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Nasal Mohs Patient & The Politics of Doing The Right Thing

Posted Aug 23 2010 8:00am

Recently I saw a patient with a small superficial basal cell cancer on the rim of her nose (the Nasal Ala.) She was referred by a dermatologist who had scheduled her for Mohs Surgery and wanted my help with reconstruction of the wound that would result from the Mohs surgery. I saw her before her Mohs surgery.

It is true that reconstruction in this area frequently leaves less than attractive results and that there are alternatives that might obviate her need for surgery namely topical chemotherapeutic creams. They only work for superficial disease which her biopsy indicated she had. I have used them before and they have worked pretty well but they do require a lot of follow-up visits.

At the risk of angering the local dermatologist I suggested that the patient speak with her about this possibility before her scheduled Mohs operation. It is true that that a surgeon working with his mind as opposed to with his hands makes less less money, but it is the right thing to do. The patient actually decided to have the Mohs surgery anyway.

I always wonder when I do these things if I am annoying the referring doctors and I may do so on occasion. The focus should be on what’s best for the patient, but business can distort that in some cases.

Best Regards,

John Di Saia MD

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