Beware of the Sun

[Ric]

I don't to sound like a nag to the younger members of this forum but beware of the Sun.

Today I had a lump on the back of my head checked out by a skin specialist and 40 minutes later I walked out of his surgery with a 3cm cut and 6 stitches.

He basically took one look at it and said "that's coming out" and removed a lump of my skin 3cm long and 1cm wide and probably down to the bone as well.

It didn't hurt at the time but when the local anesthetic wore off boy did I know something had happened to my head.

I also have the double wammy in that I cant take any panadol or aspirin for it because they react and nullify the effects of my diabetes tablets so I have to ride this one out.

The doctor said that the removed section is now tested and if it's benign that all that has to be removed. If it isn't then he will have to remove more to be sure he has it all.

Like I said I don't want to be a nag but wear a hat, long sleeves and sunscreen. I doesn't seem like a big deal now but it will come back to haunt you in the future.

[renormalised]

Yes....take it from me too. I have BCC's in various places all along my arms etc. No tan is healthy, nor is getting burnt too much.

[mswhin63]

I can understand what you are going thru, i was so ignorant right up till until 3 years ago. I got my first BCC. Then it spiralled from there and now 1 BCC and 3 Melanoma's later I finally realised how careful we need to be. I dont get nowhere near as much sun as most people either.

One of the most irritating is most of my removal have Keloid and bubbling and needed about a years worth of Quarterzone injections.

I do not understand how you are feeling about the pain relief, that would be most annoying.

Good luck and keep checking.

[GrahamL]

Good advice Ric, and don't forget the sunglasses.

My optometrist ( michael jackson ) when having a look at a newly noticed growth on my eye stated that he thought that perhaps 60% or more of people don't were sunglasses regularly, I thought straight up thats got to be wrong , but on looking around since , hes pretty much right.


Our eyes have the ability to switch to protecting themselves if there owner won't, I've found this out the hard way :thumbsup:

[CraigS]

So, being a veteran of numerous unpleasant encounters with Dermatologists over the years, I am left with many questions as to the accuracy and precision standards in diagnostic/treatment process.

Very rarely do I get answers to these questions from busy Dermatologists.
Someday, I may get answers .. in the meanwhile I am resigned to having to live in hope ...

My first question is how accurate is pathology diagnosis? I have had fairly extensive subsequential excision surgery (skin), following a biopsy, only to find out that the original lesion was entirely removed by the original biopsy. I felt like the second stage treatment was entirely unwarranted. Upon going back and reading the original biopsy report myself, I found rather ill-defined terms like "leading towards", which seemed sufficient justification (for the referring Dermatologist) to pass me onto a plastic surgeon for further removal of a sizable chunk of me.

Until this encounter, I was entirely unaware that there is still significant uncertainty following the pathology/biopsy stage.

The second question is about the 'surgical margins' taken during the excision process. It would seem that the size of the chunk removed by these folk is entirely arbitrary, (at the upper end of the scale), and it is this, that can result in the removal of major chunks of body parts … perhaps unnecessarily so (?)

My concern is that frequently, we place our care into the hands of busy professionals who are motivated to make decisions on our behalf, which may involve exceeding the 'minimum' amount needed to remedy the cause of the problem, especially given the uncertainty in the pathology domain.

I am aware of the 'better-to-be-safe-than-sorry' counter to all of this, but following several encounters, I am left with feelings that there are more options, than we are frequently led to believe behind a closed door.

Cheers

[mswhin63]

Hi Craig, exactly what my Doctor said, safe than sorry, he initially took out a section, was all clear but decided to be safe took an extra 20-40% afterwards but only after a positive result. I had another mole remove which proved negative and went no further.

[CraigS]

Ever been verbally abused behind a closed door by a Dermatologist ?
I have. It seems that questioning one's doctor is verboten !

It seems that its all my fault .. despite the fact that when I was young, I was always the only kid on the beach wearing a full neck and arm covering skivvy, and every other square inch of exposed flesh was smothered in Pink Zinc !

Seems covering up, and 'slip slap slopping', didn't work for me.

'Twas a bit rough when the sand got in the Zinc and inside the skivvy to, I might add. ;)

Mind you, I'm pedantic about my family wearing suncream, hats etc, now. Beaches are to be avoided wherever possible … there's only bad news at beaches. :(

:)
Cheers

[renormalised]

That wouldn't have worked with me....I'd have interrupted his little tirade and said "do you want to keep your job??". I'd have threatened him with being deregistered because I definitely would've reported him to the complaints committee of the AMA. Regardless of what you may have said, he has no right to verbally abuse you or anyone else for that matter.

He's lucky this isn't the US....you could've sued him for a fortune!!! :):)

[CraigS]

Ah .. don't worry Carl ..

I'm more devious than that …

I think she realised that she'd lost it and ever since, she's bulk-billed Medicare and, despite the occasional 'normal specialist fees', the most she normally charges me is twenty dollars (for the biopsies). These $20 procedures also include local anaesthetics/stitches/cryo, etc and return visits .. so I'm way ahead, financially !!!

Just goes to show how a little moderation (on my part) has probably saved me thousands !

Mind you, it also shows how arbitrary their fees are, too !!

Cheers

[Morepower]

My wife recently had to have a "skin cancer" frozen off the tip of her noze, which totally freaked me out because she is everything to me. My soulmate. So I told her I was marching her back up to the GP to demand he give her a referal to a skin specialist. She is a RN, and agreed without any resistance which i thought was a little strange as she always argues with me on medical stuff. But she had an alterior motive, and that was to get ME checked out as I have worked in the Sun (swimming pool industry) for 18yrs, even installing solar pool heating on roofs for 4yrs. Guess who walked out of his office with a referal ? Back then you didn't seem to hear many warnings (I am 45yo now), and when you did no one took them seriously. I never used sun block and I am fair skinned, as a matter of fact I can remember my boss used to tell us that the girls loved tanned guys because they looked healthy. Seriously they were his exact words. So I'm kind of not really looking forward to that appointment, actually I havn't made it yet for fear of what he is going to tell me. Stupid Stars !!!

[Jen]

:eyepop: sorry to hear that Ric

You just reminded me to put some sun screen on today :thumbsup:

[CraigS]

G'Day Craig;

Prepare yourself for about 5 - 10 mins of blame laying !!

And I've found that a vigorous defensive response also comes into consideration in the 'surgical margins' decision (ie: how much to chop). Once when I defended my life's history, I was confronted with being told that they'd have to take a strip 1 inch by 2 inches and I'd need a skin graft as well.
.. That one eventually got talked down to cryo (freezing) treatment and left no visible scarring !

Good luck.

Cheers

[Morepower]

Not going to happen my friend, I eat doctors for breakfast. If you knew me you would understand. It may have something to do with how they like to treat my wife like crap from time to time being a nurse. I once stripped a doctor down in front of 3 nurses who had been taking his arrogant crap all day when I was in hospital a few years ago. You wouldn't believe how he spoke/treated them in front of myself and the 2 other patients on the ward. They looked after me real nice after that, I got whatever I wanted including beer with my dinner after that. It's not what I was looking, for or why I did it, I just can't stand men standing over women in any way, shape or form. It's gutless and tweeks a nerve in me. I am the patient/customer and things will proceed only if I agree with them. Sorry for the rant, and thanks for the good luck. I feel I may need it.

[mswhin63]

I prefer politcically incorrect doctors, we rely on them to cure us and provide advise and we sue them if they fail. I bet you if the doctor was correct and didn't become more forceful in the advice then we would sue them for not telling us correctly. Not only do they help cure they are also teachers and I alway find one that is not wimpy. If i can't take the heat then I should dig my own grave now.

[ZeroID]

I find it interesting that you all seem to have to argue with your doctors etc to get answers. I've been lucky enough not to have had too many encounters with them but when I have had it has always been on a very consultative approach. Ask the right questions, get the best known answers and agree on treatment and feedback. And I have had a number of doctors over my nearly 62 years so not an isolated instance.

We currently are managing my sinuses and tinnitus, both ongoing issues without much hope for real relief and he is active in finding things that may help releive it. When I got made redundant we had quite a long chat about stress and choices with regard to my health.

He is part of a medical group of about 4 or 5 and I have seen most of them when my particular Doc is not available and never had issues with any of them.

[Ric]

I'll have to agree with Brent, the doctor I went to was very good.

He explained all about the procedure and talked me through it while he was carrying it out.

He encouraged me to ask questions at any time as well. His thoughts were that "it's your body so you have a right to know everything"

[Morepower]

Don’t get me wrong there are a lot of good doctors out there, I have 2 that I use. One is a moron, but is directly across the road from where I work, he bulk bills and you don't need to make an appointment. I use him for scripts only. The other I go to when I have any sort of major issue, he is the one who gave me the referral, etc. He is awesome and understands me. It's just that some of the doctors out there seem to have a "God" complex and treat people as though they were inferior and beneath them. I hate people like this and will always knock them down a peg or four if they try that crap on with me, or my family. I can't be the only one that has experienced this, or seen it for what it is. The way some of them treat nurses is appalling, which I have seen first hand and of course have been told the stories from my wife. That being said they are not all bad, I have met a lot of very nice, genuinely caring and dedicated doctors which is what a doctor is supposed to be. I have no doubt the many years of dealing with the a$$hole Public(seems especially in Sydney, all of you that have travelled around OZ a bit will understand this comment) has taken it's toll and left their mark on some of them, anyone who works with the Public knows what I am talking about.

Anyway back on topic I would rather they take a little more of me than not enough as the ramifications of not is that it spreads through the lymph nodes and then you either end up with years of suffering chemo and radiation therapy or you die a horrible death you wouldn’t wish on your enemies. Just my 50 cents worth.

[CraigS]

Hmm ..

Upon having a deeper think about all this, the personality issues/attitudes and bedside manner issues are really 'in the noise' as far as I'm concerned. Admittedly, several rather unusual incidences have happened to me over the years but honestly, I acknowledge that in instances where I have been allowed to review the pathology report, I would not have requested a change to the treatment.

This would not necessarily be the outcome however, if a functioning bodily part was about to be seriously impaired with little/no evidence of adequate review of all the variables involved in coming to a decision.

Very frequently, (on other medical issues), I find community based statistics being raised in conversations, and subsequently I find myself being categorised, (seemingly), entirely on a statistical basis.

Surely a diagnosis and/or treatment should be primarily based on the evidence specific to my own test results/clinical history .. not solely on an interpretation of which category of a parent population I fit into.

In my experience, I have frequently found that humans (doctors included), have difficulty in keeping all risk factors present in mind, prior to making decisions. When it matters, I will actively seek out a doctor who has strengths in this aspect, rather than being concerned about their personalities.

Ric: Apologies if I've altered your intent for this thread. As I said earlier .. I am extremely cautious about covering up, whilst outside. Removal of that variable makes it simpler for everyone involved in the process.
(Its a lot like smoking, in that respect).

Cheers & Rgds

[Morepower]

Funny you should say that. For 2yrs I was unable to get off the lounge, it was thought to be laziness, depression or chronic fatigue syndrome. I was treated with a whole swath of anti-depressants(and like I was a bum), etc, but in fact I was about to have a major heart attack which came within a hair of killing me. All of the medical staff who came to see me said I should not have survived. The reason it wasn’t diagnosed is, I believe, for two reasons, 1.) I was only 33yo and 2.) I was not experiencing any chest pain, just felt nauseous whenever I did anything physical. 2 weeks after a blood test which showed my cholesterol at 8.9 I chucked a hearty. So I hear you on the “being categorised” bit as it nearly cost me my life.
But all you young'ens, don't worry about how the opposite sex is going to see you just because you are nicely tanned. It won't be worth it.

[Ric]

I got my stitches out yesterday as well as the pathology report.

The report showed that the lump was cancer free so I didn't have to have any more taken out.

That made me a very relieved and happy chappy.

Cheers

[casstony]

I don't think they'll listen - I wouldn't at that age - peer pressure is too strong. The only cure for young and dumb is to acquire the wisdom of later years.

Although it seems there has been some positive shift in the teenage groupthink due to the slip/slop/slap campaigns.

[CraigS]

Well .. y'know Tony, when some young kids, (6 - 12 yrs old), see what their parents have to endure, and hear the cause and effect story, I think over time, it will change.

Glad to hear you pulled up OK, Ric. (So far, so have I)

One can now ponder whether the size of the 'chunk' your doctor took, had any other basis in justification, other than statistical 'risk' factors, based largely upon segments of the community, which you may, or may not, fit into.

In retrospect, clearly the chunk he took was not justified.
(Which is all too easy to say in arrears, however).

Cheers

[casstony]

..... except that the kids are likely to be in their 20's or 30's before they see the consequences in their parents - the damage is already done.

As you say though, hopefully over time changing community attitudes are having a positive impact on teenagers. But I wouldn't hold my breath :) .

[erick]

Dr took samples of some skin lesions last year for checking - benign. Just before Christmas I noticed another lesion develop - right in the V on my chest under the neck where the sun shines brightly on the skin. Alarm bells! From nowhere to quite a lump in a month - so I saw the Dr at first opportunity. Sampled and again tested benign - whew! My parents had many BCCs removed in the later years of their life. I'm now 55. I keep a close eye on them and ask Dr to do the same.

[CraigS]

Parents should be closer to say, Hugh Hefner's age then !!
(Eeeeewww … uggghh !!! :eyepop: )

No there's a shocking image !

Cheers

[Jen]

:cool::cool: great stuff Ric :thumbsup:

[Ric]

Cheers Jen :thumbsup:

Treated myself to a nice wide brim Arkubra today. I need more protection now I'm a bit thinner on top. ;)

[jjjnettie]

Glad you got the all clear Ric. :)

[jjjnettie]

When excising cancer, it's normal to give a 2cm clearance all round.
Sure, you can bully your doctor into giving you different treatment (farrah fawset did) but your doctor deals with this on a day to day basis. I'd rather live (emphasis on the word LIVE) with the disfigurement personally.

[Starman73]

Hi there All,

I am a Registered Nurse, working in a very busy Sydney public hospital. Just like all members of the human race there are good ones and bad ones, not just doctors. Younger doctors are more approachable than older ones, passing all of their exams and being able to call themselves a specialist can be the turning point. I have seen many doctors change once they become a "boss".

This is also part of the doctor culture. All doctors will tell you how bad and dangerous things are when they are forced to work 36hrs or more without sleep. The problem is that nothing will ever be done about it because the older doctors believe that they had to go though the long hours ect, so the younger dr's need to as well.

There is also the culture of "thats not my job" call my intern, he will do it. Things have changed over the years, but its going to take a very long time.

In the past, when a person has gone to the doctors it was always, "Doctor do what you think is best". People are starting to want to have a greater say in their health care. I once heard a surgeon talking to another doctor about 10yrs ago expressing his distaste for the internet because it was making people question his judgement. He was very unimpressed by a particular patient who had the audacity to have researched their condition before they went to the doctors. Luckily we are finding more doctors these days who are welcoming patients inputs into their health care.

About the point of taking too much from around a lesion. I am sure you could talk to your doctor about not taking too much, but I am sure you would be advised that it is better to take more now, then less, then discover that all of the lesion has not been taken and having to go back to take more. By going back to take more they would probably have to take even more tissue then they would have originally because they don't have the original lesion as a reference point. You should always however, be able to ask your doctor questions and have him/her explain things to you, as this is all part of giving an informed consent. Always remember, same as going to a mechanic, you can always get a referal to another doctor if you are having problems with the one you are seeing. Also, if a doctor is confident about their diagnosis, they should be very happy to refer you to someone for a second oppinion. If you are not happy with the way they will carry out a procedure, there is no reason why you can't see another doctor and see if they will be willing to do it differently.

As with the other people, prevention is better than cure. Slip, slop and slap and as they say in the TV add hopefully you won't find yourself in the operating theatre getting any lesion removed.

Regards
Paul

[CraigS]

Hi jjj;

I presume the 2cms clearance is entirely dependent on the outcome of the biopsy ? For melanomas maybe .. for SCCs and BCCs .. the margin would then depend on a number of variables (and maybe as small as a couple of millimetres clearance). Where the lesion is located, how long its been there, etc, also comes into play … a multivariable issue, it seems. Where multivariables are involved, there are always 'safety margins'. I find these 'safety margins' are very much related to statistical analyses, which include other peoples' cases/issues and thus, may not relate to my specific case. The needs of the community are separable from the needs of the individual, and yet, I've found this concept is extremely difficult for GPs (& specialists) to visualise. (Try it on a GP/Specialist sometime .. and you'll see what I mean).

Biopsy 'samples' do not need a 3 cm cut and 6 stitches, for example.

'Bullying' is not an approach that I'd endorse, either. ;)

It seems that the only person taking the position of minimising the impact of overly cautious treatments thesedays, is the patient. Management of the entire process thesedays comes down to being informed, from whatever information may exist. Such is modern life. I am very concerned for the non-internet literate generation (ie: our parents). They are the most vulnerable although, I've found that I also need to be firing on all cylinders, whenever the stakes are high, for issues concerning my own well being.

It all requires great discipline, which is not always easy, especially if one is not feeling 100%.

Cheers, Rgds (and I appreciate your views).

[CraigS]

Hi Starman;
I really appreciate your sharing of your experiences and I 'resonate' closely with the examples and your thoughts on each of them. Thank you.
:)

Some comments follow:

On internet research & wrangling with doctors ..



I find this highly encouraging .. I wish I could find these types .. so far, I haven't had much luck.



Surely this issue can be overcome with technology, by taking accurate 'before' measurements/details, recording and marking the margins prior ! I find this argument, (whilst very common amongst surgeons), in this day and age, to be like using the ol' sledge hammer to crack a peanut !



Once again, I find the characteristic of GPs/Specialists, of being reluctant to separate the needs of the community, from the needs of the individual to be very strong, regardless of which doctor one approaches (see my previous response to jjj). Better to hammer it out with one, than keep running to find someone with a more agreeable personality ! Great value can come from intense, gritty discussions. Trying to find one who will engage in such, is extremely difficult, and can waste valuable time .. better off spending the time before the stakes become higher.



I whole-heartedly agree … with a corollary reason though …
If one removes the basis of suspicion of past 'misbehaviour', one is on firmer ground to manage the process. ;)
:)

Cheers & Rgds (and I appreciate your views).

[mill]

I had a lesion removed from my nose on Thursday that had been there for more than 25 years.
It only had to be removed because i have to wear reading glasses and it was becoming an annoance.
They only took a tiny bit away from around the lesion so it will heal quick.
The nurse who did the first examination said straight away that it was cancer and i told her to get a specialist first before making such a judgement.
The specialist took a look and asked how long it was there and then said it was benign.
Monday i'm going back to get the stitches removed :)

Ric i wish you good luck and hope everything goes well :)

[Starman73]

Hello Craig,

I am happy you found my comments valuable. I have had about 15yr experience working with doctors. Working with them from intern to specialist makes for interesting psychological and sociological examination.

Nahh really, they are nice people on the whole. There are a few that think they are God. Some people will be like that no matter what.

Other thing to remember is that doctors are only human as well. I have seen plenty of them who become over cautious because of bad experieces, near misses. They are only trying to prevent bad stuff from happening again. Once again, doctors are humans as well, and humans make mistakes.

Well I wish you all the best.

If there is anything more I can help you with or anything, please drop me a message.

Regards
Paul

[Ric]

Thanks everyone for the well wishes. I appreciate them all.

I see that there is discussion as to how much should be removed from around a growth and are they taking to much?

In my opinion and from my one and hopefully only experience I am happy that my doctor took a large piece and if there is a future occourance I would probably encourage him to do the same again.

I see the ads on telly where they miss a bit and it gets into the blood stream, that's scary.

If you have a choice between life or disfigurement and scars, it's not really a contest in my books.

Cheers