Posts Tagged skin cancer
Nursing Home Patient With Skin Cancer – An Ethical Dilemma
Posted by admin in Dr D's Truth on March 5, 2013
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.
Best Regards,
John Di Saia MD
Originally posted 2010-12-15 07:30:54.
Mohs Surgery and Plastic Surgery – How Does This Work in Orange County?
Posted by admin in Dr D's Truth on March 4, 2013
Mohs surgery is surgery for the removal of skin cancer which is common in Orange County due to our “sun sitting tendencies.” It is mostly offered by dermatologists and is specifically designed to remove the cancer with a low recurrence rate. Derms generally perform it under straight local (numbing shots in the office) and it is quite profitable for them. In this case the procedure to make the hole (that is what Mohs does) pays much better than the surgery to repair that hole. Some Derms in Orange County try to use Moh’s for nearly everything as it is profitable. This is not always in the best interests of the patient.
At times a dermatologist will refer the patient to a plastic surgeon for the closure after the Mohs is complete. This can be upsetting to the patient because unless it is arranged ahead of time, the plastic surgeon may not be able to get the patient scheduled for a few days.
You may have seen people walking around with large bandages on their ears or noses. They may not have had accidents as you might have thought.
An alternative is to have the skin cancer surgery performed entirely by a plastic surgeon which can decrease the patient’s total expense and allow for anesthesia and completion of surgery in one day. The plastic surgeon may order a frozen preparation of the removed tissue in the operating room (called frozen section) and the results have a similar cure rate and often look a whole lot better. Many plastic surgeons will take cases like these as long as the cancer isn’t too small because we are paid less to remove the cancer with conventional surgery than the Derms get with Mohs.
Best Regards,
John Di Saia MD
Originally posted 2011-03-04 07:30:28.
Tanning Salon Owners Mislead Clients
Posted by admin in Dr D's Truth on February 13, 2013
Many tanning salons are downplaying the health risks associated with indoor tanning while claiming that time in a tanning bed offers an array of health benefits, according to an investigative report from Democrats on the House Energy and Commerce Committee. Committee investigators, posing as fair-skinned teenage girls, called 300 tanning salons across the country, and found that 90% said that the use of tanning beds did not pose a health risk. When pressed about skin cancer risks, some salon employees said the link to indoor tanning was “hype” or “a big myth.”
Source: skinandallergynews.com/newsletter/the-skinny/singleview40946
/tanning-salons-mislead-teens-congressional-probe-
finds/4aaea3a6b8.html
Studies showing tanning bed use is associated with increased risk of skin cancer and even melanoma skin cancer are now plentiful. It is funny though to expect businesses outside of medicine to discuss risk much. Does it really surprise anyone that tanning salon management downplays the risk of the services they provide?
As far as I am concerned tanning salons are cancer traps. They should have warnings similar to those on cigarette packages proclaiming the absolute foolishness their patrons have in using their services. I will even donate to the hypothetical copy of such a statement:
“To our Clients,
While we appreciate your patronage please be advised that tanning beds have been associated with increased risk of skin cancer and premature aging. The money you are pouring into our pockets might be better spent on sunscreens and sun avoidance clothing. By using these facilities you have decided to go against your better interest and as such the ownership takes no responsibility for the cavernous wrinkles, cancer and even death you might receive in the bargain.
Thank you.”
Best Regards,
John Di Saia MD
Originally posted 2012-02-09 07:30:06.
Patient Comment – A Plastic Surgeon in Orange County For Skin Cancer – Who Knew?
Posted by admin in Dr D's Patients on October 30, 2012
Patient Comment:
I am so thankful that you were able to remove and repair my skin cancer. I didn’t know that a plastic surgeon would do this for me and Medicare would pay. Thank you. It really looks better and better every week. You are great! I really think you should blog on this as I am not sure people know that plastic surgeons are willing to help with skin cancer. Why would I ever go to a dermatologist for this again?
Thanks for the kind words.
I have been taking care of skin cancer for years and am a regular Medicare (not Medicare HMO) provider. I guess not many people know that they can often have skin cancer removed and repaired by plastic surgeons to minimize the appearance of the event. Repair of disfigurement might also be covered but it varies by insurer.
Best Regards,
John Di Saia MD
Originally posted 2010-12-07 07:30:20.
Reader Laura on Tanning Beds & Skin Cancer
Posted by admin in Medicine in the News on March 8, 2012
Reader Laura’s Comment:
“FDA advisers urge stricter regulation of tanning beds”
Do you think that stricter rules for tanning beds will help with the rate of skin cancer? Have you seen a rise in the number of people coming to your practice with skin cancer?
Skin cancer is the most common cancer. The incidence has been rising and studies have linked increased risk to tanning beds as well as other sources of UV light exposure. I am not big on regulating everything however. People should simply be responsible for their own actions.
When you use tanning beds, you increase your risk of skin cancer, skin aging and the like. Adults need to be aware of these risks. Restrictions on adolescents might be reasonable however.
Best Regards,
John Di Saia MD
Originally posted 2010-05-24 07:30:17.
Sunscreens Can Cause Skin Cancer?
Posted by admin in Medicine in the News on December 5, 2011
According to that study, nearly half of the 500 most popular sunscreens may actually increase the speed at which malignant cells develop and spread skin cancer such as melanoma.
Why? Because they contain Vitamin A, an ingredient that was added to sunscreen formulations because it’s an antioxidant that slows skin aging.
This isn’t necessarily new information….as some studies suggest “that vitamin A might have some phototoxicity.”
Source: health.msn.com/health-topics/skin-and-hair/articlepage.aspx?cp-documentid=100260739
Take it easy folks. One study on the effects of Vitamin A on skin cancers in animals does not invalidate sunscreen use. We don’t really need Vitamin A in sunscreens though. We need good blockers of UVA and UVB at an SPF of at least 30.
Best Regards,
John Di Saia MD
Originally posted 2010-07-12 07:30:47.
Governor Jerry Brown Nose Job? – Not Really.
Posted by admin in plastic surgery news on October 26, 2011
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.
Source: news.yahoo.com/s/nm/20110501/people_nm/us_california_brown
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.
Best Regards,
John Di Saia MD
Originally posted 2011-05-01 07:30:29.
Plastic Surgeon for Skin Cancer – Why?
Posted by admin in video clips on October 17, 2011
I have had a practice in Skin Cancer for years. When there was more cosmetic business around, I did less. Now I am doing more.
Why Do Patients Want A Plastic Surgeon For Their Skin Cancer Surgery?
Because I help minimize deformity. That’s one of the things plastic surgeons do. Looking at the image here, I helped not only make it look better, but reduce loss of function of the hand by reducing tissue loss.
Best Regards,
John Di Saia MD
P.S. I made a little YouTube video of part of this operation if you wanna check it out.
Originally posted 2009-03-04 08:30:00.
Kaye Cowher dies of Skin Cancer at 54
Posted by admin in Medicine in the News on August 19, 2011
Kaye Cowher, the wife of former Pittsburgh Steelers coach Bill Cowher, died Friday after battling skin cancer, the Pittsburgh Post-Gazette reported. She was 54.
Born Kaye Young in Bunn, N.C., she met Bill Cowher at N.C. State in 1976, where he was a football player and she and her twin sister Faye played women’s basketball. The couple married in 1981.
Kaye Cowher played a key role in her husband’s decision to retire from coaching in 2007 and move full-time to Raleigh, so the family could be together as their daughters completed their high school and college basketball careers.
-from ESPN.com
Skin cancer death are almost always due to melanoma. The family has not released any information, but this is the most likely cause. Wear your sunscreen….
Best Regards,
John Di Saia MD
Originally posted 2010-07-24 12:00:15.
When You Really May Want A Plastic Surgeon For Skin Cancer….
Posted by admin in skin cancer on August 19, 2011
We discuss skin cancer and plastic surgery here intermittently – most recently here.
Large Basal Cell Skin Cancer Neck
Here is a case in which the gentleman had a really large skin cancer behind his neck. He of course didn’t realize it was that large. His dermatologist sent him to me before she did the removal surgery to take the skin cancer out.
After she removed the skin cancer, she sent him to me with the hole you will see after the jump (if you would like.) I operated on him the day after to perform a local flap to get this wound covered. These are not pretty cases. Many plastic surgeons avoid them as they believe that the results will impede their cosmetic practices. They may.
Obviously, this is not a cosmetic case although plastic surgery can make it look less objectionable that it would have in the hands of other specialists. If it were cosmetic, his health insurance wouldn’t have covered it. It did.
Best Regards,
John Di Saia MD
Originally posted 2009-12-31 07:30:12.
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