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Visit the MaineHealth Cancer Resource Center

The Maine Medical Center Cancer Institute

Skin Cancer Program

Skin cancer is the most common type of cancer in the United States, and the incidence is increasing approximately 2% per year. Among the different types of skin cancers is melanoma, which is responsible for 75% of all skin cancer deaths. In Maine, there are an estimated 440 new cases of melanoma projected for 2014 with higher incidence rates found along the coast.

Each year, more than 68,000 Americans are diagnosed with melanoma, and another 48,000 are diagnosed with an early form of the disease that involves only the top layer of skin. Also, more than 2 million people are treated for basal cell or squamous cell skin cancer each year. Basal cell skin cancer is several times more common than squamous cell skin cancer.

The most common types of skin cancer are:

Learning about medical care for skin cancer can help you take an active part in making choices about your care. This booklet from the National Cancer Institute tells about:

  • Diagnosis and staging
  • Treatment
  • Follow-up care
  • How to prevent another skin cancer from forming
  • How to do a skin self-exam

Also see the MaineHealth Cancer Resource Center.

Sroll through the content below or click on a topic to go directly to that content.

Our Approach

Maine Medical Center has the state’s only multi-disciplinary team of experts who meet monthly to review patients’ cases. This team includes skin cancer specialists in surgical oncology, medical oncology, dermatology, pathology, plastic surgery and radiation oncology. Together they conduct a complete review of clinical presentation, history, pathology, imaging, and treatment to date. The team then recommends the treatment and management of the patient’s skin cancer using their experience, the latest information from their colleagues around the country, and the evidence-based guidelines of the National Comprehensive Cancer Network.

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Diagnosis and Staging

Expert treatment begins with thorough evaluation to establish the most accurate diagnosis and stage, or extent, of disease.  The Maine Medical Center Skin Cancer Program utilizes the latest techniques in radiology and pathology needed for this process, including CT, MRI and PET scans, ultrasound evaluation of  lymph nodes, sentinel lymph node sampling, and molecular testing of biopsy specimens.  Expert determination of your diagnosis and stage enables your team to develop a treatment plan that is custom fit to your unique clinical situation.  We also offer genetic risk assessment through our Cancer Risk and Prevention Clinic for patients with a family history of cancer that suggests a possible genetic or inherited predisposition to cancer.

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Comprehensive Treatment Options:

There are several kinds of treatments for skin cancer, including the following:

TOPICAL - Topical treatments can be used to prevent or treat some forms of skin cancer.  Topical treatments are treatments that are applied to the skin and include:

Cryoablation - This treatment uses an instrument to spray liquid nitrogen onto the skin.  The liquid nitrogen freezes and destroys the tissue in a small area without the need for surgery.

Topical 5-FU - This treatment uses a cream that is applied to the skin.  The cream contains a chemical that can kill some cancer cells and some precancerous cells without the need for surgery.

Imiquimod - This treatment uses a cream that is applied to the skin.  This cream contains a chemical that causes inflammation in the area of skin treated.  This can sometimes be used to treat skin cancer to allow the cancer to be controlled while limiting the need for surgery.  

SURGERY - Surgery is a common treatment for skin cancer. It is used in most cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure. Surgery may include the following procedures:

Curettage and Electrodessication - This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), followed by cauterizing the wound with an electrosurgical unit.

Excision - A scalpel (a sharp surgical instrument) is used to excise and remove the growth. The wound is usually stitched or held closed with other techniques. For basal cell and squamous cell, the tissue may be removed and immediately frozen for evaluation by a pathologist.

Mohs' Microscopically Controlled Surgery - This type of surgery involves excising a lesion, layer by layer. Each piece of excised tissue is examined under a microscope. Tissue is progressively excised until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors.

Excision with frozen section and immediate reconstruction - The skin cancer can be removed by a plastic surgeon with immediate evaluation by a pathologist. This is another common treatment option for basal cell and squamous cell carcinomas. This can be followed by immediate reconstruction and closure at the same visit.

Laser Therapy - Laser surgery uses a narrow beam of light to remove cancer cells, and is often used with tumors located on the outer layer of skin.

RADIATION - Radiation therapy is another treatment option for skin cancers.  Radiation treatments can be used to cure most early non-melanoma skin cancers, to improve the chance of cure for melanoma, and to control symptoms for those that cannot be cured.

Orthovoltage Therapy - This superficial form of radiation therapy is curative in the vast majority of patients with early squamous and basal cell carcinomas.  Treatment is often completed in 10 or fewer daily visits. 

Electron Beam Radiation Therapy - This common type of radiation therapy uses a high energy electron beam that can penetrate deeper than the orthovoltage beam and is often used for more extensive superficial lesions.

Photon Beam Radiation Therapy - Deeper and more complex targets, including lymph node draining stations from melanoma are often treated with photons, via a 3D conformal approach.  Intensity Modulated Radiation Therapy (IMRT) is also available for the most complex cases.  In these situations, the healthy tissues surrounding the tumor target can be spared while maximizing dose to the tumor. 

Stereotactic Radiosurgery (SRS) - For patients with a limited number of tumors involving the brain, SRS can be used to accurately treat these lesions in a single fraction while limiting dose to the surrounding normal brain. 

SYSTEMIC TREATMENT - Systemic treatments are medications that are administered by various means to go all throughout the patient’s body to treat cancer that is too advanced to be cured by other means alone.  There are many types of systemic treatment and they are administered by various means, such as in pill form, or by injection under the skin (like a flu shot), or by intravenous injection (in a liquid injected through a tube inserted into a vein).  In rare instances, these treatments are injected into a selected artery to deliver the medication to just one region of the body.  Systemic treatments are used to cure some forms of skin cancer, even in advanced stages.  Systemic treatments are used to palliate, or control, other forms of skin cancer that cannot be cured.  Systemic treatments include:

Chemotherapy - Chemotherapy treatments use chemicals that are toxic to cancer cells but also to normal cells.  Chemotherapy can be given in pill form, or by injection.  There are many different chemotherapy programs and each program has its own particular side effects, risks, and potential benefits.

Immunotherapy - Immunotherapy uses a variety of medicines that help the body’s own immune system to kill or control cancer cells.  Immunotherapy treatments can sometimes eliminate even very advanced, or metastatic, forms of skin cancer.  Immunotherapy treatments are given by injection under the skin or by intravenous injection.  As with chemotherapy, there are many different immunotherapy programs and each has its own side effects, risks, and potential benefits.

Targeted Therapy - Targeted therapies are medications that have been designed to target cancers cells with particular mutations that are present in some but not all cancers.  Molecular testing of a sample of tumor cells is often used to determine whether or not targeted therapy can be helpful.  Targeted therapies are often given in pill form and tend to have less side effects and risks than other systemic therapies.

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Research

Research is an ongoing process that seeks to improve the effectiveness and to reduce the side effects of cancer treatment.  Research sometimes requires the participation of patients with cancer.  Research studies that require patient participation are called clinical trials.  In general, clinical trials are research studies that evaluate the safety and effectiveness of new therapies or diagnostic tools.

The Maine Medical Center Skin Cancer Program offers cancer patients access to a variety of clinical trials.  When available, clinical trials offer patients access to new and promising treatments that cannot be given outside of a clinical trial.  Clinical trials usually offer the most sophisticated and up-to-date treatment approach available for a particular clinical problem.  A wide variety of clinical trials specific to skin cancer are available through Medical Oncology at New England Cancer Specialists, the largest and most comprehensive medical oncology and hematology practice in Maine.  We also collaborate closely with cancer research programs in Boston and elsewhere around the country to expand access to clinical trials for our patients and to ensure that patients in our community can access the latest treatment options available anywhere in the United States.

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Outreach

Members of the Maine Medical Center Skin Cancer Program participate in a variety of activities to promote prevention and early detection of skin cancer, including free skin cancer screening clinics during May of each year, public service announcements, and participation in state and national initiatives such as No Sun for Babies program, etc.

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Our Team

The Maine Medical Center Skin Cancer Program has a team of cancer experts that includes hospital- and community-based physicians. While some of MMC's cancer doctors are employees of the medical center, others are in private practice.

Every member of this team is committed to participating in programs and initiatives that enhance the quality of cancer care at MMC Cancer Institute.  In fact, with the full range of sub-specialty expertise, our team provides patients with state-of-the-art care right here in Maine that meets or exceeds national guidelines and the rigorous standards of an accredited teaching hospital cancer program from the Commission on Cancer of the American College of Surgeons. Patients can feel comforted that they can remain close to home for their care.

Members of our sub-specialty team include the following:

Justin Baker, M.D. Justin Baker, M.D., Surgical Oncologist
Maine Medical Partners – Surgical Care
Chairperson, Melanoma and Connective Tissue Work Group
Dr. Baker is an accomplished, Board certified surgeon who leads MMC’s multidisciplinary Melanoma and Connective Tissue Work Group and oversees all patient conference review activities. He is a graduate of the University of South Dakota School of Medicine and completed his residency at Maine Medical Center, where he also served as chief resident. Dr. Baker completed a fellowship in surgical oncology at the University of North Carolina Lineberger Comprehensive Cancer Center.
   
Dougald MacGillivray Dougald MacGillivray, M.D., FACS, Surgical Oncologist
Maine Medical Partners – Surgical Care
Dr. MacGillivray is an accomplished, Board certified surgeon who has been practicing medicine for more than 25 years. He is a graduate of Tufts University School of Medicine and completed his residency at The New York Hospital-Cornell Medical Center, where he served as chief resident, and at Memorial Sloan-Kettering Cancer Center, as a rotating resident. Dr. MacGillivray is Board certified in surgery and is a fellow of the American College of Surgeons.
   
Lisa Rutstein Lisa A. Rutstein, M.D., FACS, Surgical Oncologist
Maine Medical Partners – Surgical Care
Dr. Rutstein is an accomplished, Board certified surgeon who has been practicing medicine for more than 10 years. She is a graduate of the University of Massachusetts Medical School and completed her residency at Maine Medical Center, where she served as chief resident. Dr. Rutstein served a fellowship in surgical oncology at the University of Pittsburgh Medical Center. She is Board certified in surgery and is a fellow of the American College of Surgeons. Dr. Rutstein is director of surgical oncology at Maine Medical Center.
   
Frederick Aronson Frederick R. Aronson, M.D., MPH, FACP, Medical Oncologist
New England Cancer Specialists
Dr. Aronson graduated with honors from Johns Hopkins University and received his M.D. and M.P.H. degrees from Yale. He trained in Internal Medicine at Rhode Island Hospital and in Hematology/Oncology at Tufts-New England Medical Center. He is Board Certified in Internal Medicine, Medical Oncology, and Hematology and he is a Fellow of the American College of Physicians.  He has served on the faculties of Tufts Medical School, The University of California, San Francisco School of Medicine, and the Medical College of Vermont.  He is currently a partner at the New England Cancer Specialists, Director of the Division of Medical Oncology at Maine Medical Center, and Clinical Professor of Medicine at Tufts Medical School.  He has been actively involved in cancer research and patient care for 30 years and he has special interests in immunotherapy, clinical trials, and genitourinary and cutaneous oncology.
   
Sirish Maddali Sirish Maddali, M.D. FACS, Plastic Surgeon
Plastic & Hand Surgical Associates
Dr. Maddali graduated magna cum laude from Brown University and received his M.D. degree from Cornell University Medical College. He completed his General Surgery Residency at The New York Presbyterian Hospital – Cornell and his fellowship in Plastic, Reconstructive, and Hand Surgery at the University of California, San Francisco, with training in Microvascular Surgery. Dr. Maddali is a fellow of the American College of Surgeons and is Board Certified by both the American Board of Plastic Surgery and the American Board of Surgery. He is on the teaching faculty of the Lahey Clinic and serves as Assistant Clinical Professor at Maine Medical Center for Tufts University School of Medicine.
   
Katy R. Linskey, M.D., Dermatopathologist
Spectrum Medical Group
Dr. Linskey completed her undergraduate studies at the University of California, Los Angeles, and received her medical degree from the University of Hawaii. She went on to complete residency in Anatomic Pathology at Massachusetts General Hospital, Dermatopathology fellowship through the Harvard Dermatopathology Training Program, and a Head & neck pathology fellowship at MGH/Massachusetts Eye & Ear Infirmary. She is board certified in Anatomic Pathology and Dermatopathology
   
Carmen Rinaldi Carmen J. Rinaldi, M.D., Dermatology and Dermatopathology
Dermatology Associates
Dr. Rinaldi received his undergraduate and medical degrees from Tufts University and fulfilled his internship at Roger Williams Medical Center in Providence, RI. He completed his dermatology residency and dermatopathology fellowship at the Mayo Clinic in Rochester, MN. Dr. Rinaldi is double board certified in dermatology and dermatopathology through the American Board of Dermatology and the American Board of Pathology.
   
Robert J. MacNeal, M.D., Dermatologist/Mohs Surgeon
Dermatology Associates
Dr. MacNeal attended Ursinus College, then went onto Temple University School of Medicine in Philadelphia, PA where he graduated with honors. He first completed a residency in internal medicine and then worked as a hospitalist at the Dartmouth Hitchcock Medical Center. Following that he completed residency in Dermatology at Dartmouth. He received his specialty training in Mohs surgery at the University of Iowa. He is certified by the Mohs College of Surgery and is board certified in both Dermatology and Internal Medicine. He also has published articles in peer-reviewed journals and professional as well as lay texts such as the Merck manual. Dr. MacNeal regularly lectures throughout the US and overseas on the topic of Mohs surgery and dermatologic surgery.
   
Allen T. Bruce, M.D., Ph.D., Dermatologist
Dermatology Associates
Dr. Bruce graduated from Johns Hopkins University and earned M.D. and Ph.D. degrees from Washington University in St. Louis. Dr. Bruce completed internship in internal medicine and residency in dermatology at the University of Michigan. He is board-certified in dermatology through the American Board of Dermatology. He served on the faculty as a clinical dermatologist and physician-scientist at the University of Michigan, where his research investigated the roles of immune cells and cytokines in psoriasis, lupus and other inflammatory skin conditions.  His prior research involved study of immune responses to cancer and cancer vaccines.
 
The following Radiation Oncology physicians, all board certified specialists, of Spectrum Medical Group support the MMC team:
Cornelius McGinn Cornelius J. McGinn, M.D.
Chief, Department of Radiation Oncology
Maine Medical Center
Medical School
University of Vermont College of Medicine, 1989
Residency
University of Wisconsin Hospitals & Clinics Board Certifications
American Board of Radiology, Radiation Oncology Recertification
   
Ian Bristol Ian J Bristol, M.D.
Principal Investigator for Oncology Research
Medical School
University of Rochester School of Medicine and Dentistry, 2002
Residency
The University of Texas M.D. Anderson Cancer Center
Board Certifications
American Board of Radiology, Radiation Oncology
   
Celine Godin Celine M Godin, M.D., MPH
Managing Director, Radiation Oncology Division, Spectrum
Spectrum Board of Directors
Medical Director, Radiation Therapy Technology Program
Southern Maine Community College
Medical School
Tufts University School of Medicine, 1994
Residency
New England Medical Center
Board Certifications
American Board of Radiology, Radiation Oncology
   
Marco Naguib Marco Naguib, M.D.
Medical School
University of Texas Health Science Center San Antonio, 2001
Residency
NY Methodist Hospital
Board Certifications
American Board of Radiology, Radiation Oncology
   
Rodger Pryzant Rodger Pryzant, M.D.
Medical School
Baylor College of Medicine, 1987
Residency
The University of Texas M.D. Anderson Cancer Center
Board Certifications
American Board of Radiology, Radiation Oncology
   
Philip Villiotte Philip J. Villiotte, M.D.
Medical Director, Cancer Care Center of York County
Medical School
Dartmouth Medical School, 1995
Residency
Duke University Medical Center
Board Certifications
American Board of Radiology, Radiation Oncology

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Contact Us

MMC Cancer Institute Resource & Referral Line: 1 (844) 504-9680 

 

 
 

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22 Bramhall Street | Portland, Maine 04102-3175 | 1-(877)-831-2129