I was scheduled for MOHS surgery this morning for basal cell carcinoma, but at the last

[dameatball]

minute (yesterday afternoon) it was denied by my medical provider. My provider wanted to send me to a local dermatologist for the traditional incision type removal. I am supposed to go to my provider's office this afternoon to discuss. Has anyone here had the same thing happen? I am trying to get my ducks in a row as to what questions to ask.

[Tetrachloride]

1. edit: other people below have more experience

Last edited Tue Jan 10, 2023, 10:49 AM - Edit history (1)

my suggestion of a lawyer is only part of the decision

[dameatball]

7. I understand and agree.

[sinkingfeeling]

2. Point out that MOHS has the highest cure rate.

[dameatball]

3. That's what I thought as well. Figures I saw said around 98%-ish as opposed to around 93%.

[if..fish..had..wings]

4. I have had MOHS for basal cell

My dermatologist stated that it was location and size (depth) that required MOHS rather than the usual incision removal.

Mine was on the jawline by the rear molar and extended inward a bit. They felt safer doing the MOHS. Ask your dermatologist why they recommended MOHS and what they feel the danger might be in doing a regular removal. Once you have that info call your insurance company, if the facts dictate, and state that your dermatologist recommends MOHS for this reason and that reason and try to get them to change their mind.

Getting a lawyer won't hurt but may not help. Insurance companies usually can only be legally threatened when damage to the patient has been done by their actions or inactions and by then its too late.

[dameatball]

6. Yes, location is a factor. I have had MOHS done on the tip of my nose and the traditional on the

top of my ear. This time the basal cells are on the flat part of my cheek so maybe they feel like that area does not require MOHS. I will ask this afternoon.
On a side note, my son is an excellent personal injury attorney. If push comes to shove I will run it by him. Probably premature at this point, as you said.

[Karadeniz]

5. My oncologist told me yesterday that it's almost time for another bone marrow biopsy. The last

time, she started one in her office, then stopped it and said she'd prefer it was done at the hospital. Even though I had a blast at the hospital... I was definitely the funniest person there... I'm again opting for the office biopsy. Compared to her office, the hospital has to be crawling with potential viruses and requires hours and lots of people around me.... no thanks!!!

My husband and I have had many skin thingies removed at the dermatologist and we've never wished we'd had the removals done at the hospital. Still, I don't know what is involved in removal of your type of skin problem.

[TNNurse]

8. Have had MOHS in the office for basal cell.

It was between the corner of my eye and my nose, so tricky spot. It also revealed two different basal cell types in that small area. There is hardly a scar.

Was there any reason given? I believe MOHS makes certain margins are clear at the time, don't think incisional can do that, but not positive. It someone has to go back for further for incisional, that would cost the insurance more...but they do not think preventively.

[dameatball]

9. Yes, I have also had MOHS and traditional. I think MOHS makes for a long day, but if it is more

effective then I want it. I am interested in seeing what they have to say at my appointment. Not sure what they are thinking at this point.

[TNNurse]

10. I think I was only in the office for 2 or 3 hours,

but it has been several years...which also means if was successful, since no reoccurrence.

I think the doc was seeing other folks while waiting on the pathology, so it is reasonably efficient for the office. I sat in a waiting room between procedures...yes, he did a second once he got results.

As an aside, a friend dropped my off since my husband had a mandatory meeting. He joined me before the second cut. Since the doc realized we were both RNs, he invited him in to watch. It was a bit of an adventure.

[dameatball]

12. Ha! Not something I would want to watch, but considering the RN part I guess I can understand that.

[TNNurse]

13. I would have watched if it were him.

[shanti]

14. I have a basal there

and it's making me really nervous. Was supposed to have it looked at in 2020, but...Covid. Could you elaborate on your procedure? I've had excisions but no Mohs. The area around the eye/nose is so thin.

[TNNurse]

15. It really was not bad at all,

after the first shot to numb it, though not all that painful, it was weird to have someone come at you with a needle there....SO CLOSE to YOUR EYES. It was several years ago, I do not remember any pain after. The scar is hard to find. The thing with MOHS is that they cut so carefully and not any deeper than necessary. It takes a process of smaller incisions to get the margins so no cancer is left.

I have never heard anyone complain of problems after this kind of procedure.

But, it is normal to be nervous, it is happening to you.

[blueinredohio]

11. I had MOHS done on my chin and my forehead.

The chin wasn't bad but the forehead required more surgery so now I have a dent in my forehead. Also there's no skin there to stitch so they glued it but all was fine.

[RobinA]

16. I Had

Mohs surgery on my face and then shoulder and leg traditional. The MOHS surgery left no scar but felt like it took forever. Traditional surgery is much quicker for areas where a small scar is no big deal.

[dameatball]

17. I agree about it taking longer. I had it a few years ago. It just seems odd that my provider refused

to authorize it when it does seem to be what some refer as the gold Standard as far as these type procedures. I will probably end up getting the traditional surgery.

[pnwmom]

18. My greatest regret is that I didn't fight for MOHS and a new doctor

after my husband's dermatologist laughed at my request. He'd had years of having an eyelid cancer lopped off, only to return. They kept telling him it was benign. I finally went with him to the dermatologist. He said it acted like a cancer, but it wasn't a cancer. I said if it acted like a cancer, we should treat it like a cancer. I wanted a MOHS. The doctor laughed and said I should stop consulting Dr. Google.

Three months later the lesion returned, and the doctor removed it in his office again. Three months after that, I went with my husband and demanded the MOHS again. He said he could refer my husband but the insurer would probably deny it. I asked what it would cost if we had to pay for it. He said $5K. I said we'd pay for it if we had to, but we wanted the MOHS.

So this thing had been returning for 6 years, and they kept denying a referral for a MOHS over $5,000.

They finally did the MOHS, and said they'd gotten it all, but it was too late. In the years while they saved the insurer some money, the thing that only "acted" like a cancer had traveled into a lymph node, and then into his blood, and then into his spinal column.

The hospital has made a hell of a lot more than $5000 from my husband since then. Maybe that was the plan.

Please, please, if there's any doubt at all, get that MOHS. Also, ask for and read all the pathology reports. A full year before the first time I asked for the MOHS, the pathologist had recommended a full excision (the MOHS is one way to do one). The dermatologist never told us that. Instead, he waited a year and a half before finally giving my husband the referral, and that was only after the second time I demanded one.

[peggysue2]

19. So sorry this happened to your husband

I've had MOHS. They removed a basal cell patch on the top of my left ear and a squamous patch on my cheek. After the biopsy results came back, there was no question it was skin cancer and no delay in scheduling me for MOHS. The surgery was successful and I've had no recurrence.

But this, your husband's experience, is a horror story--the delay, the refusal of a referral which allowed the cancer to spread. There's no excuse for such medical negligence or the unnecessary suffering your husband has obviously experienced.

I think it is a reminder to all of us that if we're unhappy with a doctor's approach and/or medical advice, we need to seek out a second or even third opinion. The fact that this physician held back the pathologist's report is utterly outrageous.

Again, I'm sorry this happened to you and your husband, pnwmom.

[pnwmom]

20. Thank you, peggysue2!