Choosing a Doctor

I was referred by my dermatologist to a doctor in her network who performs Mohs to remove the basal cell carcinoma.  My mother had used this doctor too. The doctor only did group consults, which was a little disappointing, but I figured that I’d just have to deal with it.

The day of the consult, I showed up to the conference room for the group consultation.  Here I was, a 43-year-old mother of a pre-teen and a teenager, surrounded by a dozen men aged at least 75 or older.  Needless to say, I felt slightly out of place.  (she did have us sign confidentiality statements to not discuss other’s cases, however)

She explained the procedure to us all, and then went around the room to examine each of our spots and tell us her plan.  I was about the 8^th person.  Everyone else before me was told “ok, you are going to have a small scar on your shoulder/back/leg etc.”  Then she got to me.  I figured I would be told I’d have a small scar too.  But what she said, was  “this is going to be bad.  You are going to need a skin graft, or a flap, or cartilage from your ear to repair it.” 

WTF? This is not what anyone wants to hear.

It tuned out that because of the location of my cancer (location, location, location!) my case was not an easy one.  Even though it was very small and we caught it very early, my cancer was located about 2 mm from the edge of my left nostril, about half way between the tip of my nose and where the nose meets the cheek.  There is not a lot of real estate there for them to work with, so they need to get material from elsewhere to rebuild it after taking out the cancer.  On top of that, my basal cell was micro-nodular, which meant that it sent down sneaky roots.  Bad news.

The good news is that mine was small, and that basal cell carcinomas are slow growing.  This was not a threat to anything other than my vanity, so I could wait a few months to have the Mohs surgery done.  In fact, the doctor told me, since this was June and we were heading into vacation season “Do everything that you want to look good for, and then we can do the procedure in September.”  I told her I was hoping to look good for the rest of my life.  Needless to say, I left fairly upset over the prospects of facing an involved reconstructive surgery when I had thought that all I would be dealing with is a few stitches. 

I got home and proceeded to talk with everyone about it – my husband, friends, neighbors and family.  Many of them recommended that I have a plastic surgeon close the wound rather than the dermatologist.   The thought had never occurred to me, nor had the Mohs doctor mentioned it as an option.  I called her office to ask whether or not she worked with a cosmetic surgeon, and did not hear back.  I called again a second time and was told that there were two in the network that she recommended, so I made an appointment with one for a consult.

The plastic surgeon told me he thought that there was an 80% chance I would not need his services, that the Moh’s doctor did an excellent job closing her own work.  Not knowing how big my wound would be until they actually do the Mohs procedure, however, all we could do was guess at what would need to be done. While this gave me some comfort knowing that a plastics doc was available if need be, I was still unsettled by the whole process, especially that the Mohs doctor never mentioned using a plastic surgeon to do the close.

As I continued to talk with friends about the situation, I got the recommendation for a different Mohs doctor from two of my friends who had used her and were very happy with their outcomes.  I decided to do a consult with this second doctor to see what she thought. 

Immediately after our consult, which was in a private appointment lasting about 30 minutes, I was reassured that she was the doctor for me.  She was warm, empathetic, and positive. The very first thing she said when she examined the site of my basal cell, was that I should undoubtedly have it closed by a plastic surgeon.  She said there was a tiny chance that the site would end up being small enough for her to close it herself, but that I should have someone who specializes in the contours of the nose take care of it.  This made a whole lot of sense to me, and I immediately booked my appointment with her for the Mohs procedure.   Her Mohs Coordinator took care of scheduling consults with 2 plastic surgeons so I would have a choice.  What a difference from the first doctor!

There were two options for the “close” with the plastic surgeon: (1) I could have it done the same day as the Mohs procedure, which meant that there was only one day of medical procedures but that I would not be able to eat all day due to the general anesthesia required for the repair, or (2) I could do the repair the day after the Mohs procedure.  I opted for the former, figuring that I’d rather have it done all at once.  In retrospect, I might do it differently next time (details later).