Posts Tagged deformity
An interesting philosophical conundrum arose at a sub acute hospital at which I see patients. These are not the plastic surgery patients you see on reality television. They are ill complicated patients too sick to go home. Sometimes they are people with brain injuries after having had surgery or a stroke.
What do you do when one of them gets a skin cancer?
I was asked to see such a patient recently and seeing what I believed to be an obvious skin cancer I obtained a biopsy. Another doctor seeing the patient asked me why I bothered. To him operating to remove the cancer for this patient was a “waste of resources.” I respectfully disagreed. Most skin cancers do not kill, but this one had obviously been left alone for quite a while. It had grown large and will likely leave deformity when (or if) it is removed. But not doing anything dooms the patient to a slow erosion of his facial features. It was pretty ugly. In my opinion it would have been better to remove this cancer when it was much smaller, but I didn’t see him then.
Unfortunately entertaining removal of the cancer opens more questions. The man does not have a conservator for medical affairs. Until one is appointed, consent for surgery cannot be obtained unless two doctors document an emergency. This is not an emergency.
My philosophy is to obtain evidence of cancer and present this to the patient or medical guardian with a series of options. This seems to be a matter of opinion.
The philosophy of your doctor makes a difference in your care. This is an interesting crossroads of such philosophies.
John Di Saia MD
Originally posted 2010-12-15 07:30:54.
The growth was removed under local anesthetic on Friday, after tests revealed the presence of basal cell carcinoma, Brown’s office said in a statement. All the cancerous cells were removed, but some reconstructive surgery to Brown’s nose was required due to the procedure, it said. Brown, a 73-year-old Democrat, is at home and conducting state business.
Basal cell cancers are very common. They number 4 of every 5 skin cancers we see. When such a cancer is on the nose, frequently a little reconstructive plastic surgery is helpful to minimize the deformity. The downtime is generally short unless the cancers are quite deforming due to size.
John Di Saia MD
Originally posted 2011-05-01 07:30:29.
This 60 year old lady had had silicone gel breast implants for thirty years. Over this time her breasts changed slowly and she barely noticed the progression to the rock hard things they had become (lower left of our image.) She came for consultation to have the hardened implants removed, but wondered if not replacing them would leave her more deformed.
Her pre-operative image (lower left) shows capsular contracture with high positioning of the implants forced by the scarring that had occurred over the many years they had been in place. Minimal correction in this case involved removing the implants without replacement and also carefully removing the scar capsules themselves so the breasts could appear more natural. Breast lifting could have been added but the patient did not desire it. She had plenty of normal breast tissue to fill in the area without leaving a deformity. She was quite happy afterward with softened normal looking breasts and no implants.
John Di Saia MD