Anyone?

[BoeingDiesel]

My wife is onboard for the second opinion and I will be there.
I had an acquaintance that went through the Mohs' surgery. They had him on the table for quite a while and would remove some and send it to pathology and then cut some more. Sounded kind of brutal but obviously necessary. I'm an old guy too, nearly 73.

 

[sarj]

my woman went through that with melanoma... had mohs' done at UCI. It was 30 days from the biopsy results til she could get in. Ended up with a little zipper that faded away with no complications. I had one right on the edge of my lower eye lid with mohs. She went at it 5 times over three hours to do as little harm as possible, but still verify clean margins. It's a good way to attack that kind of problem. A very good lady did it for me, and I was fortunate to have a great plastic surgeon to fix the hole it left, and you can't even tell it was done. There are some really good people out there making it look easier than it sounds if you can find them

 

[BoeingDiesel]

That's a very encouraging account Sarj and glad it all worked for you and your wife. We may end up at UCI after the second exam.

 

[endoscott]

Quote "I stopped mostly to use the internet for medical research, to much b....t out there."

For sure a ton of BS on the internet but also a lot of access to actual medical journals through PubMed, JAMA, NEJM, BMJ, Lancet etc. You just have to be searching for ACTUAL medical literature, forget Dr. Mercola-his is all about profiting with crazy-ass ideas like tanning beds are "healthy" and he just happens to have one to sell you for $4 grand.

ABSOLUTELY get 2nd opinions and get educated about the various treatment options. Remember, 50% of doctors are "below average" right? We have some of the best in the world in America for sure, but there are lot of hacks out there too, 5 minute appointment and a prescription. If you are not sure about a biopsy result get another opinion on that too. Looking at cells through a microscope is less exact than you might think. There is a lot of interpretation. Eventually AI will take over-it's getting close in radiology. Humans are imperfect observers.

And if you have a doctor who doesn't want to discuss your questions, or balks at your getting a second opinion, RUN, don't walk away. Anyone worth their salt as a high level physician should welcome questions, and second opinions should be facilitated. Win-win.

Here is an example of a possible search "medical literature and indications for Mohs surgery". You will get a ton of good references to sort through. Or try "medical literature for Melanoma", lots of good stuff not only for clinicians, but don't be afraid to dig in to the literature directed to doctors too. Some of it may be too technical to digest but you might be surprised at what you can figure out.

 

[kthaxton]

My doctor did what he called "slow Moh's". His office didn't have the needed equipment and his staff wasn't trained, so he would normally have to perform the procedure in a hospital. I don't recall the roadblock to doing it in the hospital (either scheduling or not covered under my insurance), so he did a "slow Moh's", where he carved out the 1.25" dia chunk from my neck, expedited the sample to the lab and left my wound open (but bandaged). 2-3 days later got the positive results then I went back in for him to sew it up.

 

[BoeingDiesel]

We're waiting on the second opinion. My wife is very patient, but me...no.

 

[BoeingDiesel]

Stage 0, so there is some time to get this done. It seems that elective surgeries are taking a back seat here in SoCal. The last word went from 4 weeks to six. If they come back with one more delay there is a highly acclaimed dermatologist near us that can do the procedure in office and I'll pay out of pocket. My wife somewhat balked at my decision and said that we'll just wait. I told her no chance... "You're worth more to me than the d**n insurance covering the bill!"

 

[BSeyler]

Good choice! Her health is worth more than money can buy.

 

[Topzide]

Waiting could increase the stage levels! If you can get done sooner than later, I'd go that route and just tune out her displeasure about paying for it! They sometime forget about the vows and promises that we made to them. Mine does on a daily basis and I remind her that it's my main job to protect and provide shelter for her! We're here for you @BoeingDiesel ! Best to you and the Misses!

 

[Tractorat]

I wouldnt play around with it. Im sure she'll be OK. But why take chances ?
We're with you.

 

[BoeingDiesel]

^^^^ Absolutely!
Thanks guy's, I do appreciate the moral support.

 

[bighammer]

My wife is onboard for the second opinion and I will be there.
I had an acquaintance that went through the Mohs' surgery. They had him on the table for quite a while and would remove some and send it to pathology and then cut some more. Sounded kind of brutal but obviously necessary. I'm an old guy too, nearly 73.

Normally, tissue samples are processed over a few hours, creating a solid paraffin block that can be sliced to just a few microns thick, stained, and mounted to a glass slide, often given to a pathologist to "read" under their microscope the next day.

A frozen section speeds up the process by flash freezing the sample while the patient is on the operating table. It still yields slides for a pathologist to look at, but the whole process takes a fraction of the time. It helps to insure that the whole lesion is removed by looking at the edges of it. It sounds like a long ordeal for the patient, but they're just sleeping. The surgeon and anesthesiologist and their staff can get a little impatient sometimes as they wait, but it's crunch time for the pathologist and their staff.

My wife was a surgical pathologist. (until covid came along and forced an early retirement) Frozen sections were one of the more stressful parts of her job. Her decisions directed the course of treatment, so an incorrect diagnosis could produce a very negative outcome. Missing a malignancy (cancer) leaves the patient to go on untreated, calling something cancer (when it's benign) may lead to unnecessary surgery, radiation, chemo, etc.

With a normal biopsy, if you got a tough or unusual case, you could research it a bit, show it to a colleague, or send it to an expert. A frozen is a much more pressing timeline.

It sounds like they caught it early and she should do just fine. Hopefully my little background view helps you to not freak out going by the clock and how long she's in the OR. If you have questions about the pathology report, reach out and ask. (them or my wife) My wife actually enjoyed meeting people and explaining things. (but maybe that's just her)

 

[BoeingDiesel]

My wife had her surgery last week and as per the surgeon and pathologist all is well. She has a 4” incision on both triceps and the results are in her favor and not requiring a biopsy of nearby lymph nodes at this point. The surgeon called night before last and gave my wife all of their findings and that the margins were excellent. She does have to go in every six months to be checked and may include scans.

I got a little testy when checking her in for the surgery as they would not allow me to stay…I said, “You don’t understand…this woman is my life and I’m not leaving her here all alone.” Just by coincidence the dermatologist/surgeon came down the hallway and kind of pulled me aside to reassure me she was going to take care of my wife and that she had done hundreds of these procedures. Helped a little but still wasn’t all that thrilled and she was out of surgery about five hours later. Bottom line…as per the doctor…if you see a spot that seems unusual, get it checked.

Thanks to all for your kind and thoughtful comments

gregg

 

[SnoKing]

Dermatologist cut a hunk out of my upper arm a year ago, and it looks like this now. Sample to lab before hand. I don't tan well at that spot now.

 

[BoeingDiesel]

Yeah Snoking, I have the same on my hands and arms...too many years of high UV exposure

 

[Jim W]

Gregg, I am glad that everything went well for your wife. I hope everything turns out well in the long run.

 

[BoeingDiesel]

Thanks Jim, I do appreciate it.