› Forums › General Melanoma Community › Is there an option for general anesthesia or even sedation type anesthesia for numerous (never ending) wide area excisions?
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Michelle820.
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- December 21, 2016 at 4:45 am
I was diagnosed with stage II melanoma, from a biopsy of a 4mm atypical mole, on my lower back, in April of 2016. I had an initial excision (wide area excision) on that melanoma, along with 6 other biopsies of atypical moles. The lab tested the excised tissue and determined there was still a margin of affected cells or whatever it's called, so I had a second wide area excision to the lower back, which now included a smaller mole next to the first one that was diagnosed with melanoma. The results of this excision showed clear. There was probably 14-15 stitches at this point, but after healing, the scar is down to 4 1/2" by 1 1/12" (very ugly football shaped). Since then, I have been back to this Dermatologist 8-9 times, to remove atypical moles with moderate to severe something or other (cellular problems?). I can't remember the exact term, but the atypical moles with slight problems I've elected to just watch.
I have had 7 more wide area excisions, on the atypical moles with moderate to severe results, with scars each one resulting in scars 2-3 inches long (I still have stiches in my mid-back). I also had a cyst removed from my left side abdomen, during these visits. I have had wide area excisions on side, left front, and mid abdomen, as well as my left calf and mid-back. I am very anxious during these procedures (I actually started shaking uncontrollably during the second wide area excision if the melanoma.
I have a high pain tolerance, but for some unknown reason, I am terrified of needles, not to mention the scalpel and the soldering instrument they use to cauterize the bleeding, prior to the inner and outer stiches. I used up to 20mg of valium, prior to treatment, but it does not help to calm me down.
I am very light skinned and have an uncountable amount of moles, which my doctor referred to as, "a bazillion", which look atypical and need biopsies. I feel like I am slowly dying by a thousand cuts! I generally don't take any time off of work for these single excisions and multiple biopsies, but they are very uncomfortable due to the equipment I have to wear at work. I've questioned my doctor and requested some type of general anesthesia, to complete 10-20 of these excisions at once (at which time I would take some time off of work to heal).
The excisions have generally healed in 2 weeks, except for the excision of the original melanoma, which took much longer to heal. I generally just remove the stiches myself and sometimes have to dig them out, due to skin overgrowing the stiches, which causes bleeding and small wounds.
My doctor told me they generally only do one wide area excision at a time, along with up to five biopsies, due to their policies and what the insurance pays. I was told that the insurance only pays 50% for a second excision and less for more. I've cancelled several appointments, at the last moment, due to my anxiety about the procedure.
I've offered to pay out of pocket for general anesthesia or even a sedative type anesthesia, but my doctor told me that is not an option and no other dermatologist or surgeon would do it that way. I'm worried about dying of cancer, but I also don't think that wide area excisions over months and years, one at a time, can be an option for me, especially due to the extremely large number of atypical moles, which have come back with negative results (moderate to severe). My doctor is a very nice guy, but I can't handle the unending surgical procedures, while I'm wide awake!
Today, he offered to possibly do two excisions, along with plug type removal (7mm), of the atypical moles, instead of just doing a slicing biopsy. But this still leaves me in a bad situation, due to the level of anxiety and number of atypical moles on my body.
I have good medical insurance and I am sure they would pre-authorize some type of mass wide area excisions, with anesthesia. If not, I would be willing to pay the difference, out of pocket.
Is this just not an option???? It feels like it's more of a doctor/corporate form of greed, rather than a insurance issue. I've checked the internet, using multiple search topics, but I can't find any information about sedation or general anesthesia for these procedures.
Please help!!!
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- December 21, 2016 at 6:50 am
I know you've posted before, but I just have to ask if all the atypical moles are changing? Are you doing body photography? Only removing changing lesions? People who have dysplastic nevus syndrome are subject to lots of biopsies but they can be minimized by removing the ones that change instead of any that strike the docs fancy.
Why not ask the doc for anti-anxiety meds? I'm not sure you're going to get anywhere with general anesthesia or lots of excisions at one time. Insurance won't likely pay for either. They do actually call the shots on lots of this but the doctor may also have his own agenda. Most derms are not setup to do OR type excisions and that is what you'd have to have for general anesthesia. (Much more expensive for an OR suite than an excision in an office setting). If you are determined to go this route, it's probably better that you see a plastic surgeon because he will regularly be using the OR and have OR priviledges.
I hate general anesthesia so much that this is something I'd never do. I have the same type of anxiety for that that you experience for local. The local is a walk in the park in comparison. But I'm also not having biopsies every couple of weeks.
Really recommend photography first – finding a doc that uses that regularly in their practice to minimize the biopsies. Wholesale removal of moles has not proven to increase your survival rates since melanoma actually shows up on new moles at least 50% of the time. Just keep that in mind.
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- December 21, 2016 at 6:50 am
I know you've posted before, but I just have to ask if all the atypical moles are changing? Are you doing body photography? Only removing changing lesions? People who have dysplastic nevus syndrome are subject to lots of biopsies but they can be minimized by removing the ones that change instead of any that strike the docs fancy.
Why not ask the doc for anti-anxiety meds? I'm not sure you're going to get anywhere with general anesthesia or lots of excisions at one time. Insurance won't likely pay for either. They do actually call the shots on lots of this but the doctor may also have his own agenda. Most derms are not setup to do OR type excisions and that is what you'd have to have for general anesthesia. (Much more expensive for an OR suite than an excision in an office setting). If you are determined to go this route, it's probably better that you see a plastic surgeon because he will regularly be using the OR and have OR priviledges.
I hate general anesthesia so much that this is something I'd never do. I have the same type of anxiety for that that you experience for local. The local is a walk in the park in comparison. But I'm also not having biopsies every couple of weeks.
Really recommend photography first – finding a doc that uses that regularly in their practice to minimize the biopsies. Wholesale removal of moles has not proven to increase your survival rates since melanoma actually shows up on new moles at least 50% of the time. Just keep that in mind.
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- December 21, 2016 at 6:50 am
I know you've posted before, but I just have to ask if all the atypical moles are changing? Are you doing body photography? Only removing changing lesions? People who have dysplastic nevus syndrome are subject to lots of biopsies but they can be minimized by removing the ones that change instead of any that strike the docs fancy.
Why not ask the doc for anti-anxiety meds? I'm not sure you're going to get anywhere with general anesthesia or lots of excisions at one time. Insurance won't likely pay for either. They do actually call the shots on lots of this but the doctor may also have his own agenda. Most derms are not setup to do OR type excisions and that is what you'd have to have for general anesthesia. (Much more expensive for an OR suite than an excision in an office setting). If you are determined to go this route, it's probably better that you see a plastic surgeon because he will regularly be using the OR and have OR priviledges.
I hate general anesthesia so much that this is something I'd never do. I have the same type of anxiety for that that you experience for local. The local is a walk in the park in comparison. But I'm also not having biopsies every couple of weeks.
Really recommend photography first – finding a doc that uses that regularly in their practice to minimize the biopsies. Wholesale removal of moles has not proven to increase your survival rates since melanoma actually shows up on new moles at least 50% of the time. Just keep that in mind.
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- December 21, 2016 at 11:26 am
Hi:) so sorry you have had to experience multiple procedures. Does your derm do thhave excisions or a surgeon? I agree to possible consult with another Doctor, preferably an oncological surgeon or a plastic surgeon. If they can do your procedures in a surgery center or OR, I believe they could order you iv sedation. I went to two doctors recently-one scheduled me with local and the other sedation? I ended up going with the Dr who used local-only because of the Doctor and faculty (pigmented lesion group instead of plastic surgeon). Honestly I also wish I was sedated. My WLE was on my left breast which was awkward both mentally and physically. Being in an OR awake was a little scary-and I am a nurse! I didn't care for all the necessary draping (I know they have to do that). It was literally covering half of my face and I could feel the surgeons arm across my cheek:/ plus as u said, the burning, tugging are also not fun.
Last summer, I had a routine colonoscopy and they used Propafol (sp?). It was awesome! Went in an IV. I woke up feeling rested and not groggy at all! However, with sedation you will be required to have someone drive u home. I hope this info helps you. If you are uncomfortable please talk to your Dr about this. Sometimes they just don't realize the mental toll this takes on a person. I too, have many moles and fear more biopsies. I have multiple scars too. However, please keep in mind you are doing the right thing by being proactive about your health. Stay strong and I wish you the best!
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- December 21, 2016 at 11:26 am
Hi:) so sorry you have had to experience multiple procedures. Does your derm do thhave excisions or a surgeon? I agree to possible consult with another Doctor, preferably an oncological surgeon or a plastic surgeon. If they can do your procedures in a surgery center or OR, I believe they could order you iv sedation. I went to two doctors recently-one scheduled me with local and the other sedation? I ended up going with the Dr who used local-only because of the Doctor and faculty (pigmented lesion group instead of plastic surgeon). Honestly I also wish I was sedated. My WLE was on my left breast which was awkward both mentally and physically. Being in an OR awake was a little scary-and I am a nurse! I didn't care for all the necessary draping (I know they have to do that). It was literally covering half of my face and I could feel the surgeons arm across my cheek:/ plus as u said, the burning, tugging are also not fun.
Last summer, I had a routine colonoscopy and they used Propafol (sp?). It was awesome! Went in an IV. I woke up feeling rested and not groggy at all! However, with sedation you will be required to have someone drive u home. I hope this info helps you. If you are uncomfortable please talk to your Dr about this. Sometimes they just don't realize the mental toll this takes on a person. I too, have many moles and fear more biopsies. I have multiple scars too. However, please keep in mind you are doing the right thing by being proactive about your health. Stay strong and I wish you the best!
-
- December 21, 2016 at 11:26 am
Hi:) so sorry you have had to experience multiple procedures. Does your derm do thhave excisions or a surgeon? I agree to possible consult with another Doctor, preferably an oncological surgeon or a plastic surgeon. If they can do your procedures in a surgery center or OR, I believe they could order you iv sedation. I went to two doctors recently-one scheduled me with local and the other sedation? I ended up going with the Dr who used local-only because of the Doctor and faculty (pigmented lesion group instead of plastic surgeon). Honestly I also wish I was sedated. My WLE was on my left breast which was awkward both mentally and physically. Being in an OR awake was a little scary-and I am a nurse! I didn't care for all the necessary draping (I know they have to do that). It was literally covering half of my face and I could feel the surgeons arm across my cheek:/ plus as u said, the burning, tugging are also not fun.
Last summer, I had a routine colonoscopy and they used Propafol (sp?). It was awesome! Went in an IV. I woke up feeling rested and not groggy at all! However, with sedation you will be required to have someone drive u home. I hope this info helps you. If you are uncomfortable please talk to your Dr about this. Sometimes they just don't realize the mental toll this takes on a person. I too, have many moles and fear more biopsies. I have multiple scars too. However, please keep in mind you are doing the right thing by being proactive about your health. Stay strong and I wish you the best!
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Tagged: cutaneous melanoma
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