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Topic Title: Overtreatment of skin cancers
Topic Summary: With under qualified personnel
Created On: 11/21/2017 11:35 AM
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 11/21/2017 11:35 AM
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ww

Posts: 14602
Joined Forum: 08/17/2007

Physician's assistants and such assessing possible skin cancers and doing biopsies.  Lots and lots of surgeries.  What could go wrong?    For those with access, NY Times.  

My dermatologist does things quickly, lousy bedside manner, but he got into an elite college that I plainly couldn't have and he's been freezing bad spots on my forehead for years.  Nothing bad since a basal cell meant having a messed-up tip of my nose.  

 11/21/2017 12:29 PM
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Central Floridave

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good article, thanks for the link. I see a PA and it is like a herding cattle. When squamous cell was found then the doctor came in and removed it. However, mostly all PA. Burn the spots off with liq-nitrogen.

from article:

Ms. Rought said it was not unusual for a skin check to lead her to to freeze as many as 30 precancerous lesions called actinic keratoses on a patient during a single visit. Actinic keratoses are called precancerous because they can sometimes turn into squamous cell carcinoma. Ms. Rought said her "rule of thumb" was that 20 percent of actinic keratoses progress to cancer.

While that might once have been the popular understanding, research now suggests otherwise. Dr. Martin A. Weinstock, a professor of dermatology and epidemiology at Brown University, reported in a 2009 study of men with a history of two or more skin cancers that were not melanomas that the risk of an actinic keratosis progressing to skin cancer was about 1 percent after a year, and 4 percent after four years. More than 50 percent of the lesions went away on their own.

Dr. Lim said the dermatology academy's position is that actinic keratoses should be treated, as it is impossible to know which ones will turn into cancer, but some specialists are questioning whether that's necessary.
 11/21/2017 01:04 PM
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bus

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Joined Forum: 10/01/2007

mixed on wether there is too much treatment. 

While in the Sunshine State. I had a few Basal and Squamous cells removed, several AKs frozen and some left. 

Just had, this past summer a quarter-sized around(about 1/4'' deep) squamous removed. And today started a chemo cream for yet another Basal cell. Both of these being AKs that I left untreated.

On the otrher hand the dermotologist that I visited in FL where quick to draw that nitro gun. Sometimes leaving me a stand-in for a surfers of meth photo shoot. 

My dr up here seems more pragmatic in her approach. Then again, I didnt show up to my appts after a daylong summer session without sunblock.

No melanoma yet.  

 

 

 11/22/2017 05:59 AM
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Cole

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I've had them burn off scars thinking they were something else, but other than that, they have been pretty good.

I'm not too sure how I feel about biopsies. Taking part of something opens a wound and the wound opens a route into the bloodstream. If you are going to mess with it, take it all.

-------------------------
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 11/22/2017 07:46 AM
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RegularJoe

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Had all my exams, 2 basal cell removals, and numerous spots frozen off, all by the PA.

I've never seen the derm MD in about 15 years of visits, other than a complimentary "aesthetic consult" about the sun damage on my face.

Originally posted by: Cole
I'm not too sure how I feel about biopsies. Taking part of something opens a wound and the wound opens a route into the bloodstream. If you are going to mess with it, take it all.


I worry about that as well. After the biopsy on my mom's brain tumor, one doctor described to me a phenomenon known as "wounded tumor syndrome" but it was more in the context of brain hemorrhaging than metastasis of the tumor. I guess if you have a bad tumor in your brain, having is metastasize to other parts of your body is the least of your worries.

For breast cancer, the technique had gone from local lumpectomy to total radical mastectomy, severely disfiguring patients in the process of "making sure they got it all." But they eventually discovered that by the time those were detected, most had already metastasized anyway, so they were still missing parts, and doing unnecessary damage.

For skin cancer, it is most often localized, and depending on the body part, not super complicated to remove (especially if a PA can do it with an electrocautery tool, implying non-Mohs).

As such, it should also be cheap enough for insurers to cover (or patients to pay out of pocket, if considered elective). Take the whole damn thing out, biopsy that, and if the margins still don't look good, or it was identified as melanoma, then order a PET scan for the rest of your body.

But leave it to patient choice, fully informed... Most patients would not choose to be overtreated surgically.



 11/22/2017 04:53 PM
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ww

Posts: 14602
Joined Forum: 08/17/2007

My dermatologist, Neil Heskel, freezes my actinic keratoses as they show up.  They're tiny and mostly on the left forehead.  As a practical matter, it's nice not to have them.  

 11/22/2017 05:26 PM
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dingpatch

Posts: 13081
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Now, with the VA, I see the Doc and the PA every 6 months; it has been long enough since my melanoma that they say I no longer need a skin check every 3 months. OK by me.
Previously, at the Health First doc, I did occasionally see the MD, but otherwise my main "treater" was his PA. She was very attentive and was otherwise very good at what she did. Her father had been a skin cancer dermatologist and he had trained her well. Out of the many, many, biopsies she did on me only 2 or 3 came back as not cancerous. Better safe, than sorry.

As the MD told me the first time I went to him many years ago: "Dingpatch, Florida surfers need to be very, very, careful with having had so much exposure, and burning from the sun. You MUST be aware of any changes you might see. At even being detected a couple of weeks too late, Melanoma can be a Death Sentence."
 01/17/2019 01:07 PM
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ww

Posts: 14602
Joined Forum: 08/17/2007

I saw the dermatologist once about a small cyst or boil or whatever on the left ear lobe. He thought it non-cancerous. Then it ruptured and wouldn't stop oozing. I was patient. After a routine visit to the internist, who didn't like it, back to dermatologist. He wasn't excited and didn't think a biopsy was essential, but that it would be a good idea. And I should work harder at applying medication, bandages, and take an antibiotic. Biopsy back, squamous cell carcinoma. That's not a real big deal. Will be treated. This, like much of skin cancer, seems to be largely a problem for older people. My only other skin cancer was back around 2001, a basal cell. Lots of actinic keratoses frozen off since.
 01/31/2019 04:03 AM
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ww

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Joined Forum: 08/17/2007

Went to the dermatologist at 8:10. Left about 11 with most of the ear lobe gone and a big bandage. Returned to the office at 1 pm for stitches (no-stitch healing would have taken longer; going to a plastic surgeon could look better, but there isn't much on the ear to assemble a new ear lobe from. Maybe trim the other one? I dunno. I might be able to get my ear wet on Feb. 11.
 01/31/2019 06:28 AM
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Central Floridave

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just got back from donating skin this morning. Actually just burned a couple spots. When in doubt cut it out.

Sorry WW!
 01/31/2019 07:23 AM
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SurferMic

Posts: 832
Joined Forum: 06/30/2012

got melanoma spotted and removed early...1 little cell in the inside of my ear looked like a freckle, Dr. got it before it set root, Hooray!!! I am still on this earth chasing waves (thx Dr. Bishop). It was in a spot you would have to push sunscreen into your ear canal to protect....Good advice from my last Dermo visit...it was recommended to document through pictures all body spots EVERY month. They need a record of growth rate, shape change, etc.... I recommend everyone do this (just keep them to yourself please). Long term photo documentation is so easy now with cams on every phone.
 01/31/2019 03:35 PM
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ww

Posts: 14602
Joined Forum: 08/17/2007

Oddly, my last regular dermatologist visit was the first in a long time with no spots frozen. I'm pretty happy to have had only one basal and one squamous, so far. A grandmother's family came from around Vaasa, Finland.
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