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| Dr. Joel Aronowitz |
When it comes to removing the lesion with the best cosmetic result, many small lesions can be removed by a dermatologist, especially an experienced, well-trained dermatologist who's conscientious about the aesthetic appearance. But, if the dermatologist is describing a procedure that you're a little wary of, for example, today I saw a patient who needed to have a skin cancer removed and the dermatologist had described these various flaps that involve making other incisions on the face and transferring tissue, those kind of things. It may be better to get an opinion, at least, from a plastic surgeon to make sure that a more major reconstructive procedure is actually warranted. Also, a plastic surgeon may have some ideas about how to biopsy something instead of the standard methods that dermatologists use because they've been a little bit more experienced sometimes with reconstructive problems.
I'll give you an example. If there is a mole, for example, that has a low probability of being a malignancy but the dermatologist feels like it needs to be biopsied, many times it's possible, especially in a younger person where the scar is going to look worse than the original lesion, to actually just take a portion of that lesion instead of the whole lesion so that a good full-thickness biopsy can be taken, but the scar is hidden by the remaining lesion. So, for example, a mole on the face that's growing hair or that looks a little bit suspicious and the dermatologist thinks it needs to be biopsied, but let's say it's a 25-year-old woman who doesn't want to have an actual scar on her face. Well, you can take that lesion, remove the central third or two-thirds of the lesion and still leave part of it so that it's much smaller, it doesn't look as ugly or suspicious-looking. The pathologist gets a nice specimen to examine to determine that it is or it isn't a malignancy and the patient gets a mole that is more attractive but no visible scar. So, those kind of situations where thinking outside the box a little bit can end up with a better result even if medically taking off the whole mole would have been perfectly justifiable.
So, basically, anytime you're worried about the cosmetic appearance of a biopsy or a treatment, it's worthwhile to inquire with the dermatologist about what will this look like after you do this procedure and if you're not convinced that you're going to have the optimal cosmetic result or there's a potentially disfiguring or really not attractive scar on your face or somewhere that shows on your body that you're willing to accept, it's probably worthwhile to at least get an opinion from a board-certified plastic surgeon. Hope that helps and until then, wear a hat or a little sunscreen so you have fewer things that need to be biopsied.”
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