OT--skin lesion removal doesn't pass my smell test--REVISITED/UPDATE

Hi folks. I need advice. This is not PC-related, but I suspect this group would have knowledge in this area.

I have a very small lesion (oval, probably < 1/8" at longest distance and < 1/16" shortest).
OK, my doctor suspects it is a basal cell skin cancer (could be squamous; he is quite sure it's not a melanoma).

Anyway, due to its location (top of nose, between the eyes), he suggested a plastic surgeon could easily take care of it. He referred me to one who I saw yesterday. While I liked him (he is quite personable), some things I did not like. His office wanted $$$ up front for the office call (they figured out what my co-pay would be). That's okay, I guess. But, here is what has me concerned:

He wants to do this in the hospital under general anesthesia. This is not the twilight stuff they give for a colonoscopy. This is the stuff they give for regular surgery. He says he wants to make sure I don't move during the procedure. He would do a frozen section and the lab would tell him in 10-20 minutes if he got it all.

This just doesn't pass my smell test. It would seem they could just give me a few numbing shots and excise the lesion that way (it is directly between my eyes, but not "that" close). I have never had problems with anesthesia, but I worry about the risks with rolling that dice again for a simple removal.

I know my regular doctor thought it would be a simple procedure. I will try and reach him next week (he is gone this weekend).

Also, his office already wants me to pay my expected portion of the surgery charge, like today (it is scheduled for 8/22). That just makes me suspicious.

So, any thoughts about needing general anesthesia for this procedure?

Maybe this is standard? Somehow, I feel like I am getting railroaded. I will probably put everything on hold and seek out a local dermatologist for a second opinion. But I figure you folks may have some knowledge here!

Mel

Post Edited (compiler) : 8/27/2016 8:16:53 AM (GMT-6)

It's not standard. I've had several removed over the years and all were done under local.The only reason to use a plastic surgeon is if you are concerned about scaring.They use finer thread for sutures and are more experienced in reducing scar tissue. My mom was in plastic surgery for 30 years so some knowledge rubbed off on me.
Unless it is super deep, an office visit with a local should be just fine. Sounds like he's ringing the cash register.

Get a dermatologist for at least yearly checks...she or he will determine if you need 6 months checks...wear hats... sunscreen...not a lot...this way you will have first opinions always on skin cancer issues...it's what they do...its ok to make mistakes..as long as you correct them..or if nothing else admit to oneself they are in deed and truth mistakes...pride always precedes the fall...not a rub in...a simple cancer out...then it will be the "good cancer" Ok a caress...not a choke...

Compiler, look into Mohs Surgery.

[url]http://www.mayoclinic.org/tests-procedures/mohs-surgery/basics/definition/prc-20014261[url]

I'd find a local dermatologist who does MOHS surgery. These guys are the BEST! They do stuff like that all day, practically every day. Had several things removed from my face...

The pay-now model does make it all seem fishy, unless you have some sort of second-rate insurance the Dr is leery of.

compiler said...
There were some negative comments about the office's propensity to collect $$$ immediately, up-front.

www.npr.org/sections/health-shots/2014/04/25/303720114/with-medical-debt-rising-some-doctors-push-for-payment-upfront

Article talks about why this is an increasing trend, and is not going away.

Have you considered Photodynamic therapy (PDT) instead of surgery? The main advantage of the method is the cosmetic result (no scars) compared to more destructive treatment methods. 3 times of 8 minutes treatment is all. I have no idea about the availability or cost in US.

Mel, let me share my experience.

I ignored a small growth above my right (non driving arm) elbow too long. The original 1.8 cm cut was done in GP's office and the biopsy came back as malignant melanoma through entire length of 1.8 cm excision. Totally unexpected as I was expecting a choice between basal cell and squamous cell, not a malignancy.

I did not do Moh's surgery but due to past PCa history, the surgery oncologist did order a sentinel lymph node biopsy that fortunately showed no distant spread.

However it took another 0.76 cm for a total of 2.56 cm to get to clear margins. So a giant larger than a golf ball sized hole did require a plastic surgeon to close the dig.

Going plastic surgeon route on your first cut does seem excessive, but do deal with it via biopsy to make sure it is not malignant melanoma.

The criteria for early intervention is either 4.0 cm deep or distant spread. So unless the Castle genetic test shows that I am high risk (one of the metrics I won't go into here was well beyond the norm) there is no insurance coverage for early chemo, ipilumimab etc. So all I can do is quarterly dermatologist visits (had never had one) until another lesion surfaces.

Hopefully they are right in that it is either benign, basal or squamous but if it does come back malignant, probably sentinel lymph node biopsy due to prior PCa would be the next step.

Jack:

Yes, I have heard that (upfront payment). While that is an irritant, it is not a deal breaker. In fact, I guess I don't mind paying up front (heck, I pay for vacations up front when I buy airline tickets).
The issue here is that this doctor is trying to play me, I think.

Mel

Good Lord Mel do what I said... its that simple you are complicating it and others here also...with all this peripheral non sense...Get a friggen dermatrollogist and be done with it... big lol...can't you see what you are doing...pretend you have me on ignore...and it was your idea...but just do it... Oh... member you can;t say you have me on ignore already...doesn't pass the smell test.. tee hee .Luv ya man...smile and DO IT....

One of the basals my GP removed off of my chest...he had to go in twice to get it all. I wouldn't have wanted that scar on my face. So the plastic surgeon isn't what's bothering me. (They're all high paid surgeons...fwiw...)

What bothers me is you're considering surgery when you don't even know if your sick or not.

Before cutting off your nose why don't you get it biopsied first???

Good ol skin cancer... Kind of runs in my family.. My dermatologist always reminds me to thank mom and dad for this horrible skin we all have.

I started seeing him every six months for the past four years... He finally put me on a once a year schedule... I somehow managed to screw that up and haven't been in 18 months.

Anyway, I have a nice little spot on my nose which is rather close to the corner of my eye. Am not sure if he'll be able to freeze it off or have to slice and dice.

The nickel size mole in my right inner ear that keeps coming back is a lot of fun to have removed... Don't try that at home.

I thought that paying up front was the new norm. I've done that several times. Someday I'll get a different Visa card so I can rack up some airline mileage points.

Joan Rivers