Skin Lesions: When to Consider Removal and Options Available

Q: Skin Lesions: When to Consider Removal and Options Available

Hello： If you want to have surgery on the same day as your outpatient visit, my understanding is that you should go to a level one medical center (such as National Taiwan University Hospital, Chang Gung Memorial Hospital, or Taipei Veterans General Hospital, but not a municipal h

excuse me?

I have a black mole about 5mm in size on the sole of my left foot, which has been there for several years.
It hasn't changed much, but I'm quite concerned about it...
so I've decided to have it removed! Today, I registered at a dermatology clinic in Toufen, Miaoli, and the doctor said it can only be removed through surgery or laser treatment.
Surgery allows for biopsy, but laser does not! Additionally, surgery requires a separate appointment, and the stitches will be removed two weeks later.
However, since the mole is a bit deep, it may take several laser sessions to remove it, costing 1000 NTD each time...
which is too expensive! I live in Miaoli City and would like to have it treated near my home, so I want to ask if the Miaoli Dermatology Clinic can perform the surgery during the initial consultation.
Otherwise, I would have to waste another consultation fee just to schedule an appointment and hear the same information from another doctor...
which feels very frustrating! If the dermatology clinic cannot perform the surgery on-site, can a plastic surgery dermatology department do it? Or do I need to see a general surgeon? Are there any other options available? I hope to receive your response, thank you!

Xiao Xin, 30~39 year old female. Ask Date: 2009/08/22

Dr. Huang Ruiyun reply Dermatology

Hello: If you want to have surgery on the same day as your outpatient visit, my understanding is that you should go to a level one medical center (such as National Taiwan University Hospital, Chang Gung Memorial Hospital, or Taipei Veterans General Hospital, but not a municipal hospital) where dermatology has on-call residents available for surgery.
Otherwise, it would be unreasonable to expect the attending physician to abandon other patients in the waiting room to perform your surgery.
You can schedule an appointment with either dermatology or plastic surgery (the latter is preferable), arrange a surgery time, and proceed directly to surgery without needing to repeat the same information.
You will need to return for suture removal two weeks later, which means three visits in total.
If you go to a medical center's dermatology department, you will have one less visit.
If you are concerned about malignancy, you should avoid laser treatment, as lasers do not effectively treat melanoma, and if it is malignant, it could delay the diagnosis.
Best wishes for clarity.
P.S.
There are no dermatologists in Shou-Miao, so you can directly schedule with surgery.

Reply Date: 2009/08/22

More Info

When it comes to skin lesions, particularly concerning moles or nevi, it's essential to approach the situation with caution and informed decision-making. You mentioned having a black mole on the sole of your left foot that has been present for several years without noticeable changes. However, your concern about its potential malignancy is valid, as any changes in size, shape, color, or texture of a mole can be indicative of skin cancer, particularly melanoma.

In your case, the recommendation from your dermatologist to consider surgical excision or laser treatment is appropriate. Surgical excision is often preferred because it allows for histopathological examination of the tissue, which is crucial for determining whether the mole is benign or malignant. This is particularly important for any pigmented lesion, as early detection of melanoma can significantly improve outcomes.

Laser treatment, while less invasive and often associated with quicker recovery times, does not allow for tissue analysis. Therefore, if there is any suspicion of malignancy, surgical excision is the safer route. The cost of laser treatments can add up, especially if multiple sessions are required, as you noted.

Regarding your question about whether a general dermatologist can perform the excision during the initial consultation, it often depends on the clinic's policies and the specific circumstances of the case. Some dermatology practices may have the capability to perform minor surgical procedures on the same day as the consultation, while others may require a separate appointment for surgical interventions. It’s advisable to call the clinic beforehand to inquire about their specific protocols.

If the dermatology clinic is unable to perform the excision immediately, you could consider consulting a plastic surgeon who specializes in dermatological procedures. Plastic surgeons often have the expertise to remove skin lesions and may also provide cosmetic considerations for the excision site.

In terms of alternative solutions, there are no home remedies or over-the-counter treatments that can safely remove a mole, especially one that is pigmented. It is crucial to avoid any DIY methods, as they can lead to complications such as infections, scarring, or, worse, leaving behind a potentially malignant lesion.

To summarize, here are the steps you should consider:
1. Consultation: Confirm with your current dermatologist if they can perform the excision during your next visit. If not, ask for a referral to a clinic that can.

2. Surgical Excision: If the mole is suspicious, opt for surgical excision to allow for proper analysis.

3. Follow-Up: After the procedure, ensure you follow up for results and any necessary further treatment.

4. Monitoring: Keep an eye on any new lesions or changes in existing moles and report them to your dermatologist.

5. Prevention: Practice sun safety by using sunscreen, wearing protective clothing, and avoiding tanning beds to reduce the risk of skin cancer.

Your health and peace of mind are paramount, so pursuing the appropriate medical advice and intervention is the best course of action.

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