Maybe just let that skin cancer grow

After receiving the bill for Mohs surgery to remove two basal cell skin cancers on my face, I vowed I’d ignore new ones and let them grow. My portion of the bill was around $600. I was horrified. (In the Mohs type of treatment, the surgeon cuts away a bit at a time, checking between cuts to see if the edges are clean—that no cancer is left. If the edges are not clean, he or she cuts some more, and so forth.) The charge for each cut was about $1,200—even more horrifying. I thought that my surgeon might be more expensive than others because his practice is in a high-end community near Stanford. But I discovered that his charges were typical.

Having gone through this before, prior to the surgery I instructed the surgeon take “big hunks.” He said he followed my orders. Nevertheless, while the cancer on my forehead took only one cut, the one at my jaw line required three before the edges showed no more cancer.

Basal cell carcinoma is slow-growing. Knowing this, in my initial visit to my dermatologist for the biopsy on the suspicious growths, I asked about leaving the cancer alone. She said she thinks about this and has decided that if it looks like you’ve got five years of life left in you, you should have it done. In my case, she recommended that I have them removed (she does not do the surgery). But she told me about a man in his early 90's with dementia and in very poor health, who she counseled to not have the surgery. Now in his late 90's, he has an open sore on his leg.

I discussed this same topic with the surgeon. He agreed with the dermatologist but told the story of a woman in her 90's whose GP told her to forgo the surgery. At the age of 103, the woman complained that the sore on her foot made it impossible to wear her pumps. My surgeon removed the cancer.

I am too good at detecting the cancers. I can feel them when they’re tiny invisible bumps that the dermatologist can’t even see but which the biopsy proves are cancer. Now we’ll see if I have the nerve to ignore them.

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