Disclaimer: I want to be very clear that I am looking for opions and NOT for medical advice. Given the number of medical doctors and nurses who post to these boards, hopefully the opinions will be informed although all others are welcome.
I have an elderly friend who discovered a lump that was located in the skin fold where the leg joins the trunk, adjacent to the groin. This friend is a veteran whose health care is provided by the VA. An immediate appointment was made with a plastic surgeon who is NOT a VA employee but who does work for them on a contract basis. He excised the lump and diagnosed a stage three melanoma. The biopsy report stated that the boundaries of the excision were clear of cancer cells.*
My question is this: Why would a plastic surgeon rather than a “regular” surgeon or a dermatologist be involved? The surgical site is not one that is likely to be seen by anyone other than a medical person. Up to now, no one at the VA has provided any answer other than a shoulder shrug.
My friend lives in an area where the VA maintains a clinic, but not a full scale medical facility, hence the use of a contract surgeon. Upon receipt of the biopsy report, his primary care physician sent him to a full scale VA facility with orders that he receive a full body scan* and a “node mapping” test. Her orders were ignored and another surgery at the excision site was done; supposedly to verify that no more cancer cells existed at the site. The results of this biopsy are not yet in. This surgery was performed by a [different] plastic surgeon.
**I don’t know if the scan was to be a CAT scan or an MRI scan or both; neither was done, in spite of having been ordered by his primary care doctor and in spite of my friend’s desire to have a scan done. I have no idea why, nor do I know why the node mapping thing wasn’t done. I am not seeking answers or opinions regarding these questions.
It just seemed to me that plastic surgeons are more specialized in other areas; maybe I misunderstand their roles—I wasn’t necessarily being critical of the choice—
I had two BCC’s diagnosed by my GP, and was sent to the Plastic Surgery department of my local hospital for excision and biopsy (luckily, both were fine). I too asked why PS rather than the Dermatology clinic, and his reply was that the PSurgeons will make a prettier job of sewing up the cut afterwards.
The VA is heavily subsidized by our government. Why would they want to send a patient to a plastic surgeon when a GP can do the same for (likely) much less money?
It’s the difference between six stitches with 4/0 proline and 36 stitches with 6/0 silk.
I had a blepharoplasty years ago (long, unnecessary story). They used 7/0 with 100 stitches per eye. The surgeon told me anything smaller than 7/0 he’d have to use magnifiers.
And now back to the OP.
Biopsies and lumpectomies, while small, can leave ugly scars. Since it was in a skin fold, it could be they wanted it be sure it was a smooth scar that wouldn’t cause pressure or errosion in another spot.
Or it may have been availability. When I worked at one major university hospital, the VA was one of our “St Elsewheres” The surgeons (usually Fellows) would go to VA when needed, rather than hang out there.
Here’s a little uninformed speculation as to why a PS might have been tasked with the job versus another type of specialist: Perhaps in certain facilities, especially one which does a lot of work with a VA hospital, the demand for plastic surgeons my be especially low. It’s unlikely that much elective cosmetic surgery happens there. So while the facility maintains a PS staff they might find it practical to assign otherwise mundane tasks to them in order to keep them busy and billable.
Anyways, it’s just a theory, I have no knowledge or experience in the medical field whatsoever, but it seems logical and similar types of things happen in IT companies for example. A DBA being assigned some data mining might be an analog.
Q, I can certainly understand FM doing mole removals/biopsies, but you guys would do a lymph node removal/biopsy? Especially one in such a… vascular area?
The derms I work for will do deep and wide excisions in the office for basal and sometimes squamous cell cancers, and sometimes dysplastic moles, if in a inconspicuous area of the body. We always refer out to plastics melanoma excisions after biopsy. It’s partly the cosmetic aspect, but also most derms don’t have the surgical setup in the office to do melanoma excisions, as they can go pretty deep and require extensive consideration of ligaments, muscles, arteries,etc.
(I’m not a medical person, but…) By “full body scan” they probably mean just that a dermatologist will visually look at the entire body (I think they may use some kind of UV light) to search for other skin cancers. That’s what they called it when they did it to me.
