Many people are unsure as to when they should seek attention regarding new or changing skin lesions, and whom they should see for treatment.
Generally, patients believe that they should see their dermatologist first, but what they may not know is that excision of such skin lesions by plastic surgeons (who in general are experts at hiding and minimizing scars) are almost always covered by their insurance policies. Some guidelines:
1) Any new, isolated skin lesion that is raised, flaking, ulcerated and/or intermittently bleeding, and doesn’t heal or resolve in 4-6 weeks should be considered for excisional biopsy. This consists complete removal and optimal closure under local anesthesia only, as well as obtaining a definitive pathologic diagnosis. Generally such lesions may be basal cell carcinoma (BCC, most common by a factor of 4), or squamous cell carcinoma (SCC), and excisional biopsy alone is adequate treatment.
2) Longer-standing pigmented lesions (moles or nevi) which have recently changed in color or character (usually darker), are larger than a pencil eraser, have blurry borders, or are bleeding/irritated maybe suspicious for a melanoma, which are generally more dangerous and may need more aggressive treatment if this pathology is confirmed.
3) Complete excision (when possible) of such lesions is generally more favorable than “punch biopsies” or shave excisions, which may leave portions of the lesion behind, or lead to “sampling error” (i.e. the portion removed was “benign”, but there may be malignant elements left behind) and/or lead to recurrence or less predictable scarring.
Again, your local plastic surgeon is an expert at completely excising these persistent or changing lesions (or subcutaneous masses) that clearly need surgical attention, utlilizing plastic surgery techniques that minimize scarring, and insurance will cover such procedures a great majority of the time.
Lake Forest Plastic Surgery