advice on skin cancer

[bluehende]

Well today has not been a good day. I was just diagnosed with 2 spots of skin cancer. One is a basal cell carcinoma which is the best kind to have. The other is a squamish cell carcinoma. A little more worrying but not super dangerous either. Needless to say it is a shock to be researching survival rates even if they are over 90%. I have a plan in place already but am not 100% sure if it is the best. The basal cell will be scraped and watched. The squamish will be removed through Mohs surgery. Here is where the advice comes in.

The Dr in the dermatology practice does not get good reviews. It is a little over 3 on yelp. Some mentioned a misdiagnosis which seems weird as I am taking a diagnosis to him. Many talk about an assembly line which seems about par for the course for this surgery as it is done in stages with wait periods. Also he seems to be a little cold and abrupt. Should I look for a new practice or another surgeon? Is a dermatology practice ( he does seem to have been doing cancer surgery for a long time) the way to go or is there another specialty to get involved.

Anybody with advice feel free to give it. I know this is the internet so will take anything I hear with a grain of salt but this community is always so smart. I have an appointment with my gp to see if he has any advice. I would certainly appreciate any considerations that I would not know about.


Let's also use this as a teaching moment.

USE SUNSCREEN

Get regular whole body checks

Do not do what I did and wait 5 yrs in between these checks. Early diagnosis means the difference in survival rates. It is too easy to get busy and ignore these routine appointments.

Wayne

 

[VacationForever]

Why don't you simply get a second opinion with another doctor and go from there?

 

[Passepartout]

Lucky you! Better found and taken care of than put off. I had one each of these discovered in about Sept and removed by the same two procedures you are contemplating. The scrape-burn and watch is still a reddish spot, and the Mohs re-shaping of my nose still feels a little funny, but is basically not noticeable. I used a 'scar removal' silicone ointment for a while that may have helped.

But I digress. I wouldn't put off the procedure- and I wouldn't put a lot of stock in a Yelp rating. Nobody is happy after surgery that shows- and skin surgery shows. If the doc is board certified, s/he has passed training, tests and observation by other docs in the specialty.

Yep, I agree about the use of sunscreen and annual whole body scans, but I'm of a generation that sought a bronzed skin. As kids we lived at the pool, and it wasn't officially summer until you had a darn good sunburn. I also served in Vietnam, mostly bare chested and without a hat. This is a price us fair-skinned folks of Northern European ancestry face.

Good luck with the upcoming surgery. It'll be fine.

Jim

 

[SmithOp]

Well first, don’t be scared, these are minor skin cancers - the one to be scared of is melanoma. I’ve had basal and squamous removed.

I go to dermatologist every 6 months and have pre-cancerous AK burned off with liquid nitrogen spray can.

I’ve had 7 Mohs procedures from 3 different doctors, I met a woman at one that had over 100. We all sit around the waiting room between layers and compare notes, its no big deal, every Mohs surgeon I’ve used has the same “assembly line” technique. Its the most efficient for their practice, can’t expect the surgeon to sit around holding your hand while the lab tech examines the tissue samples.

What you want is one that is good stitching it up. I have sensitive skin that develops cheloids, lumps on scars. I have one on my neck that raised up, I never went back to that doctor. I like the dermatologist I have now in Newport Beach, a young woman who’s main practice is cosmetic procedures. Her sister performs the Mohs surgeries one day a week, she commutes from LA.

Follow their recommended procedures for wound care and you should be fine.


Sent from my iPad using Tapatalk Pro

 

[bluehende]

Why don't you simply get a second opinion with another doctor and go from there?

That is why I am going to the gp. Not sure I need a second opinion other than whether this is the dr I want in this situation.

 

[PamMo]

I agree with Jim's post. And like you, I'd be anxious with a diagnosis of skin cancer, but basal cell and squamous cell carcinomas are very treatable if caught early!

Have you met the dermatologist? I wouldn't put off the appointment because of a mediocre Yelp rating. With social media (even here on TUG sometimes), people will rant over perceived wrongs, but you don't get the whole story. A better start is to look up his training. Ask a doctor you trust if they'd send their spouse/kids to him. I doubt your doctor would refer you to him if he didn't think he was good.

 

[bluehende]

I agree with Jim's post. And like you, I'd be anxious with a diagnosis of skin cancer, but basal cell and squamous cell carcinomas are very treatable if caught early!

Have you met the dermatologist? I wouldn't put off the appointment because of a mediocre Yelp rating. With social media (even here on TUG sometimes), people will rant over perceived wrongs, but you don't get the whole story. A better start is to look up his training. Ask a doctor you trust if they'd send their spouse/kids to him. I doubt your doctor would refer you to him if he didn't think he was good.

I go to the practice but have never met the surgeon. I already have an appointment. I am now running around to see if I can get a good recommendation other than just following the path of least resistance which is staying in this practice. I made the GP appointment just to get a view that is outside the dermatology practice but has some knowledge of the community.

It is that caught early part that I cannot wrap my head around. It has been 5 yrs since my last full body check. At that time I had the liquid N2 treatment on the spot where the squamous cell one is. That balance between slow growth and early detection is where my worries lies. I wanted this thread to be a reminder to not be like me, the typical male, and not put off those appointments.

 

[moonstone]

Shortly after my mom was moved to into a long term care facility she complained of shoulder pain. I had a look and there was a darker coloured spot resembling a bruise about the size of a dime right on the top of her shoulder. I just assumed she had bumped her shoulder as (partly due to her dementia) she couldn't remember bumping it. The next week the area was raised and more red so I asked the nurse to have the house Dr take a look at it. He did and got mom an appointment with a dermatologist since he said he could feel a lump and it was not from a bruise, and also mom couldn't raise her arm up. We had to wait about 2 weeks for the dermatologist appt and by the time I took mom over the lump was the size of a walnut! Instead of taking a biopsy and having us return for removal the Dr decided to remove the lump and then send it for biopsy, especially since it was so fast growing. He said it looked like basal cell cancer. The Dr let me stand beside mom while he removed the lump and I could not believe the size of it. It had a 'tail' that had worked its way down into Moms shoulder joint and was about 3 inches long. The Dr said it all came out cleanly and he stitched the incision up. He said there was no need for any further treatment and now the scar is barely noticeable. I take mom to the dermatologist annually for a check up and other than a couple of squamous cell carcinomas that were 'frozen' off she has had no further trouble.

Mom, being a red-head, fair skinned person, always used sunscreen so I was surprised that she developed both types of skin cancer. That was a wake-up call for DH & I to get checked by a dermatologist regularly, especially since we spend so much time outside in the sun with spending the winters down south.


~Diane

​

 

[WinniWoman]

Sorry to hear about this. May I ask - was it your primary physician who discovered this? I have not been to a dermatologist but I know people who go every year just to have their skin checked. I have always relief on my Family doc for that during my annual physical.

Who recommend this dermatologist to you?

I Would get a second opinion if possible- if not to just see if you can get a doctor you like better.

Best of luck with this. Good thing it was caught.

PS many surgeons are of that personality type for whatever reason. Take it from one who was around docs most of my working life. Doesn’t mean they are not good surgeons. Just the nature of the animal.

 

[dmbrand]

If your lesions are in conspicuous places, consider using a cosmetic surgeon. I had a lesion on my shoulder removed; when the biopsy came back as melanoma, they sent me to a cosmetic surgeon because they needed to remove a larger area of skin. This was back in 2000. So instead of a divot in my upper shoulder, I call it my Harry Potter scar, due to it looking like a lightning bolt. It is barely visible now.

 

[mjm1]

I had Mohs surgery 11 years ago to remove a melanoma on my calf. The surgery went very well as they caught it very early. Otherwise, I wouldn’t be here today. My dermatologist referred me to him. Since then I see my dermatologist every six months unless he says to wait one year.

I would recommend taking care of it as soon as possible. If you try to get second opinion let them know you have been diagnosed and need to get in as soon as possible.

Best regards.

Mike

 

[bluehende]

Sorry to hear about this. May I ask - was it your primary physician who discovered this? I have not been to a dermatologist but I know people who go every year just to have their skin checked. I have always relief on my Family doc for that during my annual physical.

Who recommend this dermatologist to you?

I Would get a second opinion if possible- if not to just see if you can get a doctor you like better.

Best of luck with this. Good thing it was caught.

PS many surgeons are of that personality type for whatever reason. Take it from one who was around docs most of my working life. Doesn’t mean they are not good surgeons. Just the nature of the animal.

Have had way too many surgeries and yes not one of them would I consider having a beer with.

5 yrs ago I saw a suspicious spot and went to the dermatologist that my wife used. The spot in question was fine but they saw a few pre cancerous areas and froze them off. I should have been going every year for the check but blew it off until 5 yrs. At this point I realized one of the old areas seemed to have a scab and would not go away. I do know I have had a physical at the gp last year and assumed he checked. Cann't remember specifics. Short answer is I was suspicious and went to the dermatologist.

 

["Roger"]

Regardless of what you decide on whether to seek out another dermatologist, you should be put on a 3 to 6 month scheduled for check-ups the next couple of years. Somewhat contradicting my opening statement, if that wasn't recommended for you, then you should seek another dermatologist. (Link)

 

[Beachclubmum]

I'm sorry you're going through all this...well wishes for a full recovery.

To answer your question, when I'm vetting doctors, I like to look at where they went to school along with their amount of experience. I've only run into one bad doctor this way (she looked great on paper). As a cancer survivor, I'm big on doing my own research and being as informed as much as possible...no one cares about YOU as much as you, yourself would. Ask questions and don't be afraid to be your own advocate. As far as bedside manner goes, some of the best doctors aren't necessarily the most personable, so that part wouldn't bother me.

Finally, thanks for the reminder! I am indeed overdo for a skin check. Red hair genes, plus freckles and a childhood on the beach do not make a good combination.

 

[clifffaith]

Cliff had his first full body check today. Nothing new was found, however the dermatologist did two biopsies on existing problem areas. This summer he had a squamous cell carcinoma removed from his hand. Between the time he first noticed it and actually being scheduled for surgery it grew to the size of a quarter around and protruded quite a bit. They knocked him out thinking he might have to have a skin graft, but he didn't. This was at the end of August. A couple weeks ago he noticed the surgery spot was growing upwards, and last week it caught my eye as looking like it was growing. So today the dermo did a biopsy on it while Cliff was there for the body check.

And he is scheduled for Mohs surgery on Dec 23 on the gross open wound on his cheek. It's interesting that the "assembly line" process is mentioned above -- I didn't realize he wasn't the only patient being worked on, but apparently he did. I guess that's why they told him to plan on being there all morning. Anyway, the dermatologist did a second biopsy on his cheek today (if it couldn't gag a maggot before, it could now) because he is convinced that is basal cell and not the squamous cell the first biopsy came back with. I don't know if that means Mohs surgery is not indicated for basal cell, but Lord I hope they do something for him. He has to sleep on what we call "dog towels", even though we haven't had a dog in almost twenty years. Otherwise the sheets look like a serial killer is on the loose.

 

[WinniWoman]

Cliff had his first full body check today. Nothing new was found, however the dermatologist did two biopsies on existing problem areas. This summer he had a squamous cell carcinoma removed from his hand. Between the time he first noticed it and actually being scheduled for surgery it grew to the size of a quarter around and protruded quite a bit. They knocked him out thinking he might have to have a skin graft, but he didn't. This was at the end of August. A couple weeks ago he noticed the surgery spot was growing upwards, and last week it caught my eye as looking like it was growing. So today the dermo did a biopsy on it while Cliff was there for the body check.

And he is scheduled for Mohs surgery on Dec 23 on the gross open wound on his cheek. It's interesting that the "assembly line" process is mentioned above -- I didn't realize he wasn't the only patient being worked on, but apparently he did. I guess that's why they told him to plan on being there all morning. Anyway, the dermatologist did a second biopsy on his cheek today (if it couldn't gag a maggot before, it could now) because he is convinced that is basal cell and not the squamous cell the first biopsy came back with. I don't know if that means Mohs surgery is not indicated for basal cell, but Lord I hope they do something for him. He has to sleep on what we call "dog towels", even though we haven't had a dog in almost twenty years. Otherwise the sheets look like a serial killer is on the loose.

Wow! Gosh- I hope he will be alright. So many things today to worry about. Geez...

 

[AnnaS]

Good luck with your upcoming surgery - get them done. If you really feel uncomfortable, get a second opinion. These are very common. Melanoma is a different beast.....

Happy for all the lucky ones and that it was discovered early!!!!!

Let us know how you make out.

My mom had the surgery at the tip of her nose. She had a nice indentation/scar. Stiches and healing is important. My mom did not go any further with trying to cover it up because of many other medical issues that came first. She had so many medical issues, that I don't even think it was wise to put her through this procedure and all her appointments. As her surgeon said, it is a very slow growing cancer. We had to decide she went through it.

 

[rapmarks]

I am being treated for two precancerous growths on my face. She removed them surgically, then expected to burn off what was left, they had grown back. After the liquid nitigen orocess, they grew back again, I now have the medication you put on the skin for two to four weeks and will see her again after that process.

 

[bluehende]

Regardless of what you decide on whether to seek out another dermatologist, you should be put on a 3 to 6 month scheduled for check-ups the next couple of years. Somewhat contradicting my opening statement, if that wasn't recommended for you, then you should seek another dermatologist. (Link)

The six month appointment was made today when they delivered the news. I think the practice is good the surgeon is suspect and is suspect only because of yelp reviews which like others have said are not a very good indicator. I am guessing he is not warm and fuzzy.

 

[clifffaith]

The six month appointment was made today when they delivered the news. I think the practice is good the surgeon is suspect and is suspect only because of yelp reviews which like others have said are not a very good indicator. I am guessing he is not warm and fuzzy.

Cliff won't meet the Mohs surgeon until he has the procedure. I thought that was odd and don't know if that's just the way it is always or because he has an HMO.

 

[geekette]

unfortunate voice of experience here (including today)

Shop different doctors. George Carlin was right: someone, somewhere is seeing The Worst Doctor in the World. By process of elimination, it must be so.

Consider that you are selecting your long term care team. you need to be comfortable, you need to trust, you need to be HEARD. On that last point, again, today, ignored on what I was there for (continuing problems from allergic reaction to surgical procedure; I'm getting worse, not better). Instead, since I was clearly in distress (it's painful and scary), it was all about shoving depression meds at me. The symptoms on my "seek help immediately if..." list were not listened to/considered. Heck, I even brought that paperwork, both from initial procedure and ER visit triggered by the onset of "seek help immediately if...." I know when I'm in trouble, and I was in trouble today, and still in trouble, so going to another doc tomorrow that will hopefully Listen To Me. Do not stop seeking appropriate treatment, and in your case, finding options. Until you see multiple doctors, you might not know about different ways to treat your diagnosis. You need that data to make the right decision For You.

Do not ever be concerned about ditching a doctor, I have left many in my wake the past couple years and just added another to the list of those that I will not EVER see again. I was lucky to find a hospital system with most all (but today) outstanding doctors. Having consolidated my care, it is easy for them to see my bag of troubles, and it is easier financially to get one bill and be able to finance at 0% bigger issues. extra bonus points that I can pilot myself there easily in most any condition.

If there is a university hospital, try them. I understand that people only want to go where their insurance is in-network, but I urge you not to limit yourself if you do not find The Doctor For You in-network. For me, healing my body is more important than saving money. I would like both, but I could not have that, so I opted for better doctors and outcomes.

if you are not HEARD, if your concerns are not addressed, Everything is worse, not just illness and symptoms, but in your head. Tonight I deal with worrying things that should have been addressed today but nobody cares about your well being as much as YOU do so do not settle. I don't bother with Yelp - consider that people are all different, and some of them, like my mother, are good little patients that do whatever the doctor says, and so long as they Seem Nice, they will get good reviews. Review them in person yourself. Do not subcontract this very important matter. A doctor could be perfectly good for some person with some issue but that does not mean that they are good for you and your issues.

I am so sorry that you are dealing with this. I well know how one nasty diagnosis can change your world. Be your own advocate, do not settle for subpar treatment. You have to live with all consequences and all successes. I have both. Do whatever you have to do to get the right treatment plan, this is not something where you want to say later "I wish I'd...."

Best of luck to you. And an extra big hug. Breathe, and be sure to make time to do something Fun for yourself very soon.

 

[VacationForever]

@geekette Very well said. I am sorry that you got a crappy doctor day who did not listen and work with you to resolve your medical issues. I agree with you to find another doctor until one who will listen and take care of you.

I have previously posted. I was a patient with Kaiser Northern California for 17 years. During that time, a chronic medical condition got from bad to worse. They never fixed my problem and I was as you said "seek help immediately..." situation for the last 5+ years... I wished each night that I never woke up the following morning. The standard treatment for someone who has mild symptoms would be 1 pill... 1 drug. They started me with 4 pills for 1 drug, then became 2 drugs of the same family for 4 pills each, and the 4 types and 4 of each of them. Yes, I was overdosed 16x for 4 years. During the time, their dermatologist said unless I had skin cancer, they were not the appropriate department to see me. I got sent to an allergist who kept loading me up with more medications and accused me of not taking enough medications to keep my symptoms under control. They also zapped my skin with narrowband UV phototherapy for several weeks. Other than giving me a bad sunburn it did not help.

I moved out of state. I kept up my 16x overdose regimen after my move. All 4 types of pills were over the counter without needing prescription and slipped under the radar of my new PCP.

My new PCP did not realize how dire my situation was until a year later when I was barely breathing when I went to him and skin on my entire body was broken down with rashes and welts. He put me on steroid and sent me off to an allergist immediately. This allergist saved my life. He stopped all medications and put me on 1 drug. I got back my quality of life overnight. I later looked it up, it is considered tier 2 drug for someone who does not respond to tier 1 drugs. My husband asked him why my doctors at Kaiser did not put me on this drug. His response was "They just don't know." This same allergist might have just solved another of my dire medical issue. 2 separate ENT specialists said my throat problem is GI related. My GI doctor then loaded me on a drug to address it and after 2 years, it has not improved. I spoke to my allergist 3 weeks ago about this issue. He asked me to reduce the drug prescribed by my GI doctor by half. He prescribed a nasal spray in addition to my existing nasal spray. It appears to be working. I am scheduled to see my GI doctor and allergist again next week. It may be I don't have a GI problem but a bad nasal backdrip.

Good doctors vs. bad doctors is not a fine line. One is fortunate when they have a good doctor.

 

[WinniWoman]

@geekette Very well said. I am sorry that you got a crappy doctor day who did not listen and work with you to resolve your medical issues. I agree with you to find another doctor until one who will listen and take care of you.

I have previously posted. I was a patient with Kaiser Northern California for 17 years. During that time, a chronic medical condition got from bad to worse. They never fixed my problem and I was as you said "seek help immediately..." situation for the last 5+ years... I wished each night that I never woke up the following morning. The standard treatment for someone who has mild symptoms would be 1 pill... 1 drug. They started me with 4 pills for 1 drug, then became 2 drugs of the same family for 4 pills each, and the 4 types and 4 of each of them. Yes, I was overdosed 16x for 4 years. During the time, their dermatologist said unless I had skin cancer, they were not the appropriate department to see me. I got sent to an allergist who kept loading me up with more medications and accused me of not taking enough medications to keep my symptoms under control.

I moved out of state. I kept up my 16x overdose regimen after my move. All 4 types of pills were over the counter without needing prescription and slipped under the radar of my new PCP.

My new PCP did not realize how dire my situation was until a year later when I was barely breathing when I went to him and skin on my entire body was broken down with rashes and welts. He put me on steroid and sent me off to an allergist immediately. This allergist saved my life. He stopped all medications and put me on 1 drug. I get back my quality of life overnight. I later looked it up, it is considered tier 2 drug for someone who does not respond to tier 1 drugs. My husband asked him why my doctors at Kaiser did not put me on this drug. His response was "They just don't know." This same allergist might have just solved another of my dire medical issue. 2 separate ENT specialists said my throat problem is GI related. My GI doctor then loaded me on a drug to address it and after 2 years, it has not improved. I spoke to my allergist 3 weeks ago about this issue. He asked me to reduce the drug prescribed by my GI doctor by half. He prescribed a nasal spray in addition to my existing nasal spray. It appears to be working. I am scheduled to see my GI doctor and allergist again next week. It may be I don't have a GI problem but a bad nasal backdrip.

Good doctors vs. bad doctors is not a fine line. One is fortunate when they have a good doctor.

Holy Moly! I didn't realize you were going through this. Terrible! But glad you are at least going in a more positive direction with this. Wow!

This is why many people get turned off going to doctors. Unless it is an emergency, I now start with the internet. I know how this sounds but that's what I do and go from there to my doc if I feel I need to. Thankfully my primary doc is sensible/conservative/common sense. Great listener and diagnoser. Unfortunately will be losing him, when I move.

 

[bogey21]

I wouldn't put off the procedure- and I wouldn't put a lot of stock in a Yelp rating. Nobody is happy after surgery that shows- and skin surgery shows. If the doc is board certified, s/he has passed training, tests and observation by other docs in the specialty.

I'm with Jim on this. Yelp rating don't excite me. Give this Doc a chance. If you are dissatisfied, find a new one next time...

George

 

[VacationForever]

Holy Moly! I didn't realize you were going through this. Terrible! But glad you are at least going in a more positive direction with this. Wow!

This is why many people get turned off going to doctors. Unless it is an emergency, I now start with the internet. I know how this sounds but that's what I do and go from there to my doc if I feel I need to. Thankfully my primary doc is sensible/conservative/common sense. Great listener and diagnoser. Unfortunately will be losing him, when I move.

Yes, we need to be self advocates. I am sworn off HMOs because of my Kaiser experience. When I selected Kaiser I thought it was great to have everything under one system. What I found out towards the end when I had serious problems was that I was at their mercy. If a specialist does not want to see you or you get one that is crap, you run out of options. If I ever move back to California, I will never ever go back to Kaiser.