Sometimes, You Must Ask for a Biopsy.

Do you know when to ask for a biopsy?

Several years ago I went to my Dermatology office to seek an opinion on a red spot / bump that was slowly growing on my right shin. It didn’t look like a mole, or anything else I could find within the medical sites on the internet – Mayo Clinic, and the like. (I do check my skin for anything unusual every month or so, using a method I’ve shared in a previous post Are You Regularly Checking Your Skin for Skin Cancer?.)

Wanting to get in as soon as possible, I was told my Dermatologist was booked for at least a month, but they did have an opening right away with one of the Dermatology Physician”s Assistant (PA) who does skin cancer screenings routinely. Feeling a sense of urgency, I booked with the PA.

She put on her gloves and did a quick full body assessment, using an overhead spotlight and feeling any bumps with her fingers.

Then I pointed out the spots of concern. She wasn’t concerned, she said. She would like to wait a while and see what they do.

I WAS concerned, letting her know I had been watching them and they were changing. Then we had this exchange:

Me: “I would like you to do a biopsy.
Her: “I don’t think we need to do one. Let’s keep an eye on them for a while longer. If they change, come back.
Me: “I have been watching them for a while, and they have increased in size and redness. Please do a biopsy.
Her: “Let’s wait a little while longer.”
Me: (Getting frustrated) “I am a Nurse Practitioner with a trained eye. They need to be biopsied. Please call one of the Dermatologists that are here today in to do it.
Her: (Sigh and smirk) “O – kay.

Biopsy result: Basal Cell Carcinoma.

Three lesions removed.

Fast forward a few years, to a new light colored bump very slowly growing on the top center of my upper lip. I have changed Dermatologists after the shin skin cancer fiasco, and see an MD who uses a Dermatoscope (read Does Your Dermatologist Use a Dermatoscope to Detect Skin Cancers?) .

photo-13

Post Biopsy

Over the past year, we agreed to watch this one as his scope doesn’t deflect back light that signals back the alarms of pre-skin cancer. But it is growing. Very slowly, it IS growing. My upper lip is slightly lumpy on the top and uneven. On this day, I go in for a regular full body check, and on my list of things for him to check, I have written “Biopsy the lip lump.”

He gets to the lip lump:

He: “Yeah, it has gotten a tiny bit bigger, but it still doesn’t worry me.
Me: “It worries me that it continues to grow. Could you please biopsy it.”
Him: “It’s in a place that I don’t want you to have a scar, which might be lumpier than this bump.”
Me: (Hearing alarms screaming in my head) “If we continue to ignore it, and it continues to grow, and it eventually turns out to be something, then your will need to remove my WHOLE LIP which would be MUCH uglier than a little scar, don’t you think?”
Him: “Yeah, true.”
Me: “And I DO like my lips!” (Thinking they are my identity – my smile, not to add that they are a sensual part of my body! And WHO will want to every kiss “Miss Lumpy Lip”, huh?)
Him: “Okay, I’ll do a light shave biopsy. But if you start to see any type of scar forming in the next couple of days you need to let me know and come right back in so I can give you something to stop the lumpy scar forming.”
Me: “I don’t mean to offend you, or cause you to think I don’t trust your skills, but if it does come back positive, perhaps we can consult a Plastic Surgeon to assist you in removing this, because, after all, IT IS MY LIP!”
Him: “No, no, I don’t ever take it personally, and I will definitely work with a Plastic Surgeon if the results come back positive and we need to remove more tissue. Let’s cross that bridge when we come to it.”
Me: “After all, IT IS MY LIP we are talking about here!”

Now that he has done a very nice job of finely shaving the tissue and not damaging my lip line, I look like I’ve have one single spot of too much Botox injected for the time being. Not pretty. Now we wait for the results.

By the way, I chose this Dermatologist because he is also certified in the MOHS procedure, which is a surgical way of removing skin cancers that completely removes it all, while preserving the most of your healthy tissue. Some skin cancers, like Basal Cell Carcinoma and Squamous Cell Carcinoma, grow into the deeper layers of your skin in finger-like growths. The normal “scoop” that a non-MOHS Dermatologist will perform, may leave cancerous cells in the lower layers of tissue. Read more about the MOHS surgical procedure in my post What is the MOHS Procedure for Removing Skin Cancer?

My point is to not be afraid to ask for a biopsy if you suspicion something, and then be prepared to ask again. Your health care provider may not be worried, but if you are, you may need to be persistent to find the reassurance that your spot (or lump) is truly not something unhealthy.

At the end of the day, it is your body, your skin, and your lump. I want us all to be healthy…. and lump – free!

About Candace

Candace Dye is an Apriori Beauty Consultant and Neonatal Nurse Practitioner. Her passion is helping others to uncover and enhance their true inner radiance with tips for health, wellness, skin care and beauty!

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