When looking into the treatment of skin cancer many patients go to their "regular doctor." We have been asked at times: "Why would I want to go to a board-certified Plastic Surgeon for skin cancer?" Did you know it is usually covered by your health insurance regardless of who takes care of it for you? Why not have it look the best it can after it is removed?
What might the area look like if operated upon by a non-plastic surgeon? Here's an example for a simple case:
Skin Cancer Removal by a non-plastic surgeon - Not by Dr Di Saia
Plastic surgeons are trained to take into account your post-operative appearance much more carefully than other specialists. This scar would be deemed unacceptable to most plastic surgeons as it has several problems:
- It is Uneven.
- It has "Frankenstein Marks" Cross Hatching from too many external sutures.
- It is a bit Thick at the center.
We see a few problems like these on occasion, but very rarely do we see all of them in one wound. We use sutures underneath the skin to hold tension, so we get much less Cross Hatching. We design our incisions to be more curved and even.
This kind of scarring is that which you often observe after surgery by non-plastic surgeons. These other doctors have as their focus to cure the cancer and there is nothing wrong with that unless you'd like to look better afterward. In really large cases or in sensitive areas of the body, your "regular" doctor may refer you to a plastic surgeon for care anyway.
Dr Di Saia performs reconstructive as well as cosmetic surgery. As skin cancer is very common (especially in Southern California,) it is reasonable to cover it here.
Skin cancers vary in severity from the relatively minor Basal Cell Cancer all the way to the potentially fatal Melanoma. There are two main aspects of skin cancer treatment:
We see a fair number of patients who have waited months to years to get treated. Skin cancers are much more likely to get larger over time than go away without treatment. Earlier treatment usually results in reduced scarring and chances of recurrence. Most skin cancers need to get quite large before they threaten life and limb. They much more commonly produce deformity.
- Removal - obviously removal of the skin cancer is advisable as the tendency is for the lesion to grow or spread. Dr Di Saia does remove some skin cancers in the office, but prefers to do complicated cases in the local hospital operating room.
- Reconstruction - This is the repair of the defect created by the removal of the cancer. This can involve layered closure, skin grafting or local flaps. Local flaps involve the rearrangement of the nearby skin to allow coverage of the defect with similar tissue. Local flaps are most commonly used on the face, nose and ear and are considered "complicated reconstructive maneuvers" by your insurance company. We cannot guarantee that your insurance company will cover all of the costs of reconstructive surgery, but they usually cover it to some extent.
Take into account that skin cancer reconstruction is not cosmetic surgery. It is repair after cancer removal. In cancer reconstruction, patients more frequently end up with scarring and distortion than in cosmetic cases. A goal in plastic surgery is to try to minimize this disfigurement. This is why some patients will consider involving a plastic surgeon in the first place. Your dermatologist is more often than not focused upon cure....as he/she should be.
A Few Examples [Before's Shown]:
On Medical Insurance
Over the past few years we have learned to be very non-committal on the issue of medical insurance. In the case of skin cancer, it is pretty likely that insurance will "cover" the procedure. Dr Di Saia sees a fair number of skin cancer cases some referred by Dermatologists (large cancers and cancers in sensitive areas (nose, face, ears)). Recently we have seen more patients refer themselves opting for a better appearance after surgery.
Most insurance plans tend to restrict your access to plastic surgeons. At this point, Dr Di Saia is a provider for few HMO plans. We still treat Medicare as well as insurance patients with "Out-of-Network" benefits. Please call ahead for availability.
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© John Di Saia, MD... an Orange County
California Plastic Surgeon
Serving Southern California since 1997 * (949) 369-5932