Do I need to see a dermatologist?

[dirty ethel rackham]

I'm pretty sure you are all going to say yes, but I am getting pretty doctor averse (accused of making mountains out of molehills or just triaging the various ailments that likely need attention.)  I have had this open sore on my face for about 2 months now.  I really hadn't thought much about how long it has been, but tomorrow is dh and my anniversary and my brother's wedding is in 10 days. 

About 2 months ago, I had this "zit" on my face above the corner of my lip  I think I scratched it and it bled.  I just cleaned it up and didn't think anything of it.  It got to the point of almost healed and then it broke open again.  It has never fully healed, just breaking open again, then starting to close up, then I scratch it in my sleep or something and the cycle repeats itself.  I tried covering it with a bandaid, but my skin is sensitive to the adhesive.  I tried liquid bandage, which stung to high heaven.  But it just itched and itched and the wound got bigger.  So, here I am, reading on the internet and getting scared that this may actually be actually skin cancer.  It is now about 1.5mm by 2mm.  2 days ago, it was down to maybe .5mm.  

I also have this bump on the edge of my lip below this open sore that I thought was a cold sore, but it never materialized into a cold sore, just this somewhat itchy bump.  

Help me think this through.  Or just tell me to put on my big girl panties and make an appointment.

 

 

[itsheresomewhere]

You need to see one.  It might not be skin cancer it could be just an infection.  

[Selkie]

I would definitely have a doctor look at it. Where I live, there can be a long wait for a dermatology appointment, so I would probably have a gp look at it in the meantime to make sure it isn't infected.

[eagleynne]

Yes, you need to see a doctor. My grandmother had something almost exactly like you describe. Her GP tried treating it like an infection to see if it would resolve, but it didn't. She ended up at a dermatologist with a diagnosis of basal cell carcinoma. She had it removed in the office and has been fine ever since. Don't put if off. If it is cancer the sooner you get a diagnosis and treatment the better your outcome will be.

[klmama]

Make the appointment; you'll feel better knowing, and they can help you if there's a real problem.  My mom had basal cell carcinoma that appeared as a sore that didn't heal, and it ended up being much bigger than it looked on the surface because it had been growing so long - a couple of years - before she got it checked.  Because of that the surgical scar was quite large, even though the "sore" was fairly small.  After that, she was fine, but I know she wished she'd had it checked sooner so her scar would have been smaller.

[Lanny]

I have a cousin who is a (mostly retired, but still teaching) Dermatologist. Eminent internationally.  I think he would suggest to you that you make an appointment with a Board Certified Dermatologist, ASAP.  Even if it turns out to be nothing, it will be money well spent.

[hippiemamato3]

My aunt had this exact thing (sore above her lip she initially thought was a pimple). She had skin cancer. She is fine now, but you need to go get it checked!

[TechWife]

A dermatologist is an option, but so is a plastic surgeon. They do cancer screenings as well. I've had a mole & what turned out to be a cyst removed & biopsied by a plastic surgeon. They are good at screenings, treating infections & minimizing scarring.

[livetoread]

I would suggest seeing a plastic surgeon instead of a dermatologist since it is on your face. It sounds like basal cell, which really isn’t a big deal, but the longer you wait, the bigger it gets, and the bigger the scar. I have a bad scar on my nose from a dermatologist who lied to me about what he was doing (long story). Finding someone who does Mohs surgery will keep the scar to a minimum.

[TravelingChris]

Sounds like my basal cell carcinoma. I did see my dermatologist and he did the Mohrs surgery and no scar on my face. I did have to put on a anticancer drug 9n the spot for a while too.

[Tap]

I had a basal cell carcinoma on my neck removed a couple years ago. I had a punch biopsy at the dermatologist and then MOHs since it was in such a distinct area. It was a red spot like a small mole that would bleed it I scratched/bumped it. 

Is the wound crusty or yellow at all. Impetigo is common around the lips.

Another thought is a staff infection (hopefully not MRSA).

Does it hurt?  I also shingles on my face. It hurt and spread into my hair in matter of a few days. The blisters could look like cold sores when they start out.

I am sorry but I am too tired to provide links.  Simple Google searches will provide you lots of details and pics :0)

[mumto2]

I would make the appointment because whatever you have it isn’t healing normally.  Have you used liquid bandages frequently or just this once for convenience due to odd location?  The reason I ask is I discovered the hard way that I have a bad reaction to them that includes a taking months to heal wound even with medical care and antibiotics.  Make sure you mention the liquid bandage at your appointment.

[Katy]

Echoing others.  A dermatologist or plastic surgeon will inject the sore with anesthetic, scoop it off with a razor blade, and send it to be biopsied.  Then it should scab over in a few hours and be completely healed in less than a week.

[dirty ethel rackham]

Thanks for the kick in the rear.  Now to find a dermatologist that doesn't have a long wait that will not leave me with a gross scar.  Our town seems to be replete with dermatologists who specialize in beauty treatments (due to the demographics of our town.)  I've asked on a local moms group fb page and I keep getting people lauding their dermatologist who does fantastic peels and resurfacing, despite asking about skin cancer.

[Katy]

6 minutes ago, dirty ethel rackham said:

Thanks for the kick in the rear.  Now to find a dermatologist that doesn't have a long wait that will not leave me with a gross scar.  Our town seems to be replete with dermatologists who specialize in beauty treatments (due to the demographics of our town.)  I've asked on a local moms group fb page and I keep getting people lauding their dermatologist who does fantastic peels and resurfacing, despite asking about skin cancer.

 

Dermatology is typically one of the more competitive specialties outside surgery.  They have reasonable hours, most of their patients are private pay because they want cosmetic treatments instead of medical care so they don't have the insurance nightmares other specialists have, and there are no emergencies so MANY of the best/smartest medical students try to get into the program.  If you have multiple people recommending their dermatologist, google the names and see what the online reviews are.  Then go with your gut. You probably won't go wrong.

[Tanaqui]

You need to see a doctor, but if your doctor is the one making you uncomfortable at the doctor's office then it may be time to try to find a new doctor. Not making patients feel like they're wasting everybody's time by showing up is the bare minimum level of baseline care I expect from my medical professionals.

[dirty ethel rackham]

6 minutes ago, Tanaqui said:

You need to see a doctor, but if your doctor is the one making you uncomfortable at the doctor's office then it may be time to try to find a new doctor. Not making patients feel like morons for showing up is the bare minimum level of baseline care I expect from my medical professionals.

Thanks for the affirmation.    I have been going to this doc for 20 years (since he was still doing his FP residency.)  He is great. I helped train him to be great since I got him when he was still a resident.  I am close to changing doctors, but this is one of the few that seems to respect people who do the research, ask questions and want to make informed decisions rather than "whatever you say, doc."   If I can't get in to see him, I end up with one of the partners ... some are good and some treat me like a hypochondriac or a head case.  (See the thread from a few weeks ago about getting medical care while female.)

My issue is with fhe office staff making the appointments and some of the nurses.  If I call for an appointment and say I have 3 things to see the doc about, of course, the person on the phone wants intimate details (when I may not be in a private setting) and then often only puts me down for the first thing I mentioned.  Or, if I call for a physical, she asks if I have any specific concerns.  I will mention that I need a new prescription for my thyroid meds, but insist that I want a PHYSICAL and then, when I show up for my appointment, it is listed as a thyroid followup.  Once, I mentioned fatigue and she put down depression screening (because I have a history.)  

[EKS]

Like the others said, that sounds like it could be basal cell carcinoma.  You should get it checked ASAP, because the longer you wait the bigger it gets--even if it doesn't look like it's getting bigger.  They grow beneath the skin.  

Go to a regular dermatologist.  You do not need a plastic surgeon to get a biopsy.  If it comes back BCC and you need an excision, then you might consider a plastic surgeon.  But first you need to know what you're dealing with.

If you can't get an appointment within a few weeks at the dermatologist, see your regular doctor.  They can probably get you into a dermatologist sooner.

[Omma]

So, two concerning things...

1.  a sore that doesn't heal

2.  if it is 'indented' in the middle, which it might be if the lower 'bump' is just marking out the lower boundary of the cancer that we can see on the surface. 

Let us know how your appt. goes and when you can get in!

Blessings (from a redhead that has had too many of these surgeries for comfort),

Brenda

P.S.  Did anyone hear about a new tool in which they can tell if you have skin cancer without having to cut and biopsy?  It sounds so exciting and gives one hope that they won't have to be 'cut up' and sliced and diced without certain cause!

[Lanny]

OP  I sent an email to my Cousin earlier today and mentioned that I had mentioned him in this thread and that some other responders have mentioned possibly seeing a Plastic Surgeon and not a Dermatologist.  Yes, many Dermatologists do Cosmetic things now so they don't need to deal with insurance companies.

It is my own belief that if I had something like you do, that I would want to go to a Dermatologist, who, I believe, is better qualified to treat something if it turns out to be Cancer or some other serious issue.

My cousin wrote back to me, and, realizing that he is an eminent Dermatologist, he has some prejudice here, this is what he wrote to me:

"plastic surgeons ONLY know how to cut, so poor choice as many options may be available
for whatever it is".

If it were me, or someone in my family, I would want them to be seen by a Dermatologist who treats people with Skin Cancer on a daily basis, and not a Dermatologist whose practice is doing Cosmetic work.

I would look for an M.D. who is a "Board Certified" Dermatologist who has that kind of practice.

Possibly there is someone in your local hospital who can suggest a Dermatologist on staff there. Better if they can suggest 2 or 3 of them...

Good luck with this!   I hope that it does not prove to be Cancer or anything serious, but you need to get it checked out, ASAP...
 

Edited July 27, 2018 by Lanny
change ot to to

[Lanny]

@DirtyEthel    This is what I would do, Monday morning, if I was in your shoes.   I would call the Dermatologist(s) I am trying to get an appointment with. If I am told there is a long wait for an appointment, then, I would say something like this:  "I am worried that it might be Cancer. Please put me on your Priority waiting list. Thank you!" 

[ktgrok]

yes. Sorry ?

That's how one of my basal cell carcinomas acted. Was no big deal to remove, but it should be checked ASAP. 

[ktgrok]

On 7/27/2018 at 2:32 PM, EKS said:

Like the others said, that sounds like it could be basal cell carcinoma.  You should get it checked ASAP, because the longer you wait the bigger it gets--even if it doesn't look like it's getting bigger.  They grow beneath the skin.  

Go to a regular dermatologist.  You do not need a plastic surgeon to get a biopsy.  If it comes back BCC and you need an excision, then you might consider a plastic surgeon.  But first you need to know what you're dealing with.

If you can't get an appointment within a few weeks at the dermatologist, see your regular doctor.  They can probably get you into a dermatologist sooner.

Also, call around to various dermatologists. Some were booked months in advance, another got me in within a week! And I love them, so it wasn't that they were bad or something. They just had more doctors I think, and have a Nurse Practitioner as well, who I see. 

And my dermatologist works with a plastic surgeon - when I had something that had to be removed on my face they scheduled it at their office, but with a plastic surgeon. He comes to their office one day a week to do this stuff, and is good at making you look good but also at getting the clear borders that are important with skin cancer. 

[dirty ethel rackham]

Thanks for all the advice.  I plan to see a dermatologist, not a plastic surgeon.  My friend was married to a dermatologist who specialized in difficult skin cancer cases and they always said that cancer should be taken care of by someone who does cancer.  I'm just having to wade through all the dermatologists in my area to find ones that aren't all about the cosmetic stuff.  I've been on about 30 dermatologists websites and they are filled with info on everything BUT skin cancer.  

[Lanny]

@DirtyEthel  OK if you are having problems sifting thru their web sites, this is what I would do:  I would call the  hospital I trust the most and ask to speak with someone who does Patient Referrals.  I would explain what I'm looking for to that person and ask for 2 or 3 names of doctors on staff there who routinely treat patients with problems like these.

I did that when I needed to have a Hernia repaired. She gave me 2 or 3 names and I went to one of them.

I am very glad that you will go to a Dermatologist!  Hopefully ASAP.

[TechWife]

On 7/27/2018 at 5:52 PM, Lanny said:My cousin wrote back to me, and, realizing that he is an eminent Dermatologist, he has some prejudice here, this is what he wrote to me:

"plastic surgeons ONLY know how to cut, so poor choice as many options may be available
for whatever it is".

Yes, his bias is showing! Plastic surgeons do know how to cut, which means they have a lot of experience and know how to minimize scarring. There’s no way I’d let a derm cut on my face. They don’t have enough experience cutting and they aren’t always good at minimizing scarring. I’ve talked to a couple of plastics over the years who have said they clean up after derms. Of course they were biased, too. But, experience is key.   Both derms and plastics use the same labs, so the tests won’t turn out differently in results, but in appearance they could have vastly different results. Getting referrals from experienced, trusted individuals is key now matter what route you choose to go.

[itsheresomewhere]

A dermatologist sent me to a plastic surgeon to see if they would remove a mole on my face.  She said they had more skill for where it was and that they would do a better job.  Give the plastic surgeon a chance.

[mmasc]

I agree with many PP. I saw my dermatologist first for a mole, but when it needed to be fully excised he sent me to a plastic surgeon. I had never heard of such a thing and thought it was so weird! But after seeing the cut that was made, I was very glad I went! So I think seeing your derm first for diagnosis is a great way to start. You can decide from there what needs to be done and with whom. 

[Lady Florida.]

On 7/27/2018 at 12:31 PM, dirty ethel rackham said:

Thanks for the kick in the rear.  Now to find a dermatologist that doesn't have a long wait that will not leave me with a gross scar.  Our town seems to be replete with dermatologists who specialize in beauty treatments (due to the demographics of our town.)  I've asked on a local moms group fb page and I keep getting people lauding their dermatologist who does fantastic peels and resurfacing, despite asking about skin cancer.

The bolded is frustrating. I found one in my area that is medical dermatology. The doctor was with a huge practice that kept leaning more and more towards beauty treatments and he went into the field for the medical aspects, so he left the practice and started his own. If you can, try to find one that has medical dermatology in the name or that clearly says they specialize in medical dermatology. 

If you're worried about scarring and plastic surgeon vs. dermatologist, keep in mind you're not required to choose the doctor who diagnosed the problem to be the one who takes care of it. You don't have to let them do anything that day in the office but can at least get a dx. 

On 7/27/2018 at 1:05 PM, dirty ethel rackham said:

 

My issue is with fhe office staff making the appointments and some of the nurses.  If I call for an appointment and say I have 3 things to see the doc about, of course, the person on the phone wants intimate details (when I may not be in a private setting) and then often only puts me down for the first thing I mentioned.  Or, if I call for a physical, she asks if I have any specific concerns.  I will mention that I need a new prescription for my thyroid meds, but insist that I want a PHYSICAL and then, when I show up for my appointment, it is listed as a thyroid followup.  Once, I mentioned fatigue and she put down depression screening (because I have a history.)  

Sometimes it's an insurance issue. I've had doctors who made me make more than one appointment because ins. wouldn't pay them if they saw me for multiple issues at one appointment. It's frustrating for both patient and doctor. This one doctor would even have you make back to back appointments so he'd see you for one issue at the first and another at the next appointment. 

[Lanny]

5 hours ago, TechWife said:

Yes, his bias is showing! Plastic surgeons do know how to cut, which means they have a lot of experience and know how to minimize scarring. There’s no way I’d let a derm cut on my face. They don’t have enough experience cutting and they aren’t always good at minimizing scarring. I’ve talked to a couple of plastics over the years who have said they clean up after derms. Of course they were biased, too. But, experience is key.   Both derms and plastics use the same labs, so the tests won’t turn out differently in results, but in appearance they could have vastly different results. Getting referrals from experienced, trusted individuals is key now matter what route you choose to go.

 

I agree with some of that, maybe the majority of it, but as my  Cousin wrote, sometimes there are numerous ways a Dermatologist might treat an issue a patient has.  My own belief is that their  training better prepares them to treat a patient who might have Cancer than the training a Cosmetic Surgeon has received.

If it were me or someone in my family, we would be looking for a Dermatologist who treats issues like the OP has and not someone who is doing Face Lifts most or all of the day. 

You want a surgeon with LOTS of experience working on whatever issue you have and  who does that frequently, if not on a daily basis.

In this case, if it is Cancer (that is the worst case) and the Dermatologist does not do a perfect job, cosmetically, one can then go to a Cosmetic Surgeon for a touch up.  If a Cosmetic Surgeon doesn't treat Cancer properly, then the patient is in deep trouble.

Hopefully, the issue of the OP IS NOT CANCER, but it may be, and one needs to keep that in mind.

This issue has 2 sides and may be a little controversial. Always room for respectful disagreement. 

[Tap]

On 7/29/2018 at 10:42 AM, dirty ethel rackham said:

Thanks for all the advice.  I plan to see a dermatologist, not a plastic surgeon.  My friend was married to a dermatologist who specialized in difficult skin cancer cases and they always said that cancer should be taken care of by someone who does cancer.  I'm just having to wade through all the dermatologists in my area to find ones that aren't all about the cosmetic stuff.  I've been on about 30 dermatologists websites and they are filled with info on everything BUT skin cancer.  

I have had experience with both. I have had great dermatologists who did excellent work and left me with tiny little scars. One of my moles was removed by a dermatological surgical specialist preforming MOHS (front center of neck just under adams apple area) and they did a decent job, but there is a distinct scar and a tiny bit of puckering. My current derm was a bit frustrated by the results I got at the dermatological surgery specialist and insisted last time I saw her, that she could have done much better. LOL   My current derm owns a high end practice that sees lots of cosmetic procedures. We ended up seeing her to get my daughters warts lasered and we stayed due to her excellent skills and staffing.  She was so frustrated she had her staff laser my scar for free to see if would reduce the scarring.  I could return to the surgeon to see if he could reduce the scaring, but don't want to pay his rates for another visit. 

A few on my face that were shaved off, have scars so small that you wouldn't know they were there unless I pointed them out.  They were done by 3 different derms, so it isn't like I just stumbled on a single amazing doctor.  I have had only one derm who left me with large scars. The moles were cut out, not shaved off, due to cancer risk.  She was a PA and the scars are on my back so I am not too worried about them but they are larger than any other scars that I have (similar size moles cut out by other MDs).  She is the only bad experience I have had and I have probably had 20 removed. Shaved off, cut out and stiched, cauterized, etc. I have had lots of doctors and lots of procedures.