as much information as possible is a good sign. It shows that they are dedicated to maintaining and improving their quality, responsive to patients, and confident of their capabilities.
If you are told that you have skin cancer, talk to your family doctor about a referral to a multispecialty medical center that uses a team approach to skin cancer treatment. Get the names of several doctors that have the most experience in diagnosing and treating skin cancer. Look for centers where research is being conducted and where patients can participate in clinical trials.
Ask the questions that we suggest on the following pages. Make comparisons. Then make your decision. Be an informed consumer for yourself and your family.
How to Use Quality Indicators
How can you use these indicators to judge if one doctor or hospital is better for you than another? By combining information from more than one quality indicator, according to a report, "The Quality of Medical Care: Information for Consumers," produced by the U.S. Congress, Office of Technical Assessment.
According to the report, patients about to have surgery can be confident if the hospital performs a high number of surgeries, has a low mortality (death) rate, and if the surgeon has extensive training and experience in the procedure.
On the other hand, the report states "...if a hospital has a high mortality rate and a low volume of procedures, the patient might wish to question the surgeon about that hospital and about alternatives, even if other hospitals require longer travel."
1. Credentials
Do the doctor and hospital measure up?
Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in health care delivery.
Doctors
Board certification, or the international equivalent, is a sign that doctors are highly trained in their fields. Doctors who specialize should be board certified in the specialty in which they are practicing. Each specialty has a national board that is responsible for setting standards doctors must meet in order to be certified. Doctors who are board certified in their specialties have completed the amount of training that the specialty board requires, have practiced for a specified number of years in that specialty and have passed a difficult examination in their specialty area. Some excellent doctors are not board certified. Board certification, however, is generally a good indicator of competence and experience.
Hospitals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on its meeting certain criteria for staffing, equipment and facility safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital that you are considering is not accredited, it is important to know why.
Some of the best doctors and hospitals are often in the public spotlight for their medical advances and the quality of their care. Information about a hospital's reputation is widely available through the mass media, listings, the government, consumer groups, books and magazines such as U.S. News & World Report.
Sidebar
For information about a hospital's status, call the Joint Commission on Accreditation of Health-care Organizations at 630/916-5800.
Are the physicians and surgeons treating skin cancer board certified in their specialty?
Yes. All Cleveland Clinic physicians and surgeons who treat skin cancer are board certified in their specialty.*
Are the hospital's pathologists who perform skin cancer biopsy examinations board certified?
Yes. Cleveland Clinic dermatopathologists performing skin cancer biopsy examinations are board certified by the American Board of Pathology or the American Board of Dermatology and have special certification in dermatopathology.
Is the hospital accredited by JCAHO?
Yes.
Have the doctors been recognized for excellence?
Yes. Eight Cleveland Clinic physicians and surgeons who treat skin cancer are recognized in the book "The Best Doctors in America: Midwest Edition" (1996). Many Cleveland Clinic physicians and surgeons who treat skin cancer serve as officers or members of professional organizations related to their specialty, including the American Academy of Dermatology; Association of Academic Dermatologic Surgeons; American Society for Dermatologic Surgery; American College of Mohs Micrographic Surgery and Cutaneous Oncology; American College of Physicians; American Society of Clinical Oncology; and American Association for Cancer Research.
Has the hospital been positively and consistently recognized for medical excellence and leadership?
Yes. Both the Cleveland Clinic hospital and the Cleveland Clinic Cancer Center are consistently rated among the top medical centers in the country. (See box at left.)
*Board certification or its international equivalent became a requirement at the Cleveland Clinic in 1989 for doctors being appointed to the medical full staff.
Sidebar
Among America's Best
- U.S. News & World Report has named the Cleveland Clinic one of "America's Ten Best Hospitals" every year since 1990.
- For the past 4 years in a row, U.S. News & World Report has ranked the Cleveland Clinic Cancer Center as the best in cancer care in Ohio.
- The Cleveland Clinic was named among the "Top 100" best-performing hospitals for the last three years in a study published by Modern Healthcare magazine.
2. Experience
Does practice make perfect?
In the case of specialized treatment for skin cancer, the more experience the doctors and hospital have, the better the results will be.
The medical center's experience in treating your particular kind of cancer is as important as the total number of cancer patients treated there each year. Every cancer is different, and experience in treating one type of cancer does not necessarily mean equal familiarity with treating another type of cancer. In a multidisciplinary practice setting, physicians can sub-specialize in very specific types of cancer, such as skin cancer.
Also, patient volumes must be related to the incidence of a particular type of cancer. A hospital may care for only a small number of patients with a particular cancer, but this experience may be many times greater than that of other institutions if the cancer is rare.
You may also want to make sure that the physician managing your care is primarily in clinical practice, seeing patients, and therefore has the experience leading to expertise in the diagnosis and treatment of skin cancer. This increases the likelihood that the physician is up-to-date on the patient care applications of new research such as the latest treatments or diagnostic advances and is likely to be involved in clinical trials of new treatments. To find out, ask how many skin cancer patients the physician sees in a typical week.
How many patients are treated for skin cancer at the medical center each year?
1,548 patients were diagnosed and/or treated at the Cleveland Clinic for basal cell carcinoma, squamous cell carcinoma or other forms of nonmelanoma skin cancers in 1996.
How many patients are treated for melanoma at the medical center each year?
344 patients were treated at the Cleveland Clinic for melanoma in 1996.
How many skin cancer biopsies are examined each year?
2,154 skin cancer biopsies were examined at the Cleveland Clinic in 1996. Of these, 712 were performed at the request of physicians outside the Cleveland Clinic.
How many skin cancer surgeries are performed each year?
More than 1,500 skin cancer surgeries were performed at the Cleveland Clinic in 1996. 719 patients had Mohs surgery, 194 had either cryosurgery or curettage and electrodesiccation, and 236 had a surgical excision.
How often do patients need other types of treatment, such as radiation therapy and chemotherapy, for skin cancer?
105 treatments of radiation therapy and/or chemotherapy were administered to patients at the Cleveland Clinic for skin cancer therapy in 1996.
How long has the hospital been treating patients with skin cancer?
The Cleveland Clinic has been treating patients with skin cancer since the Department of Dermatology was established in 1923.
Sidebar
Mohs Surgery
The Cleveland Clinic is one of only a few medical centers in the region performing Mohs surgery. Clinic dermatologic surgeons are among the most experienced Mohs surgeons in the country and are trained through the American College of Mohs Micrographic Surgery and Cutaneous Oncology.
3. Range of Services
What services are available?
Medical centers with a broad range of services can treat more complex medical conditions and better handle complications that may occur. If complications arise, you want the best care available, and you want it immediately.
Range of specialty departments
Skin cancer may require the services of a number of specialty departments. This largely depends upon the type of skin cancer and the stage, or extent, at which it is diagnosed. Therefore, access to a full range of specialty and subspecialty departments within a facility is critical when seeking treatment for skin cancer. This is especially true when removing a large or complex skin cancer lesion. When this is the case, choose a facility with surgeons who are experienced in performing skin grafting and reconstructive surgery.
Range of diagnostic and treatment options
Choosing a facility that can treat skin cancer in a variety of ways allows you to get the most effective, appropriate and cost-effective treatment available. Mohs surgery, for example, preserves more surrounding healthy tissue and results in better cure rates. With skin cancer, getting the most appropriate treatment may depend on the availability of the latest standard treatments as well as promising new ones.
The diagnosis and treatment of skin cancer may involve health care professionals from more than one discipline working as a team, including dermatologists and dermatologic surgeons, dermatopathologists, plastic and reconstructive surgeons, medical oncologists, oculoplastic (eye) surgeons and otolaryngology (ear, nose and throat) surgeons.
Is help available from a full range of specialty departments?
Yes. 850 physicians at the Cleveland Clinic provide care in more than 100 specialties and subspecialties, including clinical dermatology and dermatologic surgery, dermatopathology, plastic and reconstructive surgery, medical and radiation oncology, oculoplastic surgery and otolaryngology. All specialties are present in one facility, so prompt consultation, diagnosis and treatment are readily available.
Does the hospital offer a variety of options for diagnosing and treating skin cancer?
The Cleveland Clinic offers a comprehensive range of options for the diagnosis and treatment of skin cancer, including:
- Prevention and screening
- Familial registries to identify persons at high risk
- Biopsy
- Computerized tomography scanning
- Magnetic resonance imaging
- Positron emission tomography
- Radiation therapy
- Laser therapy
- Biological response modifiers
- State-of-the-art surgical techniques, such as Mohs surgery
- Topical and oral chemotherapy using the newest drugs
- Hormonal therapy
4. Participation in Research and Education
What type of hospital is it?
There are many advantages to selecting a hospital that combines patient care with research and education.
Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This approach results in the most rapid transfer of basic scientific knowledge from the laboratory to care delivered at the patient's bedside.
Those individuals on the staff of such a hospital are exposed to an important interchange of ideas. They are also exposed to the newest treatment and forms of technology. At teaching hospitals, physicians are available 24 hours a day.
There may be other advantages to choosing a teaching hospital. Private, not-for-profit teaching hospitals had lower mortality rates than other types of hospitals, according to a December 1989 issue of the New England Journal of Medicine.
Is the hospital associated with a teaching program?
Yes. Incorporated in 1935, The Cleveland Clinic Educational Foundation sponsors one of the nation's largest physician post-graduate training programs and is affiliated with The Ohio State University College of Medicine.
Does the hospital have fully accredited residency or fellowship training programs in specialties related to skin cancer care?
The Cleveland Clinic has one of the country's largest residency programs in dermatology and long-standing fellowships in dermatopathology, dermatologic surgery and cutaneous oncology. Many physicians and surgeons who have trained at the Clinic have gone on to become chairmen and directors in their specialty at other major institutions. The Cleveland Clinic offers fully accredited residency training programs in radiation oncology, and fellowship training programs in hematology and medical oncology, radiation oncology and neuro-oncology. In addition, the Department of Ophthalmology includes training in ocular skin cancer as part of their residency and fellowship programs.
Does the hospital conduct research or clinical trials related to cancer, specifically to skin cancer?
The Cleveland Clinic Cancer Center belongs to four of the largest cooperative study groups in the country. These groups study relatively rare cancers as well as expedite the testing of promising new therapies for common cancers, including skin cancer. This participation assures Cleveland Clinic patients access to a wide variety of promising treatments through clinical trials.
Currently, the Cleveland Clinic is conducting four clinical trials aimed at delaying or preventing the recurrence of melanoma. They involve the use of new medical therapies, vaccines, or a combination of chemotherapy and immunotherapy.
5. Patient Satisfaction
Is everybody happy?
If you ask one person about his or her experience with a doctor or hospital, you get one person's point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.
Most hospitals routinely use surveys to learn if patients are satisfied with their medical experiences. The hospital can use these results to improve its services.
Patient satisfaction often reflects the personal side of care. Surveys ask questions such as: How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?
Patient satisfaction information can predict what your experience in a particular hospital is likely to be.
How satisfied are outpatients with their experience in departments that treat skin cancer?
98% of patients seen in the Department of Dermatology and the Department of Plastic and Reconstructive Surgery said they were either very satisfied or satisfied with their experiences. 99% said they would return.
97% of patients seen in the Department of Hematology and Medical Oncology said they were either very satisfied or satisfied with their experiences. 98% said they would return.
Would patients seen in these departments recommend similar care at the Cleveland Clinic to their family and friends?
99% of patients seen in the departments of Dermatology, Plastic and Reconstructive Surgery, and Hematology and Medical Oncology would recommend the Cleveland Clinic to others.
Is there a program to help patients and their families with any difficulties that may arise during their care?
Cleveland Clinic patients may call an ombudsman — another name for a patient-relations representative — if they have any concerns or questions about service or care.
Patients in the Cleveland Clinic hospital may also dial a 24-hour Helpline if they have any problems, questions, suggestions or concerns.
6. Outcome Indicators
What are the risks?
Cancer is a very complicated group of diseases, and many different factors influence a person's prognosis, or prospects, for recovery. Some cancers may not respond to even the latest therapies. Fortunately, skin cancer is almost always curable when detected and treated early. The national cure rate for primary basal cell and squamous cell skin cancers is 95% or more. The cure rate for melanoma is also very high when detected and treated in its early stage.
National statistics on outcomes for basal cell and squamous cell cancers are not kept, primarily because of the large number of cases. However, outcomes concerning recurrence rate for patients with basal cell and squamous cell carcinoma can be affected by the type of surgery performed. For example, compared to other surgical techniques, Mohs surgery produces significantly higher cure rates when treating recurrent skin cancers. Likewise, Mohs surgery produces much higher cure rates for certain subtypes of skin cancer and for cancer lesions in certain prominent or hard-to-reach locations, such as the face, nose and ears.
When treating melanoma, the stage or progression at the time of diagnosis is the most important factor in determining outcome. Stages range from a small lesion that is confined to one location to a larger lesion that has spread beyond the skin. The survival rate continues to drop significantly when melanoma advances beyond this early stage.
What is the cure rate for patients treated with Mohs surgery for a recurrent skin cancer compared to other surgical techniques?
The cure rate for patients treated with Mohs surgery for recurrent skin cancer at the Cleveland Clinic is 90% or better, which meets or exceeds the national cure rate. This compares with cure rates associated with other techniques of only 50%.
What is the cure rate for patients treated with Mohs surgery for a new skin cancer compared to other surgical techniques?
The cure rate for patients treated with Mohs surgery for a new (primary) skin cancer at the Cleveland Clinic is 93% for squamous cell cancers and 99% for basal cell cancers, which meets or exceeds the national average. This compares with cure rates associated with other techniques of up to 90%.
What is the hospital's survival rate for patients with melanoma?
At the Cleveland Clinic, patients treated for melanoma in its early stage (less than 1 millimeter thick) have a greater than 95% five-year survival rate, which meets or exceeds the national average.
Sidebar
Multispecialty Care Lowers Risk, Improves Result
Choosing a large, multispecialty center to treat skin cancer may lower your risk of complication or infection and yield a better cosmetic result. For example, at the Cleveland Clinic, a large or complex skin cancer wound is closed immediately following removal of the lesion. This lowers the risk of infection and complication by eliminating the need for additional surgeries. Facilities with limited specialty care typically do not have the resources readily available to perform such procedures. The Cleveland Clinic provides patients with this type of seamless care; you are evaluated, diagnosed and treated at one location by a team of specialists with the experience and skills necessary to give you the best possible functional and aesthetic (cosmetic) results.
Pioneering Work in Cancer
The Cleveland Clinic Foundation is recognized worldwide for its comprehensive commitment to understanding, controlling and preventing cancer. Doctors and scientists here have pioneered many advances in cancer, and some specifically related to skin cancer, including:
- First medical center in the country to perform Mohs surgery using the CO2 laser, which allows surgeons to remove the lesion with greater precision and less bleeding
- Initiated national reporting on the findings of CO2 laser treatment of multiple superficial basal cell carcinomas
- Pioneered an interdisciplinary approach to the management of skin cancer by integrating a multispecialty team of physicians and surgeons
- One of the first centers to use the chemotherapy drug 5 fluorouracil (topical and injectable) for the diagnosis and treatment of pre-malignancies and superficial basal cell carcinomas
- Conducted studies and published articles on the mechanisms and pathology of the spread of skin cancer
- Developed nationally accepted guidelines on the indications of skin cancer recurrence
- Designated by the National Cancer Institute to conduct pioneering studies of biologic response modifiers
- Cancer Center specialists were among the first to successfully use biologic response modifiers in kidney cancer and are now studying their application in melanoma
- Pioneered minimal resection techniques for treating skin cancer that has invaded bone
- Among the first to utilize microscopically controlled surgery for unusual types of skin cancer
- The Cleveland Clinic Cancer Center participates in the largest cooperative cancer study groups in the country
Sidebar
Appointments
For an appointment in the Department of Dermatology, please call:
216/444-5725
(in Cleveland)
800/CCF-CARE 223-2273, Ext. 45725
(toll-free outside Cleveland)
For More Information
If you would like to receive any of the other guides in our series: "How to Choose a Doctor and Hospital for Your Treatment," please call 216/444-8919 (in Cleveland) or 800/545-7718 (toll-free outside of Cleveland) or visit us online at:
http://www.ccf.org
Empowering Yourself
Controlling the incidence of skin cancer is as much a public health burden as it is a medical one. Because skin cancer is basically a preventable disease, caused by over-exposure to and under-protection from ultraviolet (UV) rays — from the sun, as well as tanning beds — the opportunity to significantly reduce its occurrence is at our fingertips: incorporate and practice sun-safety prevention as part of our daily lifestyle.
Prevention of skin cancer starts with awareness. The National Weather Service is helping medical, environmental and public groups promote awareness about the risk of developing skin cancer from the sun's UV rays by including the UV Index with its daily weather forecast. The UV index is a measurement of the sun's ultraviolet radiation expressed in levels.
Index Value Exposure Level Minutes to Burn*
0-2 minimal 60 min.
3-4 low 45 min.
5-6 moderate 30 min.
7-10 high 15 min.
10+ very high 10 min.
*for a fair-skinned person, without protection, during noonday sun
By practicing prevention to safeguard against UV rays — sunscreen with an SPF (sun protection factor) of 15 or more applied every one to two hours, sunglasses with UV protective lenses, protective clothing and hats — you significantly reduce the risk of developing skin cancer.
Cleveland Clinic Florida
Cleveland Clinic Florida provides state-of-the-art programs in cancer treatment with the support of the Cleveland Clinic. A group of dermatologists and a dermatologic surgeon trained in Mohs surgery, as well as plastic and reconstructive surgeons, are on staff to diagnose and/or treat all types of skin cancer.
For an appointment at the Cleveland Clinic Florida to see a dermatologist, call toll free 800/359-5101, ext. 5124.
Reprinted with permission by: Med Help International
Copyright © The Cleveland Clinic Foundation. 1997 All rights reserved
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