Is Your Dermatologist Wearing Too Many Hats? ~By Wendy Quaccia

San Carlos, CA…Experts in the dermatology field have agreed that it is difficult for dermatologists to read biopsy slides. If this is true, then why do some dermatologists still insist on doing so, resulting in patient compromise?

It’s frightening for me to think of how trusting I was with my family dermatologist of about 20 years. He always educated me with every visit, appeared to be confident in his ways and patient with my questions. My dermatologist knew me well. Years ago, he had diagnosed my dad with melanoma and forwarded him to a specialist for further treatment. I felt that I had established myself with the best dermatologist in the area and never had a reason to doubt his guidance. About every other year I scheduled an appointment for a skin exam due to my family history of melanoma. Through the years, I probably have had more than 25 moles removed out of pure suspicion. Each time I had this procedure done, my dermatologist would say “I biopsy everything.” His words lead me to believe that he was taking the proper steps to ensure an accurate reading for a true diagnosis by sending it out to a pathology lab.

Three years ago, I had gone in for a routine skin exam. During this visit, I brought his attention to a hard bump on my upper back that I had discovered a year prior. The bump was about the size of an eraser at the end of a pencil, was pink/skin in color and itched. My dermatologist removed the bump, noting that it was deep with a lot of damaged tissue and said that it was the result of a spider bite. I questioned his diagnosis, being unaware that a spider from this area could do such damage. However, my dermatologist was sure of his assumption. With his confidence and knowing that he would biopsy the tissue, I figured that unless I heard otherwise in a few days, that I would have nothing to be concerned about. Less than two years later, the bump was still there and I again requested that he remove it, for the second time. Months later, the bump was still present.

With growing concern, I established myself under the care of another dermatologist. It was determined by a pathologist that the “bump” was and had always been a very deep melanoma that was of the dangerous kind, a nodular melanoma that seems to be kept hidden from most dermatology brochures. I later learned that my family dermatologist did his own in-house reading and that my biopsies were never sent out to a pathology lab! Therefore, his assumption of a spider bite remained as an assumption and I suddenly found myself with a 3-year delay in a diagnosis of melanoma in the year 2013. At that very moment, the trust and confidence I had in my family dermatologist had been shattered.

It is worth your while to verify that your dermatologist does in fact send every biopsy out to a pathology lab for review. We all have to be our own advocate when it comes to health care. I have found that the best advice is to listen to your own gut feeling. Learn to do your homework before you visit your doctor by going online or reading articles in an area that you have concerns. Also, bring as many questions as you need answers to his/her attention during your visit.

People shouldn’t have to wonder if their doctor is doing all that he/she can to ensure the best care for their patients. My doctor’s play on words has been a life game changer for me. According to the dermatology community, it is still acceptable for dermatologists to do their own biopsy readings in-house. If no changes are made, the probability of this happening to more individuals is likely. Isn’t it time to take another look at the current dermatology regulations and have some revisions made?