This is a review of Dr. E Eugene Bain III. I originally had a mohs procedure by Dr. Bain in 2014 on my first BCC just under my nose and above my lip. I had a significant defect as a result that was repaired by a plastic surgeon, Dr. Surowitz (who was outstanding and I cannot recommend enough). I had gone to a different dermatologist about the red spot initially (I don't remember this dermatologist's' name) and he dismissed it as "not skin cancer" several months earlier and gave me a topical cream. As it got worse I went to a plastic surgeon (Dr. Surowitz), and explained that I was told it wasn't skin cancer by a dermatologist but that I wanted it removed with as little impact to my appearance as possible. The plastic surgeon suggested a biopsy just to be safe and sure enough it was a BCC. Dr. Surowitz called me in person to give me the news. He then recommended Dr. Bain for the Mohs and Dr. Bain did the procedure with Dr. Surowitz doing the reconstruction the following day. The end result was great, and I credit the Dr. Surowitz with that. I had a second BCC removed by Dr. Bain on 27 Jan 2016 (which was delayed a week, as his secretary canceled my 0900 appointment the previous week at 0830 on the day of the procedure - I was literally walking out the door on my way to the office - wife took the day off to bring me and I obviously took off work, which was a week of because I work in a different city than where I live). This turned out to be a blessing because it gave me a little more time to demand a same day appointment with a plastic surgeon be arranged after the Mohs. This BCC was on my nose. Dr. Bain took a biopsy initially then had his secretary or someone call me to tell me it was cancer and to schedule a Mohs appointment. I asked if I would need to schedule an appointment with a plastic surgeon, giving that the spot was on the ala of my nose, and I anticipated that it could really impact my appearance if not done property. The secretary was dismissive and said the Dr. Bain would make that determination the day of the surgery. I told her that I could contact the previous plastic surgeon, who was great, Dr. Surowitz, and she said that Dr. Bain had specific surgeons he worked with and again he would make the call on post surgery but that he mostly does the closures himself. Maybe I was spoiled by Dr. Surowitz, who showed me several photos of his previous work, took photos of me ahead of the procedure, walked me through everything, and managed my expectations, which he then exceeded, but Dr. Bain offered nothing. He didn't even have the courtesy to tell me in person that I had cancer again, but had his secretary call me, who then refused to give me any information about how extensive Dr. Bain thought the defect would be or consult me on closure and reconstruction, but simply repeated over and over that I should come have the procedure and if he didn't feel that he could do the repair himself, he would recommend an unnamed plastic surgeon. I contacted Dr. Surowitz's office but he had unfortunately moved to different city, but his old office advised me that I should call Dr. Bain and speak to him in person to get my questions answered. I did so, and Dr. Bain never called me back, his secretary just continued to call instead and eventually, on the third call, gave me the name of the plastic surgeon and offered to schedule an appointment there for the closure after the Mohs. I accepted, because I wanted to get on with everything and not delay the process. The Mohs resulted in a large defect that definitely needed a plastic surgeon, far worse than my initial BCC, due to it's location. I did not have a pre-op appointment with the plastic surgeon, and I will never rush like that again. I had the closure done by the new plastic surgeon, which so far, does not appear to be working out very well for me, but I'm reserving judgement on Dr. Pyle. I'm only at 5 weeks post op, but it appears that I will need some revision, as there is significant "pincushioning", where the flap from my cheek used to cover the defect was not thin enough, so there is very unnatural bulkiness. See photos. I believe Dr. Bain should have called me himself to tell me I had cancer again. He also should have called me back in person, after I asked him to, and in a timely way. He should have explained his expertise to me in terms of performing closure if he wanted to do it, not just ask his secretary to try to compel me to allow him to "make the call" on the day of surgery. This is my life, as I'm sure the others on this forum know. I'm 36 years old and I'd like to maintain my appearance for a few years if possible. If it's possible to take a week to do a pre-op visit to the plastic surgeon and have everything well-arranged in advance, I think Dr. Bain should have not only facilitated that, but recommend it. I was very upset at the time with refusal to call me back and answer my questions. My wife is in medical school and she was irrate. I won't go back there, although I haven't spoken to anyone at his practice since I left my last procedure. As far as the Mohs treatment, I can only assume that he did it well. So far, I have no recurrence of cancer in either of the two locations. My problem was with how he appeared flippant about my closure and the repair on my nose. I usually don't write reviews, but for medical care, the only way to keep doctors honest, is for us, the patients to communicate with one another. We're at their mercy and I believe we deserve a genuine concern for our well-being and we can collectively regulate arrogant or distracted physicians. All the best to those of you who struggle with skin cancer. It's tough and I'm sorry. Hang in there.
For pre-cancerous lesions (actinic keratoses), Mohs surgery is not required and would not be appropriate. This would be best treated with liquid nitrogen or even one of several topical prescription medication, of which there are several options. I would see your dermatologist or Mohs surgeon for this. Mohs micrographic surgery is still the preferred treatment for the removal of skin cancers (basal cell carcinoma and squamous cell carcinoma most commonly). When done by a qualified provider (member of the American College of Mohs Surgery, ACMS), Mohs offers the highest cure rate possible among skin cancer treatments.
While smaller lesions tend to result in less skin excised for tumor clearance, infiltrative basal cell carcinomas do have a tendency to spread out in a subclinical way beyond the visible lesion. It's very difficult to say at the outset of any Mohs case what will be required in the removal of the tumor. And in some cases, I've found the pathology from the biopsy underestimates the true aggressiveness of the skin cancer. You're doing the right thing by having Mohs as your method of excision. Not only will this have a higher cure rate, but your surgeon will be looking at the tumor as it's being removed. This allows any additional concerning features to be noted and taken into consideration in his or her overall treatment plan for you.
The Vbeam is a pulse dye laser which primarily targets lesions with strong vascular (blood vessel) component. As such, it will work well for some of the redness and scarring you have. Given that yours is mild, one treatment may suffice, however in our office we always counsel patients that 2-3 treatments may be necessary to see a sufficient reduction in redness. For some of the scarring you have, a fractionated resurfacing laser would also be beneficial and should be considered once the redness has improved.
The primary reason for your soreness is probably all of the bruising and swelling you've experienced post operatively. It's not uncommon following Mohs excisions and reconstructions on the face for patients to have significant bruising at and below the operative site due to the many blood vessels on the face. In general, you should follow the instructions of the surgeon performing the procedure for post operative care guidance. Vaseline (petrolatum) is relatively insert and unlikely to cause you to have a reaction. Many over-the-counter topical antibiotics are common causes of allergic contact dermatitis (Neosporin being one of the main offenders) which is why most dermatologists and Mohs surgeons will recommend plain Vaseline to be applied to surgical sites. But with any concerning changes at your surgical site (worsening redness, discharge, tenderness, bleeding or swelling), contact your surgeon as he or she may want to see you in person for a more thorough evaluation.
There should be no problem receiving these two treatments in close proximity time wise. Two of the main treatments that come to mind to me that you would not want on the same day would be a botulinum toxin and sculptra. This is mainly because self massage of treated areas is required after sculptra, and you would not want to accidentally massage an area treated with botulinum toxin due to the risk of product migration. This should not be an issue with radiesse as no massage is required post treatment.
