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

Thanks for the responses. In addition to these responses, I have friends who have had stuff removed. They all agree that there appears to be no reason for general anesthesia.

I am going to cancel the scheduled surgery.

I also expected they would first do a biopsy (although both doctors are pretty sure it is a BCC) first.

Back to square one: find someone to do it.

The local dermatologist choices are surprisingly few. The problem is that the one I want to see has a 6-month wait (that's what I heard - I'll know Monday). It may be quicker to schedule myself at Umich.

Amazing such a routine thing has taken this annoying turn!

Mel

I have had numerous actinic keratosis (AK's) removed over the years, and one MOHS surgery so far. General anesthesia seems like expensive overkill. Typically with a MOHS procedure there is a biopsy by your dermatologist with a diagnosis days later. For the actual procedure there is the surgeon and an assistant. They use a local, take they the part out they need, send you back to the waiting room while they do the pathology. Then they either let you leave, or call you back in for more removal. All with a local. The one thing unique with MOHS surgery is the surgeons are trained to do their own pathology. I believe its typical for surgeons trained in MOHS surgery to also be plastic surgeons. The payment upfront thing seems to be gaining more traction too. When I started on my PCa journey I had to pay all of my expected out of pocket costs for the biopsy upfront.

alephnull said...
Just MHO

Sounds fishy as heck to me.

I had a nickel sized mole taken off my neck in my PCP's office. He just froze it off.

Same here. I have had several basal cells removed in the office, including on my face just above my lip, no sedation, just a "OK, hold still this is going to sting for a minute".

First off, why do they think you even need a plastic surgeon? I doubt you are all that vain so as to be bothered if a small scar between your eyes is even all that big of a deal if it is not quite as perfect as it could be. A plastic surgeon did my 1st one on my lip about 12 years ago, but that was only because I was working with him in surgery and said "Hey Doc, take a look' and he told me to just come on over to his office that day after work. His office had just closed and he didn't even have anyone there to help him, just numbed me up and cut it out.

Now, waiting for the path report is indeed the state of the art way to do it. Cut a little bit, send to pathology and wait for the report. If good, close em up. If a positive margin, cut some more until it's all gone then close em up. I used to work with a plastic surgeon who brought all his patients to the hospital or surgery center so he could do it exactly that way. But even he did not put them to sleep, I would only give them some very slight sedation, enough so that that would be calm, have a little pain relief for the numbing(they did not need any pain relief after a good block), have some amnesia, but could still cooperate. We did that for years, all parts of the body with plenty on the face, never a problem.

So that is state of the art, but so what? It's not like a small basal or squamous cell is going to kill you if you don't get it all out that day. Just cut as wide as normal, close up and go home, get lab report in a few days. If he missed a smidgen, go back to the office and do it again. My dermatologist does it that way all the time. In his office, no sedation, no big deal. General anesthesia seems a bit much. Sometimes- not saying it is in this case, but sometimes, that sort of thing is done for the surgeons convenience. Some of those guys just can not stand to deal with patients, or having to be polite or feeling inhibited about yelling at the help, or having to nicely ask a patient to be still. They want to sit in the lounge until the patient is asleep, prepped and draped, until the get a call "we are ready for you doctor", walk into the OR, gown, glove, cut, and leave as fast as possible. (though in your guys case wait for a path report) And if they need to yell at some one they don't want any awake patient being concerned about that or being a witness to it.

Having said that, and to be fair, I suppose if he thinks it was something real extensive, he might be concerned you would not be able to cooperate adequately for the time he was going to be working. Admittedly, some of us are just too -what's the word?- nervous to hold still or tolerate the numbing with slight sedation. Once you get to a large amount of sedation, there may be airway problems which are hard for anesthesia to manage it with your face under a drape and the surgeon cutting on your face near your eyes. That can be a royal, unsafe pain in the arse for all concerned, so IMHO in those situations it's either SLIGHT sedation or NO sedation and the patient MUST be able to cooperate( or, general). So this guy may have had a bad experience or 2 with that situation and has decided "BS, no more of that, I want them out with a breathing tube in!". Still, it's done the other way all the time. So if you think you are able to hold still for 10 minutes to an hour with just some local or very slight sedation, you should talk to your doc about that. Ask him if he can't just do it in his office. I can almost guarantee my dermatologist would.
( EDIT: I see you have already cancelled the surgery. Good move, you should have plenty of time to get it taken care of elsewhere)

( EDIT #2: They had you sign a contract saying if you cancelled you would have to pay a stout fee? Man, I'm glad they let you out cheap, avoid these people in the future! They sound very suspicious to me! Just find a dermatologist who will do it in the office, even if that takes a while! You may need more of these done anyway so might as well get a relationship going with one of them. )

Post Edited (BillyBob@388) : 8/9/2016 1:32:46 PM (GMT-6)

UPDATE:

Saw the dermatologist on 8/25. He is definitely experienced: 41 years. Nice guy. He looked at it carefully. He is not even sure it is cancer. It could be a sebacious something (not a cyst). He said it is quite small and let's do a biopsy. From the time he injected the numbing stuff to completing the biopsy, it was about 3-4 minutes. He also examined me carefully and found no other suspicious spots.

I'm to call his office in a week. If benign, I'm done. Otherwise, he will remove it in his office. He seemed extremely confident.

This is what I expected to happen when I saw the plastic surgeon (or even a complete removal at that time).

Frankly, I am much more ticked off at that plastic surgeon. He was going to turn a relatively minor procedure into a major thing, with certainly an increased risk to the patient, moi.

I am glad they did not try and charge me extra for canceling.
They did want me to pay my share of the surgical cost that day (of my first appointment). The whole thing stinks.

Incidentally, I had to pay $20.50 that first day as my share of the office visit. I just got my EOB and my share is actually about $16.50. I decided not to call them and request a refund. I don't want anything else to do with them, especially with the contract indicating a penalty for canceling ("a share of the surgical cost").

Just curious: is it worth reporting to some kind of medical board? Is their behavior that aggregious. I actually think it is. Any thoughts? I am not going to follow up as my plate is full with my PC, going back to work, and some other issues. Also, I just want to run as far away from those people as possible.

Mel

Halbert:

I get the profit motive. But doing a "major surgery" with general anesthesia on a very small lesion removal seems to be a violation of their oath: "First do no harm." They are putting a patient at risk -- a needless one.

Mel

FINAL UPDATE:

Got the biopsy results. Negative for cancer. Done!

(Wish that was the case with my 2009 prostate biopsy!)

Mel

Great news Mel!

I agree with the post above. Also complain to a medical oversight board.