Some dermatological rip-offs

I have never felt ripped off by my dermatologist, not even the first one whom I didn’t like. My current dermatologist and dermatological surgeon perform only necessary procedures and are conservative in their approaches. Everything is done in the office.

This is not always the case. The New York Times tells the story of a woman whose dermatologist (actually it was a physician’s assistant) took a biopsy of a tiny white spot on the side of her cheek, which did turn out to be cancerous—a small, slow-growing basal cell carcinoma. After removing the cancer, using the Mohs treatment, the patient was sent across the street to a surgical center to have the wound closed by a plastic surgeon. The patient protested that she didn’t want a plastic surgeon and didn’t care about having a scar, but the doctor told her she had no choice. This patient had to don a hospital gown, was given an IV, and was sedated by an anesthesiologist. Her bill included $1,833 for the Mohs surgery, $14,407 for the plastic surgeon, $1,000 for the anesthesiologist, and $8,774 for hospital charges. Ridiculous!

Because it is more expensive than other techniques and highly profitable, some say that Mohs surgery is overused. The incidence of Mohs surgery increased by more than 400% in 10 years, which may be due in part because of our aging population. In a sample of 100 Mohs surgeries, the cost ranged from $7,594 to $474,000 with the higher costs for hospital-based physicians. When the surgery is performed in different steps by different specialists, each specialist can bill for his or her own procedure, such as the surgery itself, closing the wound, anesthesiology, and facilities fees. This can total more than $25,000 for a single procedure, as in the case of the patient in The New York Times article.

I recently had a basal cell carcinoma removed from my chin (Mohs method) and chose not to have stitches. I now have a bit of a dimple. Because skin cancers tend to be slow growing, I've toyed with the idea of ignoring them. But I don’t have the nerve.

Next week: Back surgery--best to avoid

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