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Need doctor info on facial skin cancer..Part Two

3 days ago

It was in December I did the topic about DH's possible skin cancer on his scalp and who needed a biopsy. Guess whose turn it is now?

Readers, just in case this is skin cancer, take my advice. Look at your face with a magnified mirror, sans makeup. Last year I was putting my makeup on using the mirror when I saw the tiniest red spot on my cheek, about an inch away from my nose. Without the mirror I never would have seen it until it got bigger, which is did. It's still tiny but it now has a tiny bump and is obvious to my naked eye.

This morning was my yearly visit with the GP who thinks it's skin cancer and referred me to the same dermatologist my husband will go to.

Here's the thing. I looked up the Derm, and she has over 200 reviews of 4.5 out of a 5 star rating. Great! Until I read the reviews about how most of the patients were extremely irritated because she is so overbooked they sit in the waiting room full of people for an hour, then go to the exam room and have to wait again.

I'm sorry, I don't do waiting. I have been know to get up and leave doctor's appointments, kind of like The Runaway Bride. :)

Not only that, because of her overbooking and high ratings, it takes a few months to get in to see her even from a referral. DH made his appt. in early Dec and isn't scheduled to see the Derm until March. The doctor told him if the spot has made no change to keep the appt, but if it changes to contact him, the GP, to get DH (and maybe myself) in asap.

What would happen if I found another highly rated Derm and did this on my own without a referral? Years ago I never needed a referral with a Derm and it was easy making an appt. Because I have new insurance, do most insurance companies only cover specialists if there is a referral? I don't see why a Derm would have to be referred because they cover so many things, from dry skin to cancer.

Second question. Since this is on my face how do I know the Derm or any Derm won't butcher it? Are they qualified to do biopsies on faces without a plastic surgeon in attendance?

Comments (21)

  • Oakley

    Last question about sunscreen. I'm ashamed to admit this but I never wore sunscreen and I'm fair skinned with light eye's. Now that I'm 65 and hardly ever in the sun anymore, even in the summer (I can no longer tolerate heat), do I need to wear sunscreen? I figure if I'm going to get more skin cancer (if I have it already) it's from all the sun damage from previous exposure.

  • mtnrdredux_gw

    kind of like The Runaway Bride

    I'm sorry I can't help w any of your q, but your joke made me laugh.

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  • cooper8828

    I can only answer part of your question. Around where I live, most specialists other than OB/Gyn will not see you without a referral from a PCP.

  • tinam61

    I have no clue what your insurance company requires regarding referrals. You should be able to find that info in your booklet or on their website.

    Regarding the wait, if it is a top-notch dr., I would deal with it. Take a book, play on your phone, etc. IMO, the most important thing you can do is use a dermatologist trained in MOHS surgery. Regardless of what closure you choose, you want the MOHS. My derm offered me the option of him doing the complete surgery or having him do the MOHS and then going (immediately) to a plastic surgeon for the closure. Because my dr. has a great reputation, has done many, MANY facial surgeries, my level of comfort with him, etc. I chose to let him do the full procedure. I was not sorry.

    Sunscreen every. single. day. It not only protects against skin cancer, but other sun damage, such as aging of your skin. You can get sun through your car window. Be diligent!

  • Oakley

    Tina, is MOH's just for cancer removal or is it for biopsies too? Right now I'm only concerned about how she closes a biopsy, but I'm guessing with so many good reviews she must do a great job. Biopsies only take a few minutes on small areas. I'm going by a mole removal and biopsy on my upper arm. Surely she has the procedure perfected for little scarring.

    I remember reading MOH's is for fast growing cancer and I can't tell if mine is fast growing or not. It's grown in the past six months though which I guess isn't good.

    I'll be buying sunscreen asap. Any recommendations?

    And you're right, I'll take something to play with while I wait. :)

  • graywings123

    I have used Oil of Olay with SPF 15 for, well, forever. There are lots of other products out there with higher SPF and other stuff. And much more costly. But this is cheap and readily available. (I actually buy the generic versions now, which are even cheaper.)

    Oil of Olay

    When you select a product, note whether it has avobenzone. Avobenzone stains white cotton and is a bear to get out.

  • runninginplace

    Re. finding a doctor, the dermatologist you were referred to sounds like she is very good which is why she is booked so heavily. I would suspend a no-waiting policy for that although I"m usually in agreement. I hate cooling my heels in a dr's office for hours but it's often worth waiting to have that kind of expertise.

    OTOH several months is a long time so it may be worthwhile to try to get in to see someone else sooner. I would do that via the doctor's office/referral system only because if it's a worst case scenario you don't want to be facing huge medical out of network bills.

    As far as the biopsy, I've had a ton and they are very small removals of tissue so there isn't any stitching involved nor scarring; it should just heal up on its own.

    For the actual removal, on the face especially Mohs it is. As the currently half-nosed veteran of one of those worst case scenarios :), cancer on your face should always mean you do whatever necessary to get the best care that will minimize scarring and also take care of the problem. I am very grateful that I had my removal done by a qualified dermatologist-surgeon because I know she did her best to get it all out and still avoid taking more tissue than needed.

    I'll also recommend that prior to Mohs you ask specifically how and to whom your doctor refers you for reconstructive closing and repair if it becomes necessary. It's not insulting to a doctor to ask who handles things if it is necessary to pass you along for a next stage treatment. And especially on the face--you want it done as perfectly as possible to get back to looking like your old scar-free self ;).

    As another fair skinned blue eyed person who didn't take care of herself in the sun.....yes you should be wearing sunscreen all the time. And if you are starting to have skin cancer or skin cancer related issues (those actinic keratoses, pre-cancers etc) TAKE THAT SERIOUSLY AND GET CHECKED FREQUENTLY. Sorry for yelling but one thing my dermatologist has said that resonates is: what you see now is the result of damage done over many years. Skin issues aren't spontaneous and if you have one problem, you are likely to have more.

    Don't ignore and don't delay--not that you did Oakley but in general. In my current situation, the side of my nose had no visible lesion at all! But I'd had a nagging feeling for a very long time that something wasn't right. I get checked regularly but it still ended up that I had a skin cancer that obviously had been growing for awhile.

    Corollary-in my experience and in support of get things checked, often a spot I think looks suspicious or which scares me turns out to be nothing, while during the check the dr finds another spot I never noticed that ends up being a problem! Suffice to say that 1) a good dermatologist is priceless and 2) once you find her or him, have that derm look you over frequently :).

  • tinam61

    Running is on it! For a biopsy, I am only familiar with scraping or a punch biopsy, I believe is what they call it. That is where a little piece of the bump, nodule, etc. is taken. It is not stitched. They heal from the inside out and it just makes the "bump" smaller, but does not scar. They don't look very pretty healing. Color science is a good sunscreen. I use a higher SPF on my face and I don't mind to spend more for a good facial sunscreen. You want something that does not irritate your face, isn't oily, etc. Good luck!

    Oakley thanked tinam61
  • Oakley

    Running, because I have a bad habit of picking things on my body, mostly my arms where the cat keeps biting me, I'm really good at noticing a new spot. :)

    The doctor told DH the spot on his head was most likely the slow growing cancer which is why waiting until March to get it biopsied is fine, unless there is any change. No change so far.

    Should I expect a full body check or do you think it will be just the biopsy? I'm thinking only the biopsy.

    This is kind of funny and an example of how I notice anything new on my skin. The side of my forehead had a light brownish spot on it and I freaked. It was about 15 years ago so I made an appt. with a dermatologist. He looked at it and then started laughing and said, "welcome to old age, it's your first age spot." lol It's never changed!

    The little spot on my face is the color of a broken capillary, red. It's the size of a pin head and now has a little bump. I have searched and searched for pictures showing early signs of cancer on the face. I got a lot of pictures but nothing like the spot I have. Not even close to it.

    I'll look at sunscreen today. Do I need it if I'm just going to the store?

  • pamghatten

    Your first time at the Derm they should do a full body check. Mine does. I've been going for 3 years now annually, since I am also fair skinned, but have used lots of sunscreen over the years. I have pre-cancerous places around my hairline that she (the PA) burns off. Actually, they do a full body check every year.

  • Bluebell66

    Sorry to hear about this! Yes, you need sunscreen if just going to the store. You need it if you never leave your house, and if it’s raining. The UVA rays are the ones that get you even when it’s not sunny, so sunscreen really is a necessity every day, year round.

    My Derm recommends sunscreen over moisturizer with SPF. She feels it’s more effective. (You could use both.) Also, you really do need to reapply sunscreen every couple of hours. Such a pain, I know, and easier to do if one doesn’t wear makeup. I have a tube of brush on Colorscience Sunforgettable powder for touch ups if I’m out and about. It’s expensive, but less so if you get it at Costco. It does last forever, though.

    I like mineral sunscreen instead of chemical sunscreen because the chemical ones sting my eyes. I prefer a tinted sunscreen for my face like Sun Bum or Elta MD. For the rest of my body, I use whatever I can find that is relatively unscented and not tinted.

    There are tons and tons of articles about sunscreens. I recommend you google for more specifics for your skin type. I find that some sunscreens dry my already-dry face out, for instance, so I look for one made for dry skin. Good luck!

  • maire_cate

    You may want to check this site from the American Academy of Dermatology - it covers how to select a sunscreen, apply, read the label etc. It's very informative.

    I used to use the Oil of Olay with a 15 SPF - however that is not sufficient. The AAD recommends 30 or higher.

  • Oakley

    Pam, I'm not sure if the full body check will be done that day because of the biopsy. But if she does do one, do I have to get nekkid under a gown?

    Bluebell and Maire, thanks for the info. I'm going to check the link out now and then I'm going to find out WHY I need sunscreen inside the house. lol

    I don't wear moisturizer in the summer because I hate it on my face if I sweat.

    This is starting to bother me, it didn't bother me yesterday for some reason. I had to do an errand a bit ago and the only makeup I wore was light lipstick and translucent powder.

    When I stood back from the bathroom mirror, not the magnified mirror, I could plainly see the spot.

  • gsciencechick

    I am going this week since I'm now on a 6-month rotation to check out some areas--yay!

    Yes, Oakley, you will need to put on a gown. I can leave my undies on (bra off) but they do peek underneath.

  • maire_cate

    You will have to be naked under the exam grown. Melanoma can occur underneath nails and on areas that don't get sun - between the toes and the bottom of the feet. So don't wear nail polish when you have your body check.

  • happy2b…gw

    I saw the dermatologist last week. Bring your own wrap or robe. She will ask you to disrobe everything except your panties and give you one of those stiff paper robes with the flimsy tie. I did not have a biopsy this visit but have once or twice in the past. They resulted in just tiny scabs that i treated with vaseline, no scar. When I had MOH's on my face, a dermatologic plastic surgeon did it. I have a very, very small divot, but no scar.

    As for needing a referral, insurance policies vary. I do not need a referral with my current health insurance. Contact your insurance company and ask. If you do need a referral, ask your doctor to write one for a different dermatologist if you want to see one sooner. A biopsy of a small bump should be a minor procedure. If it turns out that you need more treatment, you can always go to the derm your husband is seeing in March. Another thought is to ask if you can be squeezed into the schedule with your husband.

  • Oakley

    Thanks for the info. I have a feeling there won't be a body check only because the biopsy will take a little while then she'll need to see her next patient. A body check can take quite a while depending on the moles we have. But I'll be ready just in case. I think I'll wear my new white undies with tiny navy pindots. lol

    Found another spot! I was looking at my right arm where all the cat and rose bush scars are and saw a spot that is brand new. Small and flat like the other one but it has a darkish center. Now it could be from something else but I'll keep an eye on it. The reason I'm concerned is I tried to gently pick at it to see if anything would come out, and it didn't. And then it started itching really bad along with the area right next to it. I read skin cancer can itch. It feels like a mosquito bit me.

    I've got a lot of explaining to do if she sees that arm. :)

  • Mrs. S

    I'm so sorry, don't have time to read every answer, sure you're getting good responses. This issue is near and dear to me. I'm fair and wear sunscreen EVERY DAY, especially on face and neck. Here's what I'm using lately, because the reviews are so good, and because I like how they go on (and they are not expensive):

    First, a chemical sunscreen, then a physical sunblock over it, to cover all the bases. The Australian Gold has a non-greasy feel, and the slightest of pale tint to it. Not much, but it's nice.

    Secondly I'd like to add (sorry if someone already did), that you can and should request your pathology reports. Read them. You can also ask who the pathologist will be who is working on your Mohs surgery. Let's just say, someone close to me is a pathologist specializing in derm, among other things, and I would make sure there's a dermatopathologist involved during the surgery, and no substitutes. Secondly, I was once having a big, suspicious mole removed (wasn't on my face), and the dermatologist started talking to me about scar minimization. I told her: "Take a big wide margin and go deep." and you know what she said? She said, "Yes, that's what I would do, too." Funny, she didn't mention that until I said what my preference was.

    I felt like everyone speaks of scar minimization, but knowing what goes into these things, I care more about getting wide margins. My 2cents.

  • runninginplace

    I just ordered Australian Gold tinted sunscreen; the PA at the dermatologist already had told me I should up my game from moisturizer w/SPF 15 so I might as well transition to something that will give me solid protection.

    Oakley, I think you can almost certainly count on the dermatologist doing a full body check; it's the basis of the care you will receive. Dermatologists do the biopsies and checking of specific spots as a corollary to that exam. And an experienced doctor can do a body check pretty quickly, as I mentioned it amazes me the spots they catch instantaneously while scanning.

  • pamghatten

    I agree with Running Oakley .. if you have even one spot that concerns you, you should have a full bofd check to see if there are any others. Mine is quite quick also.


    Timely! I just returned from dermatologist appointment for full body skin cancer inspection. My experience was the paper gown with undies on. The exam did not take all that long and she did look over every area with a magnifying glass--front and back. I had a couple of newish spots that looked weird and she noticed them. Said they were nothing to worry about and not cancer, just from something having scraped or cut the area in the past. I don't remember having a skin injury in those areas, but she says we can have it happen and not notice if it's a light abrasion. Anyhoo, that's what happened today. Thought I'd let you know. I was a bit nervous as I live in CA and sun is our near constant companion here. Got a good report, thankfully as for many years sunscreen and I did not get along well.

    This dermo likes how Elta MD sunscreen protects and says most patients tolerate it well. She prefers the physical sunscreen version of theirs over the chemical one. I am really liking Supergoop Unseen Sunscreen SPF 40 for face myself and she gave it a thumbs up too.

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