I have a mole on the border of my lip that I need to have removed. Mole Removal by Dermatologist or Plastic Surgeon?
Doctor Answers 31
In this case, it may take a team approach. Depending on...
In this case, it may take a team approach. Depending on the type of malignancy that it is, the best option may be to have a specially trained dermatologist perform Mohs micrographic surgery to remove the lesion and a facial plastic surgeon or plastic surgeon perform the reconstruction.
Mohs micrographic surgery is a procedure where a specially trained physician, usually a specially trained dermatologist, will remove the lesion in such a way as to be able to examine the borders at the time of the excision. If some tumor remains, additional removal can occur. In this way, the maximum amount of normal tissue is maintained.
Mohs surgery cannot be performed for all tumors though. Some tumor simply require excision with 'surgical margins' - areas of normal tissue removed to ensure that no tumor remains.
Some Mohs surgeons will be comfortable repairing these defects but at times they will refer patients to plastic surgeons or facial plastic surgeons for repair of the defect that is created. The best surgeon for repair will be the one with the most experience in facial surgery. There are excellent plastic surgeons who perform facial surgery, but then again there are some who perform mostly breast and body surgery, shying away from the face. In general facial plastic surgeons will have training and experience only in facial cosmetic and reconstructive surgery.
Dermatologist vs Plastic Surgeon, the good, the bad, the ugly
First off, I am a Dermatologist. I have a general dermatology practice and perform many cosmetic as well as advanced surgical procedures in treating skin cancers. I am military trained and have worked extensively with 3 Mohs surgeons and have set up Mohs programs in military training centers. Another qualifier is that there are good and not so good physicians in every specialty. In your situation, based on your history, you probably have a squamous cell carcinoma of the lip, which I have removed many. You can have a wedge resection of up to 50% of the lower lip with incredible results, with virtually no scarring and a very natural look.
Dermatologist- Everybody knows that if you have a mole, or are concerned about a possible skin cancer, you should see a Dermatologist, the experts in moles and cutaneous malignancy. This is what Dermatologists do all day long is evaluate and remove moles. They are also trained in histopathology and many Dermatologists read their own biopsy slides. Mohs surgeons are Dermatologists trained to remove and close advanced skin cancers. Most Mohs surgeons do nothing else, and all day long they are removing malignancies, tracking their invasiveness under the microscope (completely removing the tumor) and then closing the resulting defect no matter how large or extensive. Most Dermatologists are very adept at evaluating and removing nevi of all types with a very cosmetic result.
Plastic Surgeons- Plastic surgeons are trained in cosmetic surgical procedures of the skin. They are very adept at such treatments as face lifts, blepheroplasty (eyelids), nose jobs, neck lifts, breast augmentation, scar revisions, etc. They are very well trained and usually provide excellent cosmetic results.
Dermatologist- I'm being honest. There are some Dermatologists, mostly elder ones that were trained many years ago, that are not surgically trained. Certainly they are more than qualified to perform a biopsy to determine if a lesion is a cancer, but some are not interested in doing the more advanced work that is required to remove the malignancy adequately with good margins. Most Dermatologist that feel this way will be happy to refer you to a Mohs surgeon, other Dermatologist or Plastic Surgeon that they feel would provide you with an excellent medical and cosmetic result. And this is very important to them because they will be seeing these patients back for many years and will be able to evaluate the results and are only interested in having a happy patient. All Dermatology training programs for the past 40 years have provided extensive surgical and cosmetic Dermatology as part of their training.
Plastic Surgeons- Plastic surgeons are not trained to evaluate moles. They do not know what a Syringocystadenoma papilliferum or a Merkel cell carcinoma look like. For me I would refer patients for additional surgery for a malignancy to a Mohs surgeon (in actuality I have a Mohs surgeon clear the cancer and then I close the defect), this is what they do routinely. Plastic surgeons do not do these procedures "routinely" unless they have made that a specific part of their practice. I have had some unfortunate patients that were sent to a plastic surgeon for addition margin surgery and the surgeon used it as an opportunity to do something they don't normally get to do, such as rotate a flap (rhombic flap, O-Z, bilobe flap, etc.) with terrible results. Some of these patients developed hypertrophic scars when they are performed on the arm or back. In my experience it is a good rule to keep it simple, and whenever I can perform a side-to-side repair along natural skin tension lines, I do it. The results often times are much better.
The ugly can be avoided. Please be sure to check on your physician's credentials and be sure that they are board certified in Plastic Surgery or Dermatology. Don't be afraid to ask them what they plan to do and what are the potential treatment options. Ask for recommendations from other physicians that you know and respect.
This is just my opinion and I don't mean to offend anyone. There are many great responses on this thread. I hope this helps!
Play it safe with your Face
Although dermatologists are completely qualified to remove moles, plastic surgeons are more qualified to keep the scar minimum afterwards.
Depending on your insurance, it may be possible for your excision to be covered, even if it is removed by a doctor outside of the network.
If your main objective is to have your face looking as if nothing were ever there, it is worth the expense for a board certified plastic surgeon to remove your mole. Especially since it is bordering your lip, which is a very delicate area, I recommend you find a plastic surgeon in your area.
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Malignant Mole on your face
Depending on what type of malignancy you may need two doctors to work together - a Moh's surgeon to cut the cancer cells out and make sure the margins are clear- and a Plastic Surgeon to close the wound to make sure you get the best cosmetic result. Surgery near the lip is a difficult area and you need someone highly qualified and trained.
It may be best to have the lesion removed by a Mohs surgeon and then see a facial plastic surgeon perform the reconstruction.
Most Qualified Surgeon to Remove Malignant Mole on Face
Your choice and you certainly have options. If it was my face I would pick the surgeon with the most training and experience. That would be a board certified by the American Board of Plastic Surgery plastic surgeon. Additionally if extra normal skin needs to be removed as in the case of many melanomas and aggressive skin cancers, the plastic surgeon would best be equipped to reconstruct the defect in most cases. Also please note that "Facial Plastic Surgeons" usually refer to an ENT surgeon and not a dermatologist.
Mole Removal on the Lip - Dermatologic Surgeon of Plastic Surgeon?
As mentioned by another physician, i think it is disappointing there are so many answers with such obvious bias. Depending on their skill, training and comfort level, both dermatologic surgeons and plastic surgeons can perform surgery on the lips and achieve great results for their patients. In fact, removing moles on delicate anatomical areas is something that Mohs Surgeons (dermatologists with specialty training in surgery and skin cancer surgical treatments) do all day. The most important thing for you is that the lesion be properly removed with proper margin control and the specimen removed be sent to the dermatopathologist for review. It is always a good idea to ask your doctor who did the biopsy for a referral for surgical treatment. But any well-trained Mohs surgeon, dermatologic surgeon or plastic surgeon can remove the mole on your lip.
To avoid being deformed, you need a surgeon...
To avoid being deformed, you need a surgeon specificially experienced with operating on the lip.
While some dermatologists have experience in these things, I think in general for a malignancy in this area, that I would suggest you see a surgeon.
Whether it should be a facial plastic or a general plastic is tough to say. Both groups have adequate training and understanding. It would come down to the experience of the individual doctor.
I'll tell you what I would do if I had this: I would see a plastic surgeon who does a lot of cleft lip surgery, as they understand the lip better than anyone.
The lip is a complex structure, and they know all kinds of tricks to move it around and reshape it.
Plastic surgery for malignant mole removal
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