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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I was right.

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.



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.

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.  

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."

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Dora Hates You

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.

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.