What kind of doctor do I need to find (basal cell carcinoma)?

I have a basal cell carcinoma (as diagnosed by a dermatologist) on my upper lip that needs to be surgically removed. The diagnosis was done in Indonesia while I was back for a short visit, so I am on my own in terms of obtaining follow-up medical care when I’m back home in Hawaii.

My question is, do I try to make an appointment with a dermatologist or a plastic surgeon?

The reason I ask is because the health clinic in Indonesia gave me the name of a recommended physician in Singapore, in case I could schedule an immediate removal. (Unfortunately, time did not permit this.) I note that they gave me the name of a plastic surgeon, not a dermatologist.

I have no idea whether removing lip carcinomas (which I gather are relatively common) is a specialty, or something all plastic surgeons do - or even whether the US medical system would approach it the same way Indonesia/Singapore does.

So, knowing that I’ve got this thing on my lip that needs to be removed ASAP, and I’ll just have to throw myself on the mercy of Hawaiian medical providers (which sucks as we have a huge shortage of doctors on my island), do I start by trying to find a dermatologist or a plastic surgeon? If the latter, do I need to look for a specialist of some kind?

FWIW, I don’t have a physician on the BigIsland, because I just moved there 6 months ago and it’s practically impossible to get an appointment with a GP or IM doc. I know because I tried when I was sick a while ago - I ended up going to an urgent care clinic instead.

I suppose I could go back to the urgent care clinic and try to get them to refer me to someone? But I’ll have to pay about $160 out of pocket if I do, since my insurance provider has already paid for the appointment in Indonesia and I doubt they would pay for a second appointment to tell me what I already know.

All suggestions for how to start dealing with this welcome - thanks in advance.

Speaking as someone who has had surgery on my face for a medical rather than cosmetic reason…

While a dermatologist is competent to perform this sort of surgery from the standpoint of removing the skin cancer, a plastic surgeon will give both a better cosmetic result and is less likely to accidentally cause complications. The face is a VERY complicated place full of nerves and muscles.

The difference in outcome is such that my health insurance at the time (in Chicago, in the US0 had zero problem with paying the higher rates for a plastic surgeon rather than a dermatologist. This is not cosmetic surgery, it is surgery for a medical reason. That said, no reason not to aim for the best possible outcome.

As to how to get access to such a doc… not sure. I started with my GP, who referred me to a surgeon, who referred me to a plastic surgeon. But that was years ago in a different state.

I would attempt to get an appointment with your GP. Even though you say it’s impossible, if you tell them you’ve been diagnosed, but not treated yet, for skin cancer and you need to see them and get a referral/recommendation, they may very well make an exception.
I’m assuming you insurance doesn’t require a referral, but you’ll probably need to touch base with your GP anyway, so if it were me, they’d be my first call.

My mom had some type of skin cancer and IIRC, she had it removed by her derm. I don’t know if she had to do any type of followup with an oncologist, but any time she notices anything (new, color change etc) with a mole, she calls the derm and can get in within a day or two instead of the usual 3 or 4 months.

I wouldn’t have thought of this being something a plastic surgeon would do, but if you were to go that way, I’d imagine you’d want to look for one that specializes in dealing with skin cancer.

Have you spoken with an oncologist? In a similar case, a friend first had a consult with an oncologist who recommended a surgeon who handled the surgery only. Postoperative care and long-term monitoring was done by the oncologist who was specifically a medical oncologist (as opposed to a radiation oncologist who would have handled radiation treatment if that modality was warranted).

Maybe (hopefully) your case is too simple to need this level of specialty care.

Just to be clear - I do not have, nor can I get within any reasonable period of time, a GP. I have lived outside the US for most of my life, and only recently moved to Hawaii. We have a real shortage of physicians here. I’ve tried calling a lot of GP/IM doctors - none of them are accepting new patients.

I am not a doctor but have quite a bit of experience with this stuff as a patient.

Do a search for

hawaii mohs

MOHS is a type of plastic surgery for skin cancer in which they remove some tissue then check to see if the margins of that tissue is free of cancerous cells, then remove a bit more if necessary – repeat until all clear.

Basal cell doesn’t generally require “immediate” removal but yes, you need to get it taken care of. I’ve had many removed over the past 30 years. Expect to see a dermatologist for a full body skin scan every year or so for the rest of your life to keep on top of things.

ETA: Sorry, the link didn’t work. Just do a search and start contacting those doctors.

I think you need a Dr. who does Mohs surgery. The page I linked to has a “find a Dr. link”. You may have to take a day trip to Honolulu.

Ninjad!

I had basal cell and it was removed by a plastic surgeon. I did have an argument with the insurance company about the extra cost but after a few telephone calls they did finally pay the bill. I think it was good to have it done by an expert as it was right in the middle of my cheek and a later dermatologist told me that some people have “crooked smiles” after this kind of procedure, and I don’t.

ETA Meant to say, best of luck, CairoCarol.

Ahh, got it, I was working on the assumption that you lived in Hawaii but were out of the country from some extended length of time [like…a year or five] and still had doctors in the states.

Go to a plastic surgeon. I had mine removed by a dermatologist, and he botched it. The stitching came undone and the wound healed badly, and it was a fiasco. I have an unsightly scar now next to my mouth. I’ve regretted ever since that I didn’t go to a better surgeon for the delicate facial surgery.

I had a small bcc removed from my cheek. Same dermatologist who diagnosed it was the one who cut it out. Good margins, nicely healed. No problems.

The lip is probably trickier as far as ending up with a functionally and aesthetically pleasing result. A plastic surgeon is likely to be more skilled in this area than a dermatologist. An otorhinolaryngologist specializes in head and neck surgeries and may be a better way to go than a dermatologist. Not sure how that would compare to a plastic surgeon.

I would start with a dermatologist who would do the diagnosis and then refer you to an appropriate plastic surgeon, since the lesion is on your face.

I lost count of how many basal cell ca I’ve had removed. Multiple Moh’s, scrape & burn :), etc. I’ve always been referred to plastic surgeons for anything on my face. But I live in NYC where there’s an abundance of plastic surgeons (though I think Moh’s requires a special certification).

Call your insurer and ask if you need to see another doctor. Chances are, you’ll probably need to go to Honolulu to see a plastic surgeon, because it’s on your face.

I’ve never had this, but Mohs procedures are very common, and almost always outpatient.

ETA: There are several board-certified plastic surgeons on the Big Island.

https://www.google.com/search?rlz=1C1LDJZ_enUS504US504&ei=wWYDXOD6LKGPjwSQ6qlI&q=plastic+surgeons+big+island+hawaii&oq=plastic+surgeons+big+island+hawaii&gs_l=psy-ab.3..0i30.31979.33409..33766...0.0..1.478.2216.0j6j4j0j1…0…1…gws-wiz…0i71j35i39j0i7i30j0i7i5i30.iw4f3QiBMNc

I was lucky, sort of. The dermatologist said “that’s cancer and it has to go.” (Okay, really, he chopped it off, sent it off to the lab, and before the next appointment confirmed that it was cancer.) It was on top of my head, and I’m fairly tall: I didn’t think twice about saying 'sure, you’re the doctor." The lucky part was his saying “my son is a plastic surgeon. He will come in to stitch it up properly.”

Moral: let the dermatologist remove the traitorous growth. See if the dermatologist knows anyone with skillfull hands to sew it up. The dermatologist should have enough ego to not be insulted; dermatology and plastic surgery are related, but everyone has their own specialty.

Including some board certified Facial plastic surgeons (ABFPRS). Choose one, check out their experience and credentials and advertising and associated institutions, call their office and ask if you need a referral or how to get in.

I just thought I’d update this thread before it became a total zombie. Thanks in part to the info I got out of this thread, I eventually made an appointment with a dermatology clinic that clearly caters to cosmetic improvement, but does reference “medical dermatology” on their website, with discussion of dealing with bcc.

I chose the clinic in part because it’s almost impossible to find a practitioner here on the Big Island but luckily they were taking patients, and in part because the advice I received in this thread made me realize that I need a plastic surgery orientation, which clearly this clinic provides.

Anyway, the place turned out GREAT. They did a biopsy (result: both bcc and squamous cell carcinoma, with positive margins), recommended Mohs surgery, and were able to schedule me with one of two mainland physicians who regularly visit Hawaii (I’m guessing they are serious golfers, as there are several excellent golf courses near the clinic) who specialize in Mohs.

So, Mohs surgery is scheduled, insurance is covered, and I’m content that I’m in the hands of people who know what they are doing.

Thanks to all participants in this thread!

I remember this thread, and am glad to see you followed through. Keep us posted.

Yes. Best wishes for an uneventful recovery and let us know how things go.

Another “thanks for letting us know.” I’m glad you found the right place for your care and hope things continue to go well.

I had Mohs surgery on my cheek and it was no big deal. About 12 hours after the surgery, the closest eye swelled up and I looked like someone punched me. Your lip is a bit further away, but just know an eye or two might react to the surgery.

Good luck!