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.