Director of the Cosmetic and Reconstructive Center

As the number of patients with skin cancers increases dramatically (more than 9,500 per day) the need to streamline the process, from referral to evaluation to treatment becomes paramount.

Considering that Adirondack Health is a rural community hospital and patients must drive great distances to be able to receive care, such a process is important.

Referral: SCCA and Melanoma need to be addressed as soon as possible after being diagnosed. To minimize the interval between diagnosis and treatment, a direct line of communication between referring physicians and my office is necessary. At Adirondak Health, in addition of fax and Internet I have an encrypted phone. It allows me to receive pictures of lesions and copy of pathology reports as well as communicating instantly with the referring physician and let us elaborate a plan of action.

Surgeries: To accommodate both the increasing number of patients requiring surgery, as well as to accommodate for urgent surgical cases (SCCA and Melanoma), I have access to Operating rooms as well as Minor procedure rooms for a total of 2 days per week. Such flexibility allows me to minimize the delay between referral and surgical excision of the tumors, between 72 hours to 1 week maximum.

Surgical Pathology: One of the challenges of advanced cancerous lesions in the Head and Neck region is obtaining clear margins BEFORE the patient goes back home, sometimes hours away. At Adirondack Health I work closely with our Surgical Pathologist who is always present during my surgery days. It allows me to obtain Frozen Sections on my surgical specimens (for SCCA and BCCA). When Clear surgical margins are obtained, I can proceed immediately with the constructive part of the procedure. Because of my training I am able to offer my patients a wide range of reconstructive options, from Primary Closure to Skin Grafts to more complex local and regional flaps.

Treatments: Besides surgical excisions, we can offer treatments for advanced skin cancers, like Melanoma, Squamous and Basal Cell Carcinoma. I work closely with our Oncology Dept., which offers the latest treatments available like immunotherapy and targeted therapy for advanced Melanoma. The Oncology Dept. also offers genetic testing and counselling.

Ancillary Services: Considering that most of my surgical patients are older and more frail, the additional resources of the Cardiology Dept., Vascular Surgery Dept, General Surgery Dept. and the Diabetic Clinic help me to optimize the overall medical condition of my surgical patients so as to obtain the best surgical outcomes.

In summary, even though Adirondack Health is a rural community-based hospital, it has the capacity to treat patients with complex skin cancer lesions and to offer them the latest available treatments with streamlined coordination between several Departments.