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Melanoma Monday _ Skin Cancer Prevention & Awareness - Drs Gastman & Mesfin

Online Health Chat with Brian Gastman, MD and Missale Mesfin, MD

May 6, 2013


Description

Experts are seeing an alarming rise in the number skin cancer cases, especially among young women. This increase is due in part with the increased use of tanning beds as well as depletion of the ozone layer allowing more UVA and UVB light rays to reach Earth. Regardless whether you’re a frequent tanner or not, there are key ways to protect your skin from the sun that should be regularly followed, as well as understanding the importance of routine skin examinations by you and your doctor.

Skin cancer is a tumor or growth of abnormal cells in our skin, and is the most common form of cancer people get in the United States. There are several types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Both basal and squamous cell carcinomas are cancers that occur in the surface layer of the skin and can be easily cured when detected and treated early. Malignant melanoma is the most serious type of skin cancer, and is more likely to spread. About 65 to 90 percent of melanomas are caused by exposure to ultraviolet (UV) light.

While skin cancer can be deadly when untreated, it often can be cured if found early. It is important to know not only ways to protect yourself from developing skin cancers, but also how to determine when it’s time to see a doctor and what can be done once you’ve been diagnosed.


About the Speakers

Brian Gastman, MD is a board certified plastic surgeon and otolaryngologist in the Department of Plastic Surgery in Cleveland Clinic’s Dermatology & Plastic Surgery Institute. Dr. Gastman’s specialty interests include comprehensive care of soft tissue malignancies such as melanoma, non-melanoma skin cancers, sarcomas, and head and neck cancers. Dr. Gastman also helped to institute the Melanoma Clinic located in the Taussig Cancer Institute, which helps to diagnose and treat patients with complex melanoma concerns.

A medical school graduate of the University of Michigan Medical School, he completed his residency at University of Pittsburgh Medical Center & Children’s Hospital of Pittsburgh and Dr. Gastman completed his fellowship in head and neck surgery at Washington University St. Louis Medical Center, St. Louis, Mo. His residencies in plastic surgery and otolaryngology and surgery internship were completed at University of Pittsburgh Medical Center & Children's Hospital of Pittsburgh, Pittsburgh, Pa. Dr. Gastman graduated from medical school from University of Michigan Medical School, Ann Arbor, Mich.

Missale Mesfin, MD is board certified dermatologist in the Department of Dermatology in Cleveland Clinic’s Dermatology & Plastic Surgery Institute. Dr. Mesfin’s specialty interests include skin cancer, cosmetic dermatology, cutaneous laser surgery and oncology, dermatologic surgery and Mohs surgery. Dr. Mesfin completed her fellowship in procedural dermatology – Mohs surgery and her residency in dermatology at University of Michigan Health System following her graduation from University of Michigan Medical School. She completed an internship in internal medicine at Mount Sinai Medical Center, Miami Beach, Fla. Dr. Mesfin currently sees patients at Twinsburg Family Health & Surgery Center.


Let’s Chat About Melanoma Monday – Skin Cancer Prevention and Awareness


Skin Protection: Sunscreens and Beyond

eileena: Which is better for covering up during a sunny day—light or dark clothes? Is there a danger from tanning sprays rather than tanning beds?

Missale_Mesfin,_MD: Light color clothing makes you feel cooler because it reflects most of the sun rays. However, dark colors actually absorb the sun rays and helps to prevent the ultraviolet (UV) radiation from getting to the skin underneath the clothing. Therefore, dark-colored clothes are more protective against the sun than light-colored clothing in areas that are covered, but are not protective for the skin that is not covered by the dark clothing. Sunscreen is still recommended for those uncovered areas.

In terms of spray tans, there are not known harmful side effects to the skin from them. In terms of the skin, it is safe to use spray tanning. Certainly there are many known risks of tanning beds that we would recommend avoiding them entirely.

eve3: When you are out in the sun all day, how often do you need to reapply sun screen?

Missale_Mesfin,_MD: Sunscreens are great at protecting skin from the sun. However, they all are only effective for a certain amount of time, and the biggest problem that people run into is reapplication of sunscreen. All sunscreens break down in the sun after two to three hours. So if you are out longer than that time, it is effectively like you haven't put any on at all. So it is important to reapply sunscreens after two to three hours to have maximum protection. If you go in the water, you must reapply sunscreen after you dry off. Even if it is a water-proof sunscreen, you have rubbed it off with toweling and drying off. In addition, it is important to use a UVA and UVB blocker, with SPF 30 or higher.

jonas: What is the truth about sunblock? Does SPF 45 really work, or is anything above 30 really a marketing gimmick? For sunscreen to really be effective do you need to reapply it every two hours?

Missale_Mesfin,_MD: Sunscreens are an important part of sun protection and, as you have alluded to, there are many different kinds available. When looking for a sunscreen, we recommend a UVA and UVB blocker that is an SPF 30 or higher. The number can be important because the latest studies have shown that the amount most of us actually apply is equivalent to half of the number on the bottle. This is because the actual amount that is tested is using the equivalent of a shot glass filled with sunscreen on the body. Most of us do not apply that much and they have found that we actually put on the equivalent of half the SPF that is tested in the lab.

Therefore, there is some benefit to an increased SPF value. If you are truly putting on a shot glass worth on the entire body, then SPF 30 is sufficient. However, if less is applied, then the increased value of an SPF 45 or higher can be helpful.

And, yes, you do need to reapply sunscreens every two to three hours. The reason is because they all break down in the sun after that amount of exposure, and are no longer effective after that time. So, yes please reapply sunscreen!

eileena: What would you recommend as protective sun coverage for children who are three to 12 years old? If they swim, should they wear a shirt at all times?

Missale_Mesfin,_MD: These days they have fabulous options for sun protection for children. Firstly, sunscreen is an important addition for children older than six months of age. There are many children-formulated sunscreens that are made for the more sensitive skin of children. As with all sunscreens, reapplication every two to three hours is important, as well as reapplying after coming out of the water—even if it is a water-proof sunscreen.

In addition, there are several companies that sell clothing with ‘SPF’, or actually ‘UPF’ (ultraviolet protection factor), a sun protective factor built into the clothing. They make many types of swimwear, including t-shirts and hats. I highly recommend these options as you don't have to worry about the sunscreen factor from wearing off, and you can feel more confident their skin is being protected while they are having fun.

beach_bum: Our family likes to go boating in the summer time, so I can't avoid being out in the sun. My father has had all three types of skin cancer, so I know my family is prone to it. What can I do to try and prevent myself from getting it? I am fair skinned and do have a lot of freckles and moles.

Missale_Mesfin,_MD: Well, despite a family history of skin cancer, we don't want anyone living under a rock for the rest of their lives! We just advocate being ‘sun smart.’ Ultraviolet radiation is highest between 10 a.m. and 3 p.m. Avoiding continual direct contact during that time can be helpful. Also, sunscreens are extremely important to protect the skin. We recommend UVA and UVB blocker, SPF 30 or higher. And the real key is reapplication after two to three hours, as all sunscreens break down after that amount of time. In addition, there is sun protective clothing that is made by several companies. These clothes have a UPF (the clothing equivalent of SPF) made into the clothing, so you are more protected. Hats are helpful to protect direct exposure to your face and are also made by these companies. Also, being in the shade as much as possible during those times is important.

In addition, given that you have a family history of skin cancers it would be beneficial to have yearly skin checks—either by your primary care physician or a local dermatologist. Checking your skin at home, every one to two months, to get a baseline of what is normal for you is important. If you notice changes, then you should see a dermatologist for evaluation.

StayWell123: Many people are deficient in vitamin D. I have heard that it is a good idea to expose oneself to the sun without sunscreen for brief time periods, 10 to 15 minutes a day, to promote the body's vitamin D production. Is this a valid approach to take?

Brian_Gastman,_MD: Vitamin D deficiency is common especially in the winter in the north. That being said, a bottle of vitamin D3 is cheap and accessible, and would avoid the risks of sun exposure.


Cumulative Damage from the Sun

eileena: I do not like to sit in the sun and I wear sunscreen year round. I also live near Cleveland and we have a lot of cloudy weather. But even though I am covered by clothing, my upper chest seems to be susceptible to melanoma. How does that happen if the area of skin is never exposed to the sun?

Missale_Mesfin,_MD: I am happy to hear that you are already using great sun protection practices. Yes, we certainly get a lot of cloudy weather here in Cleveland, but ultraviolet (UV) radiation is still active despite the clouds. Even though you are protecting your skin now, it is likely that in your younger years you were exposed to the sun more often. A major part of our sun damage occurs in our younger years, during the first 20 years of life, before we may have started protecting our skin. The changes present themselves later with the DNA damage that has occurred over the years. Common areas to see these changes are the face, neck, upper chest and shoulders. However, we do get cumulative sun damage from over the years so it is important to protect our skin continually. You cannot undo the damage that was previously done, but it sounds like you are doing a great job of preventing further sun damage.

grammol: I had three serious sunburns as a preteen where I had to seek medical help. I developed a basal cell cancer in a spot that never sees the sun. I am careful now, yet have also had squamous cell carcinoma. Is it because of those burns as a child? If I avoid the sun altogether is it a moot point because of the past?

Missale_Mesfin,_MD: Certainly it is known that even one blistering sun burn increases the risk of developing skin cancer, including melanoma. I am glad to hear that you are careful about protecting your skin nowadays. It is possible that those burns, as well as other significant sun exposure in your younger years, led to the development of the basal and squamous cell carcinomas.

However, cumulative sun exposure also leads to the development of skin cancer. So whenever we get excessive sun exposure, there is a potential for UV (ultraviolet radiation) damage to our DNA. This damage leads to mutations in our DNA that can cause more skin cancers to develop. Therefore, I would recommend continuing to protect your skin with sunscreens, protective clothing, shade, etc.

kts: Do people with darker skin have the same issues with sun exposure and skin cancer? I am of mixed race and have never really had a problem with sunburns, although I do tan.

Missale_Mesfin,_MD: People with darker skin also undergo the effects of sun damage. Although the risk of skin cancer is lower, it is not zero and skin cancer does affect people of darker skin. And actually, even tanning is the body's response to sun damage so you don't actually have to burn to have negative effects from the sun. I tell all of my patients to check their skin, despite the color of their skin. In fact, there is a subset of melanomas that occurs in skin of color, so there is no one without risk of skin cancer. Also, sun damage can lead to wrinkling, uneven skin tone and other negative effects down the road. So protecting the skin with sunscreen and other methods is important for everyone!

toot toot: I never had freckles as a child. Now, in my forties, I notice that when in the sun for too long, I am now getting these 'freckles.' What are they and how concerned should I be?

Missale_Mesfin,_MD: Freckles that occur in our 30s, 40s or later are the result of sun damage from earlier years. The sun damage eventually catches up with us and it leads to both freckles and sometimes white spots. The medical term for these freckles is lentigines. It is not uncommon for individuals to notice these developing, most commonly on the face, hands, arms and shoulders. They are not concerning lesions, as long as they resemble one another. If any start standing out and looking different than the others, then they should be checked out by a local dermatologist.


Types of Skin Cancer and Frequency

Sky: What are the different types of skin cancers and how can each be cured, particularly melanoma?

Brian_Gastman,_MD: There are dozens of types of skin cancers, but 95 percent are basal cell carcinoma, which is the most common and least deadly. The second most-common skin cancer is squamous cell, which is also not usually deadly if treated. Melanoma is the least common, but 15 percent of patients diagnosed with this skin cancer do succumb to the disease. Skin cancer often can be cured by surgery, which can consist of Mohs surgery or traditional surgery. Mohs surgery is a procedure often used on the face because it allows for tight margins and ensures the entire affected area is removed. Being seen by a surgeon who is familiar not only with skin cancer, but the area being treated is very important. Most plastic surgeons, for instance, feel comfortable operating on the face, hands, feet and most other locations.

grammol: I have had both basal and squamous cell carcinomas. How likely will I get melanoma?

Missale_Mesfin,_MD: Given that you have had basal cell and squamous cell carcinomas, you have shown that you have the sun damage and genetics to develop skin cancers. Basal cell and squamous cell carcinomas are extremely more common, over one million cases diagnosed per year, than invasive melanomas, which are estimated at 76,000 in 2012.

There is not an actual figure to estimate if you will develop a melanoma, but you are at a slightly increased risk than someone who has not had other skin cancers. It is important to check your skin at home once a month to evaluate for any new or changing lesions, as well as have regular skin checks by a dermatologist every six to 12 months.


Screening of Moles and Melanoma

clara: I have a father that died from melanoma cancer, and a brother that had it several years ago. My husband also had melanoma cancer. How often should my children, who are adults now, be checked for melanoma cancer? I go once per year.

Missale_Mesfin,_MD: I am glad to hear that you are being proactive about getting skin checks, which is very important for those who have a family history of melanoma. First-degree relatives (fathers, mothers, siblings and children) of those who have had melanoma do have an increased risk of developing it, since they share the same genetic pool. I would recommend yearly skin checks for your adult children by a dermatologist. Also, they should perform self-skin examinations themselves once every month using the ABCDE guide for moles:

    A: Asymmetrical lesions (mole doesn’t look the same on both halves).
    B: Irregular borders (hazy, fuzzy and not well-defined edges).
    C: Color—multiple colors in one lesion, with possible dark brown, black and blue tones within a mole.
    D: Diameter greater than 6 millimeters, or the ‘ugly duckling’ sign—a spot that stands out from the crowd.
    E: Evolving, any mole that is changing.

talk to me: How do you know when to have a mole checked out?

Missale_Mesfin,_MD: Our guide for checking moles is using the ‘ABCDE's’ of melanoma:

    A: Asymmetrical lesions (mole doesn’t look the same on both halves).
    B: Irregular borders (hazy, fuzzy and not well-defined edges).
    C: Color—multiple colors in one lesion, with possible dark brown, black and blue tones within a mole.
    D: Diameter greater than 6 millimeters, or the ‘ugly duckling’ sign—a spot that stands out from the crowd.
    E: Evolving, any mole that is changing.

These are just a guide for any suspicious lesions. Also, any moles that are itching or bleeding on their own should be checked. Certainly, not all moles ‘follow the rules.’ So it is always good to have a baseline skin exam to have an understanding of what is normal.

abrams29: I have been trying to get a doctor’s appointment for a suspicious mole, but I can’t get in to see my physician for four months. If it is cancerous, is that too long to wait? How fast can skin cancer spread?

Brian_Gastman,_MD: At Cleveland Clinic we have same day appointments. Dermatology, by nature and really volume of patients, is not always that fast, but you should be able to get an appointment much earlier. If you cannot you should try calling our scheduling line at 216.444.8846 and we can see you much earlier.

For patients with melanoma or aggressive skin cancers we have a unique melanoma clinic where patients can see a surgeon, medical and radiation oncologist and many more types of doctors at one appointment in one location. This unique way of seeing patients allows them to have the timeliest of care by physicians who are national experts in the disease.

So if you do have a diagnosed skin cancer—if it is melanoma, you should be seen right away in a clinic that is at least somewhat specialized to see the disease. If it is a less dangerous cancer, depending on its location on the body, you have some more time.

If you’d like more information on our Melanoma Clinic, you can visit our website at clevelandclinic.org/melanoma.

carmonm2: Are the skin cancer screening ‘apps’ on smartphones effective?

Missale_Mesfin,_MD: These apps may be a good segue to visit a dermatologist or other skin cancer specialist. It can provide screening information that would be helpful. However, the most effective way of diagnosing skin cancers is through a biopsy. This procedure allows us to see the specimen under the microscope and make an accurate diagnosis. This is ultimately the best way to diagnose skin cancer.

fast3r: Should a person be checked regularly for melanoma, or only if there is cause to be concerned? What are the current recommendations?

Brian_Gastman,_MD: If they have no history for melanoma, other skin cancers (or pre-malignant skin cancer) or a family history, then the only reason to be checked is if you see a mole that meets the ‘ABCDE’ criteria, I would add if you have a lesion or mole that is changing, enlarging or just makes you concerned, those are also good reasons to see a board-certified dermatologist for evaluation.


Melanoma Diagnosis and Skin Protection

Selrahc: I had melanoma five years ago and have been told to avoid exposure to the sun and to use sunblock and protective clothing. I also have been told that it takes many years for the effects of ‘today’s exposure to be felt. I’m 81 years old, so do I really have to worry about the long-term problems or are there other more immediate risks for a melanoma survivor?

Missale_Mesfin,_MD: I am glad to hear you received good care for your previous melanoma. Yes, it is true that using wise practices in avoiding excessive sun exposure is necessary now. Although a major part of the sun damage occurred in your earlier years, ultraviolet sun exposure still causes mutations in the DNA that can lead to DNA changes. Whenever we get these changes, it is unknown how long it takes for skin cancer to develop. While it is true some of the effects are long term, some changes can develop more quickly. As a melanoma survivor, you have already shown you have the genetic background to ‘make’ these atypical lesions, so it is important to be aggressive in protecting your skin from sun damage.

loveshack: I am in my mid 40s and was diagnosed five years ago with an in situ melanoma. I noticed the 'freckle' about one and one half years before it was removed. It showed up during a pregnancy. Is it possible that is was hormone related? My dermatologist really just removed it to appease me and was surprised herself. Is it likely that it would have never turned into anything or do all of them tend to grow inward? I use 100 sunblock all the time now and have not had another occurrence.

Brian_Gastman,_MD: This is an example of how the level of sunblock may not be as important as how often you re-apply it and/or how much sun exposure you get. Include family genetics and it becomes clear why these moles converting to cancer can be unpredictable. We now have computers that can analyze moles and freckles on your body and at least tell the dermatologist that they should consider biopsy. Unfortunately this technology is not yet widely used across all practices, so it is still recommended that you continue to receive regular checkups and discuss any concerns you may have with your dermatologist.

Anecdotally, we are studying whether hormonal therapy affects the development of melanoma in young women. We are a major referring center for women under the age of 50 with melanoma and are asking these provocative questions through our database of almost 10,000 melanoma patients.


Skin Cancer and Other Body Sites

Tazzy: How common or rare is it to get melanoma inside the body as opposed to exterior? My father had melanoma that started in his trigeminal nerve. After removal it showed up again 12 years later in his optic nerve and also cranial nerve (CN) 3, 4. Cranial nerve 2, his eye and eyelid were removed completely, but within two to three years, the melanoma spread to his brainstem then to his brain. Between all these surgeries and Gamma knife it also spread to a few superficial spots on his back, ear lobe and neck. His ENT (ear, nose and throat) physician in Youngstown told him in 1996 that it was a very rare cancer and he had only heard of two other cases. This physician knew of a surgeon in Michigan and another one in Pittsburgh that would consider surgery to treat the melanoma in his trigeminal nerve. When it showed up in his brain stem 2010 he was referred to Cleveland Clinic and they gave him 10 radiation treatments to the brain stem. Is melanoma inside the body rare or was it just rare to that particular physician?

Brian_Gastman,_MD: Although this exact situation is rare, I get this question often. By far melanoma is mainly a skin disease. We also see it in the mucosa (lining) of the mouth, sinuses, anal and vaginal areas as well as in the eye (uveal). Usually melanoma starts at the skin (or more rarely in the mucosa) then tracks to a major nerve. Without knowing more information it is possible that your father had a melanoma, say in the skin, that regressed (a known phenomenon where the original cancer is killed by the immune system, but the metastases persist), but had already spread to the major cranial nerves.

jon: Can skin cancer spread to other parts of the body?

Brian_Gastman,_MD: Unfortunately, yes. For non-melanoma skin cancers, thankfully, this is rare. For melanoma or even rarer cancers like Merkel cell carcinoma spreading to regional lymph nodes is much more common. For instance, for patients with a newly diagnosed melanoma regardless of thickness (which has a major influence) there is about a 15 percent chance that it has already spread to a regional lymph node (depending on the study). Once in the lymph nodes it can then spread to major organs, and the brain. Luckily for melanoma there are newly FDA approved drugs to treat the disease at this stage.


Medical Treatment of Melanoma

Moxie: Are there any types of treatment, besides surgery, available for skin cancer or melanoma? If so, are there side effects?

Brian_Gastman,_MD: There are many types of treatment. From topical treatments and light therapy for pre-malignant lesions to new U.S. FDA (Food and Drug Administration)-approved drugs for melanoma and basal cell carcinoma. In the case of melanoma we expect more FDA approval of drugs even this year. Considering that it has been decades without any new treatments for this disease, these are game-changing events for patients and their families diagnosed with such a tumor. Some of these drugs have significant side effects; others do not. However, for the chance of cure each patient should have an individual discussion with his or her physician before these drugs are considered.

Finally, during surgery we are pioneering new ways to diagnose whether the melanoma has spread to regional lymph nodes.

tjc45: What is the prognosis for Stage 4 BRAF melanoma, and what treatment is most likely to increase survival and for how long? My liver is apparently affected, as well as lymph nodes. Is Cleveland Clinic the best place to go for treating this, and if not, where would be?

Brian_Gastman,_MD: If you mean BRAF (gene) mutation positive, then like most institutions we are using Zelboraf® (vemurafenib). There are newer drugs we are trying in clinical trials, such as combining a BRAF inhibitor with a MEK inhibitor (which inhibits targets of signaling pathway), combining these with Yervoy® (ipilimumab) and also using anti-PD-1 therapy. If these fail we have a number of other clinical trials available.


Skin Cancer Surgery

Venus: Can you remove all of the cancer through surgery alone?

Brian_Gastman,_MD: For non-melanoma cancers with appropriate margins or Mohs surgery the cure rates with surgery are above 95 percent. For melanoma, approximately 85 percent are located in the skin only and these are usually cured by surgery. The bigger problem is when the melanoma has spread to the lymph nodes, where even with surgery and postoperative immune-boosting medications the cure rates are much lower.

Sar: What type of surgery is needed to remove skin cancer? Is it possible to get this done without leaving a scar?

Brian_Gastman,_MD: For actual cancer, surgery is usually the mainstay of treatment. For appropriate cancers—say on the face, Mohs surgery can reduce the amount of normal skin removed. Unfortunately, scarring is likely to occur in all surgical cases, with their severity depending on the nature and location of the cancer, the patient’s genetics and postoperative skin care (which your surgeon can discuss with you). The amount of scarring may also depend on the type of surgeon doing the operation, such as a plastic surgeon.

There are drugs we use for pre-malignant lesions, these are applied topically and/or can be given with special light therapy. You can learn more about Mohs surgery at www.clevelandclinic.org/mohs

jakst5: Can you tell me what the standard of care is for removal of malignant melanoma in situ? I am seeing various reports that suggest 9 mm should be the gold standard for wide excisions. I recently had one removed with 5 mm margins. At the time, they thought it was only a dysplastic nevus. Should I revisit my surgeon to have wider margins taken?

Brian_Gastman,_MD: The National Comprehensive Cancer Network® (NCCN®) guidelines recommend 5 mm. However, others recommend larger margins. What I see is that melanomas in situ (MIS) can either be a mole converting to a melanoma and a 5 mm margin is fine. However, we also see MIS as an epicenter of condemned skin. So the center may be actual melanoma or MIS, and adjacent to the 5 mm margin is MIS (which is sort of pre-melanoma). Beyond that margin there may be other skin changes like lentigo maligna (sort of pre-pre-melanoma). Sometimes this can predicted with a Wood's lamp. In your case if the margins are clear you just need good follow up. If they are positive, you can choose more aggressive surgery or alternatives like Aldara® (imiquimod).

yrc2649: Can any type of skin cancer be treated by Mohs surgery? What are the chances of the cancer recurring after the surgery?

Missale_Mesfin,_MD: There are several types of skin cancers that are treated with Mohs surgery. The most common are squamous cell and basal cell carcinomas. These are the most common skin cancers that occur and certain types, depending on a number of factors, are treated with Mohs. There are other more rare tumors that can also be treated with Mohs surgery. On occasion, some Mohs surgeons will also treat melanoma in situ with Mohs surgery, but not invasive melanomas. The cure rate with Mohs surgery is just over 99 percent. We are able to evaluate the margin at the time of surgery to ensure that it is entirely removed. Therefore, the chances of a skin cancer recurring after Mohs surgery is less than one percent.


Skin Cancer Research

tjc45: What clinical trials for Stage 4 are open to new patients right now at Cleveland Clinic, and what treatments are these?

Brian_Gastman,_MD: We have a number of clinical trials currently. They depend on how disseminated the disease is. From immune-based approaches to inhibitors of the cancer biochemical machinery, there is little we do not have access to.

To see a list of available clinical trials at Cleveland Clinic, visit www.clevelandclinic.org/clinicaltrials or the U.S. National Institutes of Health at www.clinicaltrials.gov.


Closing

Moderator: I'm sorry to say that our time with Cleveland Clinic experts Dr Brian Gastman and Dr. Missale Mesfin is now over. Thank you, for taking your time to answer our questions today about skin cancer.

Brian_Gastman,_MD: Thank you all for submitting your questions. With melanoma on the rise, especially in young women we have developed a multidisciplinary approach to this disease. Knowing that there are concerned individuals helps us get our message across and fights part of the battle for this challenging disease.

Missale_Mesfin,_MD: Thank you so much for your questions today. I hope that you were able to learn more about sun protection and skin cancer. Enjoy your summer and remember the tricks to being sun smart!


For Appointments

To make an appointment with Dr. Gastman or Dr. Mesfin, please call 216.444.5725 or call toll-free at 800.223.2273, ext. 45725. You can also visit us online at www.clevelandclinic.org/DPSI.


For More Information

On Cleveland Clinic

Cleveland Clinic is a national leader in caring for patients with all types of dermatologic conditions, from the routine to the complex. Our patients benefit from access to a multidisciplinary staff where close collaboration and teamwork between dermatologists, dermatology surgeons, and plastic and reconstructive surgeons allows us to offer comprehensive, coordinated and patient-focused care. Patients can also benefit from the most advanced technology and centers for diagnosing and treating dermatologic conditions, such as Mohs surgery, photodynamic laser therapy and our Melanoma Clinic.

At Cleveland Clinic's Melanoma Clinic, patients have access to plastic surgeons who specialize in removing melanomas and reconstructing areas on the entire body, including the head, neck and hand. Assisted by oncologists, radiation oncologists, specialty nurses and social workers, patients receive the benefits of a multidisciplinary approach in a timely manner.

Our team is highly involved in all areas of research for melanoma. This means state-of-the-art treatments, bringing hope to those who previously had no treatment options for their cancers. The outcomes of melanoma patients at Cleveland Clinic continue to be on par or better than published national data, with the Melanoma Clinic setting the standard of melanoma care. We also offer patients reconstructive surgery options for those with large or complex melanoma removals.

The Department of Dermatology includes 35 dermatologists who offer a full array of subspecialized care for adult and pediatric patients. Our physicians provide expert diagnosis and treatment of all disorders of the skin, hair and nails, whether primary or related to an underlying systemic illness, including industrial-related conditions. The department offers Mohs micrographic surgery, which provides the highest cure rate for high-risk melanoma skin cancers, while sparing the maximum amount of normal skin.

The Department of Plastic Surgery includes 17 plastic surgeons, making it one of the largest plastic surgery departments in the country. Our board-certified specialists have significant experience and expertise in all areas of aesthetic and reconstructive plastic surgery.

The Dermatology & Plastic Surgery Institute works in collaboration with ear, nose and throat specialists, ophthalmologists and dentists to provide the highest level of care and ensure that patients’ varying aesthetic needs and functional requirements are met.

Members of the Institute are located in 14 Cleveland Clinic facilities throughout Northeast Ohio: Avon (Richard E. Jacobs Health Center), Cleveland, Beachwood, Chagrin Falls, Elyria, Independence, Lorain, Solon, Strongsville, Twinsburg, Westlake, Willoughby Hills, Wooster, and Lutheran Hospital.

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Reviewed: 05/13