Well, that’s not exactly what he said. And I’m not even sure he’s a dermatologist, though it sure sounds like it.
For newcomers, this is the latest in a four month saga, including these posts:
- Time to practice what I preach: I have skin cancer again. (Feb 9)
- I’ve started an RFP for my skin cancer (Feb 11)
- Decision: Just scrape it off (ED&C) (May10)
- Raw numbers for treating my basal cell carcinoma at three hospitals (May 21)
Today (Saturday 6/16) on the “decision” post, commenter “Joe” (apparently a dermatologist) said the most interesting, thought-provoking stuff I’ve ever seen anywhere about basal cell carcinoma treatment options:
Been a while since I checked in here.
Would love to know who is charging $3000 for Mohs first stage. We get paid about $700 for the first stage which is the price we do it at.
Well that’s interesting to read; news to me, after all that research.
It probably would be more like $3000 if you had it done in a hospital. (which is where health care is going at huge expense and worse service – guess who wrote the health care bill – big hospitals or a friendly small doctor office down the road)
There is always much more to recurrence rates than just the published figures.
In general we never ED & C on the face, not least of all because, if done right, the scar will be nasty.
I was aware of that, and decised: with this particular teen-acne-ravaged cheek, I was okay with that, especially on the side under the ear.
Then this delicious thought-provoker:
But also ED & C is much less effective in hair bearing areas – e.g. scalp and beard area. Why? Because the tumor can go down hair follicles, trying to scrape it out is like trying to shovel snow in thick grass, the follicles get in the way and the tumor has a passage to go deeper into the skin.
First, I love that visual metaphor (shoveling snow in thick grass); and nobody had ever mentioned this idea. Thoughts, anyone out there? Especially other knowledgeable clinicians or patients?
With a tumor that size in that location the standard of care is Mohs surgery.
It’s fine if one does substandard treatments, we often do especially when cost is involved.
Yep: c’est moi. :-)
The key is follow up to monitor for recurrence.
Yep, as noted in earlier posts. But then this fascinating addition:
The difficulty with ED & C is that the recurrence can be under the scar, so you have to wait for it to grow up and around the edge of the old scar to see it, i.e. the tumor has to get pretty big.
Now that’s interesting. Thoughts, anyone?
Still it can work and hopefully it did, just make sure you continue to get a skin exam every year.
The cost of a one stage Mohs and linear repair in my hands is about $1100. You can never guarantee ‘no scar’ even with Mohs, everyone heals differently.
As I look at the photos again blown up it looks pretty small, you will probably be fine, again just keep monitoring it.
First, Dr. Joe, thanks so much for your contributions. I’m honored and I hope this process continues to help people.
Now, folks, here’s a question that goes to the heart of healthcare social media:
Is there any website anywhere,
government-approved or not,
that says all this?
Again, I emphasize that I don’t know if Joe is who he says he is, and I have no way of verifying what he said above. This is, after all, the internet, and all we know is that somebody said this stuff.
That’s exactly why I asked, twice, what other readers think. When in doubt, verify – then be careful about the verifiers, too.
BUT, if my back-end sleuthing has correctly identified this dermatologist, his local HealthGrades rating is a perfect 5 stars in every category except wait time, where it’s a mere 4.4 stars (usually, not always, within 10 minutes of scheduled time).