The Surgeon Minute

Elegant Skin Cancer Excision

Elegant Skin Cancer Excision

According to the latest statistics from the Skin Cancer Foundation, there have been more people diagnosed with skin cancer over the last 3 decades than with all of the other cancers combined. Sun damage and exposure starting in the teenage years through the 20s can be all it takes to contract a skin cancer 20 even 30 years down the line.

As someone who lives and works on the Jersey shore, Dr. Caroline Glicksman of New Jersey has spent the past 25 years treating skin cancer. A worrisome trend that she’s noticed in recent years is patients coming to her with large, unsightly scars where a skin cancer has been excised. Achieving the best possible cure rate is vital, but also is the aesthetic outcome. It’s important that patients educate themselves on their options when it comes to removing skin cancers.

MOHS Versus Direct Excision

There’s been a lot of controversy lately on the best way to treat skin cancer. MOHS or micrographic surgery is a specialized technique in which thin layers of tissue are removed from the skin cancer one by one and placed under a microscope until the margins are completely clear. Once all the cancerous cells are gone, the patient is then sent to a plastic surgeon to try and close the resulting hole.

There was a time when it was thought that MOHS delivered a higher cure rate than a direct excision by a plastic surgeon. But, according to Dr. Glicksman, the studies have shown, “that there is not a significant difference in the long term outcomes whether a direct excision is performed or MOHS surgery is performed.”  The real difference is in the outcome of the scar.

You Don’t Want a Physician’s Assistant to Excise Your Scar

Patients need to think long and hard about who is going to perform their surgery. What are their qualifications? What is going to be the cosmetic or aesthetic outcome? “We can cure basal cells, but we don’t have to disfigure you,” says Glicksman. She advises her patients that if they need to have something biopsied then go ahead and have it done by their dermatologist. However, if the biopsy comes back positive for cancer, especially on the face or the chest, then they need to consider whether or not to see a plastic surgeon to have it removed.

Many plastic surgeons will either accept insurance or work with your insurance company. And though it may still cost more than seeing your dermatologist for a direct excision, won’t it cost a lot more in the long run to have a lifelong scar?

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The problem isn’t really about the skill of your dermatologist versus the skill of a plastic surgeon. It’s probably OK to let your dermatologist do an excision. The issue is that a lot of these dermatology practices that are part of many HMO or PPO plans are factories, and the patient is often being treated by a physician’s assistant who may only have a couple of weeks of experience.

Bottom line, make sure to ask questions. There is absolutely no need to live with an unsightly scar when the chance for a well-performed procedure is so readily available.

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