I have had four Basal Cell spots removed from my face in the last 2.5 years. One of them was quite extensive involving composite grafts from my earlobe to my nose. I am pretty well versed in Basal Cell and MOHS surgery.
I have since moved overseas due to my husband's job and now I have limited access to decent medical care. I went to the dermatology clinic with a spot on my jawline, just down from and in front of my earlobe, about six months ago. I was told by the PA that it was a "beauty spot." I disagreed with him, and explained that I have had several Basal cells and this seemed similar, but he refused to biopsy it and told me to wait six months. So, I watched this thing change and grow for six months. It actually got bigger than any of the other ones that I had before! I finally went back, but asked to see the Doctor this time.
The Doc agreed that it was basal cell and we talked about MOHS surgery. Apparently, their MOHS surgeon had just moved back to the states. She said there was a local MOHS surgeon that she could refer me to, or her colleague may decide to just do a simple excision. I indicated that I would prefer MOHS. She said we would discuss treatment options once the biopsy results came back.
Well, the biopsy came back as expected, but she said her colleague was perfectly capable of performing a simple excision. I replied that because it was in the H Zone of the face, that MOHS should also be an appropriate way to treat the area and I would prefer to have a referral. She actually raised her voice at me and said, "I am YOUR Dermatologist and I have determined that MOHS is not necessary in this case!" She proceeded to tell me that nodular BCC is nothing and that she thinks that she "probably already got it all with the shave biopsy anyway".
In the end, she agreed to put the referral in, but added, "I don't know what I am going to write for the reason for referral, but I am not going to lie."
Then she proceeded to tell me that based on how she writes the referral, my insurance will probably refuse to cover the procedure.
I have no other options for going to another Doctor over here. So, how do I handle this? Am I being unreasonable for wanting MOHS for a spot on my jawline? IS simple excision the better way to go? The spot in question is probably greater than 6mm, it is nodular, however some of the other spots that I have had removed in the past were "surprisingly aggressive" according to my MOHS surgeon at the time.
There is also the consideration that if I have had five spots on my face in the last three years, and I am 45 now, how many will I have had by the time I am 55? How much skin will be left for repair by then? What about when I am 65?
There is a possibility that we may move back to the US this summer. I may just wait and see if that happens and seek treatment then. I really don't think that excision is the way to go in this case, and I certainly do not want to go back to this derm clinic after the way I have been treated.
Thank you for hearing me out. I welcome any and all suggestions!