Dr. Charles Longo
_ Options regarding skin cancer
There are so many factors that seem to be shaping health care today, trying to cut costs and improve care. So this is what we have all been told, but I’m not so sure. The takeover of medical decision making by the insurance industry, accountants and politicians has been devastating to the quality of care and its accessibility to you the consumer. Unfortunately without a medical background you can be led down any path presented with little resistance, not having a clue there may be a cheaper more efficient and more skilled approach to resolving your problem.
A classic example is the treatment of skin cancers. Originally the treatment and reconstruction of resulting defects from these common skin problems rested in the hands of Plastic and Reconstructive surgeons. We fielded skin cancer problems sent to us from dermatologists, family practitioners, Internists and other surgeons. Logic prevailed that the experts in reconstructing damaged or missing anatomy anywhere on the body would be Plastic & Reconstructive surgeons. Which makes us the only choice for excising these common cancers and reconstructing the defects so well, that you had trouble seeing where the cancer was.
For a variety of reasons the times have changed. What used to be for the most part, a one-stop-shop process with diagnosis, removal and reconstruction being done in a single procedure has now evolved into the current state of care. You are sent to a dermatologist who does a punch biopsy. A positive biopsy sends you to another dermatologist, a Moh’s surgeon. (I take issue with the term surgeon since the Department of Internal Medicine trains all Dermatologists). This physician then does several excisions, along with a pathology fee for each specimen until all margins are clear.
After the Moh’s technique is completed you frequently have to come back another day for reconstruction of the defect. Unfortunately, the Moh’s surgeons are dermatologists without the seven to ten years of surgical training required to become a Plastic & Reconstructive surgeon. The choices of reconstructive options available are entry level compared to the options of a trained Plastic & Reconstructive surgeon. Frequently you end up with patch work skin graft on the end of your nose and you are told how lucky you are that they got all the cancer. Unfortunately this scenario has been sold to the health insurance industry and to the public.
Even with a complex problem excision, the procedure fees and facility costs can be less than most people’s insurance deductibles. This means that you can have the one-stop-shop process done by doctors that invented the techniques of reconstruction for often times, less than the cost of the current conventional route.
What can you the consumer do? Ask to see a Plastic & Reconstructive surgeon for the initial diagnostic excision. You have choices!