HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

Welcome to the Pigmented Lesion Clinic at the University of Pennsylvania. We hope this information will be helpful, please read it through and call with any questions. Enclosed is your packet of information including material for you to read and some for you to fill out prior to your appointment with the physicians at the Pigmented Lesion Group (PLG). Inside you will find the following: A letter from Peter Kanetsky, Ph.D. introducing the melanoma research projects being conducted by scientists at the University of Pennsylvania and the potential for your voluntary participation. Common questions and answers about melanoma. Various pamphlets including one about the Pigmented Lesion Group. New Patient Instruction Packet o Inside is a list of information that you need to provide the Pigmented Lesion Group prior to your initial appointment, including all melanoma biopsy reports, operative notes, and possibly, glass slides. any medical reports such as chest x-ray, pathology reports and blood work. Also in the packet is the fee schedule for clinical photography (may be recommended at the time of your visit). o Please note that most insurances do not cover clinical photography and payment is due at the time of service. The last piece of melanoma information includes A detailed explanation of the research study for primary melanoma called, Clinically Useful Prognostic Models in Primary Melanoma. If you choose to participate there is an authorization form for you to sign after reading. Additional questions can be discussed with the physician at the time of your appointment. Please note, choosing not to participate will in no way compromise your ability to receive care from the PLG physicians. A five-page questionnaire asking for information about your medical history, including the names of your physicians, their addresses and telephone numbers. Please bring the completed questionnaire with you on the day of your appointment. Also included, o Driving directions. o A color map of the hospital. (#14 on your map). The Pigmented Lesion Group is a multi-disciplinary group of talented physicians who bring their expertise together every working Monday of the year. PLG is located on the 2nd floor of the Rhoads Pavilion, around the corner from the coffee stand. Thank you for taking the time to read the information. It is important that we receive the requested information well in advance of your PLG appointment. Please note there is a $25.00 NoShow Fee for cancellation notice of less than 24-business hours. If you have any questions, please do not hesitate to call us.
3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

Dear New Patient to the Pigmented Lesion Group; Scientists at the University of Pennsylvania are studying why some people develop melanoma skin cancer while others do not. These studies will help researchers understand how genes and other factors may lead to the development of melanoma and other pigmented lesions. We hope that the results of our studies will help to prevent melanoma in the future. During your initial visit to the Pigmented Lesion Group, you may be asked for voluntary participation in one or more of these ongoing studies. Please be assured that your participation, or lack thereof, will in no way jeopardize your time with or ability to see a physician during your clinic visit. The Pigmented Lesion group has research faculty and staff who will be present during your clinic visit. We will be able to talk with you about potential study participation and will gladly answer any research-related questions you might have. These studies, in general, should not take more than an additional 20-30 minutes of your time, and can be completed during your visit to the Pigmented Lesion Clinic. Although specific requirements for participation in each study vary, some of the types of things that you may be asked to do include filling out additional questionnaires, giving a cheek swab sample, completing a skin examination with the research nurse, or giving a blood sample. Your individual participation is extremely important to this research on melanoma and pigmented lesions. Please take the time to speak with our knowledgeable researchers so that you can make an informed decision to participate or not, in a research study. The future of melanoma research can begin with you! Sincerely,

Peter A. Kanetsky, Ph.D. Assistant Professor, Department of Biostatistics and Epidemiology Faculty Investigator, Pigmented Lesion Group

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

COMMON QUESTIONS & ANSWERS ABOUT MELANOMA

Malignant melanoma is a potentially serious skin cancer in which the pigment-producing cells in your skin that produce a dark-colored substance call melanin undergo uncontrolled growth. Melanoma may suddenly appear without warning, but can often develop from or near a mole. However, it can occur anywhere on your skin.

o WHAT IS MALIGNANT MELANOMA?

Yes, but if melanoma is caught early, it can nearly always be treated successfully. In the late stages melanoma spreads to other organs and can be fatal.

o IS MELANOMA A SERIOUS DISEASE?

Although melanoma is less common than other skin cancers, it is increasing at a faster rate than any other form of cancer, except lung cancer in women. There are an estimated 53,000 new cases expected to be diagnosed this year in the United States. During the past 15-years, the number of cases in the U.S. has almost doubled.

o HOW COMMON IS MELANOMA?

Excessive exposure to ultraviolet radiation from the sun may be the primary cause of melanoma. Malignant melanoma has been linked to both overexposure to the sun over a lifetime and to painful sunburns during childhood. Genetic factors may also play an important role in melanoma development.

o WHAT CAUSES MELANOMA?

Malignant melanoma can strike anyone. However, whites are at far greater risk than individuals with darker skin. Melanoma occurs in both the young and middle-aged and affects men and women equally. Certain individuals are at greater risk. Some factors include: Prior diagnoses of malignant melanoma. Having unusual (dysplastic) moles or many moles. Family members who have had melanoma (parent, child, sibling). Fair skin. Red or blood hair. Lots of freckles. Excessive exposure to the sun in the first 10 to 15 years of life or a lifetime of intense sun exposure. Certain kinds of birth moles.

o WHO GETS MELANOMA?

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

A nevus is a mole. Almost all moles are normal. Atypical, or dysplastic nevi, are unusual moles that are generally larger than normal moles (bigger than the width of a pencil eraser) and are either flat or have a flat part. They have irregular borders and often have varying shades of color, particularly shades of brown. Most often, dysplastic nevi appear on the back, but may also occur on the scalp, breasts and buttocks. The presence of atypical nevi may mark a greater risk of malignant melanoma developing on apparently normal skin.

o WHAT ARE DYSPLASTIC NEVI?

o SHOULD

ATYPICAL CANCEROUS?

(DYSPLASTIC)

NEVI BE REMOVED BEFORE THEY BECOME

Specialists recommend careful and regular monitoring of these moles and surgical removal of some suspicious or changing lesions, depending on the clinical situation.

Melanoma generally begins as a medium brown to black, flat discoloration with irregular borders. The discoloration is often at least -inch in size and may turn shades of red, blue, and white, and may also crust on the surface and bleed. All, or a portion, of the melanoma may be raised. Often melanoma occurs within previously existing moles. They frequently appear on the upper back, torso, lower legs, and head and neck. A changing mole may be an important risk factor and a mole that is different or ugly or begins to grow requires prompt medical attention.

o HOW CAN I RECOGNIZE MALIGNANT MELANOMA?

Yes. When detected early, surgical removal or melanomas can cure the disease in most cases. Early detection is essential: there is a direct relationship between the thickness of the melanoma and survival rates. Regular self-examination of your skin to detect changes in your skin and in existing moles or blemishes is urged. Additionally, a head-to-toe skin examination by your physician is recommended once a year in many patients.

o CAN MELANOMA BE CURED?

Yes. Because overexposure to ultraviolet light is thought to be a primary cause of malignant melanoma, dermatologist recommend the following precautions: Avoid the peak sunlight hours between 10 am and 2 pm when the suns rays are the strongest. Avoid tanning parlors and sunlamps. Apply liberally and regularly a sunscreen with a Sun Protection Factor (SPF) of at least 15. Reapply every two hours when working, playing or exercising outdoors, and apply initially about half an hour before going outdoors.

o CAN MELANOMA BE PREVENTED?

Wear protective clothing, including a hat and long-sleeved shirt and pants during
3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

prolonged periods of sun exposure. Examine your skin regularly once a month is recommended. Learn the danger of skin cancer and at any sign of change see a qualified melanoma specialist immediately. If you are at risk for melanoma, get professional check-ups on a regular basis. Teach your children about the risks of sun exposure. Protect them by keeping them out of the sun or minimizing sun exposure, and apply sunscreen regularly when they are outside.

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

NEW PATIENT INSTRUCTIONS

1. OUTSIDE MEDICAL DOCUMENTS
In order for us to complete our evaluation of your medical condition for your upcoming appointment, it is critical that we receive all the necessary medical reports, documents, and pathology slides well in advance of your PLG appointment. Please note: If you are unable to obtain your pathology slides and reports in time, your appointment will be canceled. The care we provide is a collaborative effort coordinated among multiple physicians including the dermatopathologist who will provide us with a consultative reading of your biopsy slides. This reading must take place before the day of your appointment and is why it is important that we receive your information, especially any needed pathology slides, well before your appointment day.

Below are instructions to help you in obtaining your medical documents, followed by a checklist for obtaining your pathology slides, reports and other diagnostic information, and an authorization for the release of the necessary medical information to us.
2. Instructions for obtaining your medical documents

For reports from your referring physician(s), such as office notes, operative reports, discharge summaries, pathology reports, and letters: contact your physicians office to either pick up the copies in person or ask that the material be faxed to us at: 215-662-4277.

For pathology reports and slides of any biopsies of moles, melanoma, or other pigmented lesions: call the office where your biopsy was performed to find out which hospital or laboratory processed the biopsy specimen into a glass slide. call the hospital or laboratory that processed your biopsy and request that both the glass slide(s) and a copy of the pathology report be forwarded to us at the following address via Federal Express: HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA THE PIGMENTED LESION GROUP Michael Ming, M.D., Director 2nd floor Maloney Building 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

3. Clinical Follow-up
Most of our patients have collaborative care that is shared between their local/referring physicians and us. This means that you would see your local physician for some of your follow-up care alternating with visits at the Pigmented Lesion Group with our physicians. Many of our patients have at least some of their local follow-up care with a dermatologist, while others have their follow-up care with their local primary care provider, their surgeon, or another physician. On your follow-up visits with your local physician, he or she would need to perform a full skin inspection as well as a lymph node examination if you have had a diagnosis positive for melanoma. If you wish to have follow-up with a local dermatologist, but do not currently have a dermatologist or do not feel comfortable with your current dermatologist, contact your primary care provider for the name of a dermatologist in your area. We can also provide you with a list of dermatologists at the time of your visit, but for insurance reasons and/or for geographic convenience, many patients find it easier to find a local dermatologist through their primary care provider. After your visit at the Pigmented Lesion Group, we will send reports of our impressions to your referring physicians, your primary care provider, and your local dermatologist. Therefore it is important that when filling out the questionnaire you complete in its entirety, the names, addresses and phone numbers of your physicians. If you do not give us complete addresses, we cannot send your physician reports. Thank you for allowing us to participate in your care.

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

Below is a checklist of materials needed prior to your Pigmented Lesion Group appointment. For each diagnosis of melanoma, you will need to obtain the following information. If you are unable to obtain your pathology reports and slides in time, your PLG appointment will need to be rescheduled. 1. Melanoma biopsy (The first biopsy that resulted in a diagnosis of Melanoma) a. _________ b. _________ Notes: Pathology report (reading of the slide). Glass specimen slide(s).

2.

Re-excision of the melanoma biopsy site. (If you had a second excision after the first biopsy.) a. _________ b. _________ c. _________ Operative note or report of the procedure. Pathology report (reading of the slide). Glass specimen slide(s).

Notes:

Questions 3 and 4 apply if you have had a lymph node biopsy. 3. Lymph Node biopsy that was POSITIVE for melanoma. (Metastatic melanoma found in the lymph nodes.) a. _________ b. _________ c. _________ Notes: Operative note or report of the lymph node biopsy procedure. Pathology report from the lymph node biopsy. Glass specimen slide(s).

4.

Lymph Node biopsy that was NEGATIVE for melanoma. (The removed lymph nodes showed no melanoma.) a. _________ b. _________ Pathology report only from the lymph node biopsy. Operative note or report of the lymph node biopsy procedure.

Notes:

5. Notes:

Any other skin biopsies that you have ever had in your entire life. a. _________ Pathology report (reading of the slide).

6.

Referring Physician Information. a. _________ HMO referral from Primary Care Physician (PCP). b. _________ Office notes. c. _________ Chest x-ray report. d. _________ Other radiology reports, including MRIs, CAT Scans, e. _________ Blood work results. f. _________ Miscellaneous

Notes:

3600 Spruce Street . Philadelphia, PA 19104-6380 . Phone: 215-662-6926 . Fax: 215-662-4277

AUTHORIZATION TO RELEASE MEDICAL INFORMATION

Name: Please Print ______________________________________ Date of Birth: ___________________

I _______________________________, hereby request that copies of the following: (Patients Name) Operative Records Microscopic Records Discharge Records Pathology Reports

relating to my MELANOMA OR PIGMENTED LESIONS be sent to The Pigmented Lesion Group at the Hospital of the University of Pennsylvania (address below).

Hospital or Doctor who performed my biopsy/surgery: ________________________________________________________________________ ________________________________________________________________________ Approximate date(s) of biopsy/surgery: _______________________________________ Address at time of surgery: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Signed: __________________________________ Date of Birth: _____________________________ Witness: _________________________________ Please send information to:

Date: ___________________

Date: ____________________

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY THE PIGMENTED LESION GROUP Michael Ming, M.D., Director 2nd floor Maloney Building
3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DEPARTMENT OF DERMATOLOGY

THE PIGMENTED LESION GROUP

MICHAEL MING, MD, DIRECTOR 3600 SPRUCE STREET PHILADELPHIA, PA 19104-6380 PHONE: 215-662-6926 FAX: 215-662-4277

CLINICAL PHOTOGRAPHY
Total body photography is an established practice for documenting dysplastic nevi in an effort to detect malignant melanoma at its earliest stage. It is an appropriate practice for patients who have a large number of moles or atypical moles. Since most insurance companies do not cover clinical photographs, the patient is responsible for the payment. Payment for the photographs is due at the time of service. Payment can be made by cash, check or credit card (see Fee Schedule below). Processing of the photos, including security protocols, may take four to six months for you to receive a duplicate copy of the photos (except scar photos). Please use these photos as a reference to look for any changes in the lesions/moles on your skin. If you do have an insurance plan that will cover the cost of clinical photography, you should submit the invoice showing your payment with the appropriate diagnosis code.

FEE SCHEDULE
STANDARD OVERVIEW $175.00*
A complete overview consists of 32 photos that record the entire skin surface, and may also include close-up photos of selected lesions as determined by the physician.

CLOSE-UPS

$35.00*/$5.00*

Close-up photographs consist of taking one or more photos of a particular lesion on the skin surface. There is a charge only if complete overviews are not done at the same time. If the physician requests close-ups, then the fee is $5.00 for each additional site up to a maximum cost of $65.00.

PARTIAL OVERVIEWS PARTIAL OVERVIEWS SCARS GLASS SLIDE OVERVIEW

$100.00* $100.00* $10.00* $175.00*

TO $273.00* PER UNIT.

Consists of 24 photographic views of the upper body. Consists of 12 photographic views of the lower body. Consists of one or more photos of a particular site.

If the pathology report on your biopsy slides was performed by a lab outside the University of Pennsylvania Health System, we ask that you request that your original glass slides be sent to Pigmented Lesion Group for consultative review by our pathologist. The charge for this service can range from $175.00 per unit to $273.00 per unit, depending upon the review. If you have managed care insurance coverage, you will need to request a separate referral for the slide review, made out to the Department of Pathology at the University of Pennsylvania. The procedure codes for a consultative reading of the slides are: 88321, 88323, 88325. * Prices subject to change.