Melanoma and Skin Cancer Program

Dartmouth Cancer Center

One Medical Center Dr.

Lebanon, NH 03756

PH: (603)-650-7901

Fax: (603) 603-643-7314

Referring Provider*

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MRN

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Presenting Symptom/Diagnosis *

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Transceted at the Base

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Transected at periphery

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History of Melanoma

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Required Information

Please attach office notes, lab reports, pathology reports, imaging reports, operative reports and site photos.

If you are unable to attach, please fax to 603-643-7314.

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Send Pathology slides to:

Pathology Department, DHMC

One Medical Center

Lebanon, NH 03756

Send Films to:

Film Library, DHMC

One Medical Center

Lebanon, NH 03756

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