Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
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Skin cancer is the most common cancer diagnosed in the United States and occurs on the largest organ of the body, the skin. Fortunately, most skin cancers are easily and completely cured with surgical removal. The exception to this rule is melanoma. According to recent statistics from the National Cancer Institute, there are over 70,000 new melanoma cases each year.
Finding melanoma in its early stage is the key to successful treatment. When melanoma is limited to the skin and removed, the 5-year survival rate is 95 to 99 percent. If the melanoma is found too late and has spread to internal organs, the survival rate drops to 15 percent.
Melanoma arises from a type of skin cell called a melanocyte. Melanocytes produce a substance called melanin, which is the source for the skin’s color. Melanin production naturally increases in response to sunlight, which causes your skin to become tanned.
In addition to being the largest organ of the body, the skin performs a variety of functions. The skin helps protect us from the outside elements. It also produces vitamin D and stores nutrients such as fat and water, and the skin regulates body temperature. In order to carry out these very specialized functions, your skin has many types of cells grouped into 2 main layers. The outer layer is known as the epidermis, and the inside layer is known as the dermis. Melanocytes are part of the epidermis.
Sometimes melanocytes can grow together in groups and form moles. Moles can come in a variety of sizes, shapes, and colors. Most moles are normal and natural. However, significant changes in the size, shape, or color of a mole can be a warning sign of melanoma.
A malignant tumor (cancerous growth) may damage the normal tissue where it is growing and can even enter the bloodstream and spread elsewhere. If it does spread, the cancer is said to have metastasized.
Risk factors for melanoma include:
The most significant risk factors for melanoma are childhood sunburn and family history of melanoma. Use of tanning booths may be considered harmful because the ultraviolet (UV) light can damage skin cells.
While not all melanoma can be prevented, there are steps you can take to reduce your exposure to harmful ultraviolet (UV) rays. Some simple steps you can take to protect your skin against harmful UV exposure include:
Changes in the size, shape, or color of a mole or other skin abnormalities can signal melanoma. Here are some signs that may signal a melanoma, often referred to as "ABCDE":
You may also notice itching or bleeding from the abnormal portion of the skin. If you notice these symptoms, please contact us for a melanoma screening.
One of the most effective tools in the fight against melanoma is self-screening and early diagnosis. Self-screening and reporting any suspicious growth may promote the early diagnosis of skin cancer. When the cancer is found early, there is a better chance of a successful treatment outcome.
Whole-body skin exams look for signs of small growths on the skin or changes in moles. Most moles are benign (noncancerous), and melanoma can develop in moles on what seemed to be normal skin.
If we locate an unusual mole or lesion, we will conduct a further test known as a biopsy. During the biopsy, we will remove as much of the abnormal tissue as possible and also send it for further testing. The biopsy sample will be sent to the pathology laboratory to help better identify the type and severity of the cancer, if it is present.
Based on assessment of the biopsy, additional tests may be ordered. Then the staging of the melanoma is determined. The stages of melanoma can differ based upon the general type. The staging process is important to help determine the best treatment plan for you. The most common stages are:
Stage 0. Also known as melanoma in situ. The abnormal melanocytes are found in the epidermis (the top or outermost layer of the skin).
Stage I. The cancer has formed. Stage I can be divided into 2 stages:
The tumor has not spread to any lymph nodes.
Stage II. Stage II is divided into 3 stages:
The tumor has not spread to any lymph nodes.
Stage III. The tumor has spread into neighboring lymph nodes. The cancer may have also spread to nearby tissues or organs. The tumor may be any thickness, with or without ulceration with additional features:
Stage IV. The cancer has spread to other places in the body. It may also have spread to places in the skin far away from where the cancer first started.
While there are a variety of treatment options for melanoma, the methods depend upon the type and severity of cancer. Following a full diagnostic analysis, we will work with you to create the best treatment plan for you.
One of the most important aspects of cancer therapy is good self-care throughout the treatment period and beyond. There are several things that you can do:
Follow-up care is very important.
We may also discuss the possibility of enrolling you in a clinical trial. Clinical trials are research studies designed to improve treatment for cancer patients. Some trials investigate new cancer drugs and treatments, while others compare standard treatments with new treatments.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we may discuss your medical and family history, and I will examine your skin and ask questions about your symptoms. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.