Self-Advocacy in Skin Cancer Treatment

With more than twenty-five years' history of skin cancer, I can’t tell you how many procedures and surgeries I have had to remove basal cell, squamous cell carcinomas and treat actinic keratoses.

Mohs on my mind

I can tell you, though, how many Mohs surgeries I have had: one. All of my other surgeries have been excision surgeries. The thought of having a Mohs surgery made me nervous. It was the unknown, to me. I had seen photos of patients post-Mohs, and some of those photos looked scary. Mohs looked invasive. I knew that Mohs had a great success rate, but I didn’t want it. For a basal cell carcinoma that was just under my nose, though, I had to have Mohs.

Considering my doctor's recommendation

I didn’t arrive at accepting that I needed Mohs right away. During one of my skin checks with my dermatologist, she said she was concerned about a small area on my face and wanted to biopsy it. The biopsy result showed an infiltrating basal cell carcinoma, and my dermatologist recommended that I go see a Mohs surgeon that was in my area and whom she recommended for patients who needed Mohs.

I trust my doctor, but I trust myself too

My dermatologist and I have previously discussed my hesitation with Mohs, so for her to recommend Mohs for this let me know that she truly thought I needed Mohs. However, I am a fan of exploring alternative options available, so I asked if I could see a plastic surgeon first to see if having it removed by excision was a viable option.

I was hesitant based on my first impression

My doctor referred me to a plastic surgeon who I hadn’t heard of, but when I did some research about him I found that he was a highly-regarded surgeon and had won several awards for his work. I thought that was a good sign, and went to the appointment feeling optimistic. When I got to his office though, I was greeted by posters about his awards – everywhere. On the walls, on the counter, on the table. This felt a little odd to me, and when he breezed into the exam room I could tell almost right away that we were not “clicking”. He was dismissive, talked over me, and had an air of arrogance. He seemed a bit hesitant to do the surgery but told me to call back the next day to schedule the surgery. I, however, wasn’t yet ready to schedule with him.

Getting a second opinion

I called my dermatologist and told her about it. I asked her to refer me to another plastic surgeon, one whom I had heard good things about. That appointment was the complete opposite of my appointment with the first plastic surgeon. The second doctor went through my history of skin cancer, examined the area, and told me she recommended Mohs but told me the reason why – the area didn’t have a lot of surrounding tissue and it would be hard for her to perform the excision and have enough tissue to have a good closure with minimal disfigurement.

She made a thoughtful recommendation

When I told her I had hoped to not have Mohs, she asked why, and she genuinely listened to my concerns. She explained why it would be best to have Mohs, and she said she would refer me to an excellent Mohs surgeon in Indianapolis (not the one near me), whom she said she would trust to do surgery on her if she ever needed it. She said this particular surgeon thought of ways to do tricky surgeries that she as a plastic surgeon wouldn’t even have thought of.

She convinced me

Based on that visit, I decided to have the Mohs surgery, and I felt comfortable with that decision. I was still nervous about having Mohs, but I knew I had done my research to make sure the treatment I was going to receive was right for me.

We have a say in our treatment

Doctors are the experts, but this is my skin cancer, and your skin cancer is yours. As patients, we are allowed a say in our treatment. Don’t hesitate to speak up if you want a second opinion, if you have questions, or if something doesn’t feel quite right, because you are your own best advocate.