Second Opinions

I'm looking for advice here. Though, I can't promise I'm going to take it.

All of this started last spring. I was sitting in the waiting room at the dentist reading some lousy women's magazine - I think it was Elle - when I stumbled on an article about skin cancer. It was loaded with product plugs and the overall tone was a fearful one: anyone can get skin cancer - anyone!... so be afraid, go to your dermatologist, buy the fifteen-dollar sunscreen. I was completely aware at the article's intent, but having a friend - younger than I - who recently was diagnosed and had to have skin grafts on her face - well, I was, on some subconscious level, affected by it.

I should also note that I have a host of other minor skin ailments - mild breakouts on my face, eczema, and annoyingly sensitive skin. So at my annual physical I decided to ask my doctor to take a look at my skin. Was a skin cancer screening necessary just to be safe... or was I being silly? I've gotten some severe sunburns throughout my life, have fair skin and a nice shower of freckles. He took one look at my speckled shoulders and said, "It wouldn't hurt to see a dermatologist."

Months later my appointment with an apparently-popular dermatologist finally arrived. I was excited to finally get some answers and peace of mind. However, after making my way past the assortment of product posters on the walls and sitting in a smock for 15 minutes, I was given a quick 3-minute scan and assured I was fine. She barely made eye-contact with me.

"But what about my face... the blackheads..." I attempted to stall her robotic routine.

She peered at my forehead, "Oh... I think a little Retin-A would clear that right up. I'll give you a prescription and some samples."

I couldn't think of a response, and she was so quick - so uninterested in what I had to say - that I never did think of one until I left that evening, tossing the prescription slips and samples in the trash: What can I do naturally?... What can I eat? Can I take certain vitamins? Is a prescription really necessary for a few little whiteheads?

The questions kept streaming in, and months and months after the appointment I became more and more irritated with the insincerity of that brief encounter with a dermatologist. My skin continued to fluctuate between acne and eczema breakouts, and I became convinced that I needed a second opinion.

In January I had my second appointment with a dermatologist, and while they were not quite as obvious, all the signs of a formulaic business were there. The posters for botox and other magically beautifying products plastered the walls, the check-in-check-out windows reminiscent of a Dunkin Donuts queue, the waiting, waiting, waiting alone in a cold room for 20 minutes in a paper gown.

This time I was prepared: I didn't want a prescription - I wanted advice. I had particular spots that I wanted checked out. I was ready. The doctor came in and was much nicer than the first, but brought with her a PA, armed with laptop and digital camera. I showed her my complexion, slightly mottled by whiteheads.

"Oh..." she said, squinting to see them. "I would recommend some Retin-A..." and off she went on the schpeal about applying the prescription every night before bed...

"But I would prefer not to have a prescription if necessary," I interrupted, "Isn't there anything natural that I can do? Certain things I can eat? Vitamins I should be taking? Cleansers I could use?"

She looked mildly annoyed and ignored most of my questions, choosing to answer the only one that involved me purchasing something. "We have a great line of skin care products that might help..." In seconds there was a brochure in my hand with a photo of a beautiful, blemish-free woman on the front and some scientific, French name. "We can get you some free samples."

She proceeded to check out my freckles and the spots, growing concerned at a particular tiny red spot on my chest. Leaning in close, she summoned her assistant with the camera. "Hmmm. That one looks strange. Could be basal cell carcinoma..." She went on to explain that basal cell was a very-treatable, non-life-threatening, very common form of skin cancer. Caught early, it was absolutely nothing to be concerned about. But they needed to slice a tiny piece of it and have it biopsied to be sure.

Hmph. Skin cancer? Biopsy? I grew worried just at the words. She was prepared for my face of concern, and reiterated that it was nothing to lose sleep over.

A month later I returned, butterflies in my stomach, for the biopsy. I am terrified of needles and all things medical, and I told the nurse as much as she numbed the area and removed part of my tiny spot. "You'll get a letter in 7-10 days with the results," she explained. "If you don't hear from us in two weeks, please call."

Um, ok. So a letter. I left the office feeling slightly nauseous, afraid to peek under the band-aid until later that night. When I finally did, I was surprised to see she had removed a chunk of skin larger than the spot itself - but only half of the spot itself. Why didn't she just remove the whole thing? I thought.

So I waited. And waited. Two weeks went by without my realizing, then last week - finally - I got a letter. "The results of your skin biopsy showed an atypical mole. There is no cause for alarm, however, this lesion will require further excision... we have scheduled your excision for April 3rd...."

What? An atypical mole? Further excision? Another procedure? They must be kidding... this "lesion" was no bigger than a chiclet! First I was scared. Then I was irritated. Then I was angry.

I researched atypical moles online and discovered that 1 in 10 people have one but they are considered "precancerous." Some doctors think that there is a slight chance that an atypical mole can turn into melanoma - a potentially deadly form of skin cancer. But statistics I found online say that it's highly unlikely - and melanoma can form from anything. Furthermore, atypical moles are only of concern when they change. If they grow bigger, change pigment, or morph in any way, then there is real cause for concern.

I called the office and told the nurse I thought the procedure was excessive, was overkill. Why didn't they just remove the thing to begin with? Why couldn't I just keep an eye on it? She couldn't give me a very good reason why they hadn't removed it already, but explained that this was a better-safe-than-sorry procedure. Yes, it was unlikely that my atypical mole would turn into anything... but, she had seen atypical moles turn into melanoma before.

I didn't cancel my appointment. Yet. But I've been researching it and talking about it with different people. My sister, who is an occupational therapist and knows her stuff when it comes to medicine, is equally torn: is it really necessary to have such a tiny, easy-to-monitor and most-likely-insignificant spot removed... just because it might turn into something? Or are they just trying to get more insurance money out of me for an unnecessary procedure?

I'm not sure. But next week I'm going to cancel my appointment and attempt to find a homeopathic doctor for an alternative opinion.

My overall feeling about the whole thing? In a health care system driven by money, we have to be incredibly cautious and aware of what "doctors" proclaim. If the signs are there - say, purposefully placed cabinets full of expensive, well-designed skin creams with brochures and posters in the examination room - we have to pay attention. The mere fact that this doctor would not offer me any advice or answers that didn't involve another appointment, a prescription, or a purchase at her spa next door (no kidding), has me thinking. The inhumanness of a letter to inform me of my results and already-scheduled appointment (it was clearly a form letter, with certain parts filled in from a computer database). The dividing of all procedures into as many appointments as possible.

All of it put up red flags for me, and while in the past I might easily be swayed by fear-tactics, I'm trying to use my head here. I'm not going to start lopping off every abnormal spot on my body because it might, maybe, someday turn into something. Instead, I want to know what I can do now - on my own - to keep my body whole, strong, and healing itself. A preventative approach, a holistic approach, a human approach.

If anyone has any thoughts, similar experiences, or recommendations for a third opinion, it is much appreciated.