Who is the best at treating skin cancer?

Patients ask me all the time, “Do I need to see a Plastic Surgeon?” In short, there is no simple, universal answer to that question.

First, let’s take a look at some facts that may help one understand the situation a little better. First, let’s look at volume–who treats the most skin cancer.

  1. Dermatologists treat far more skin cancers than any other specialty.
  2. Mohs’ Surgeons perform more reconstructive surgery in cosmetically and functionally sensitive areas (i.e. nose, ear, lip, eyelid, face, etc.) after skin cancer removal than any other specialty. In a recent study, over 75% of reconstructions were performed by Mohs’ Surgeons–not Plastic surgeons, Facial Plastic surgeons, or Oculoplastic surgeons.

Experienced Surgeon:

So to summarize the above, Dermatologists and Mohs’ Surgeons treat more skin cancer than any other specialty, even on cosmetically sensitive areas.

That being said, more (performing more procedures) does not mean better (a better cosmetic outcome). More means more experience. For example, if I paint 8 hours a day for the next 10 years, I will not be a great painter. If I paint for 20 years, I still will not be a great painter. I will be an experienced painter, but that does not mean that I will be a great painter. More experience does not equate to better. More equates to more experience, which is also important.

So, what do we need to look for when choosing a surgeon to treat a skin cancer: 1. Experience, and 2. Skill.

Skilled Surgeon:

Finding someone who is skilled in reconstruction is more difficult for a lay person to evaluate. First one can evaluate the work that has been done on other patients. This is tricky and I will give a good example that a friend of my parents once told me. They were seeing a physician who flew up once a month from South America and performed Restylane injections in his hotel room in Miami. Now, that alone is enough to have me concerned for many reasons, but that is not the point I am trying to make. This couple had been treated several times by this physician and were very happy. They then planned on having him perform a facelift. Because they were so happy with the results of their Restylane treatment, they extrapolated that he is a good surgeon despite never seeing a single result of a facelift that he performed. Now this is quite an extreme example, but the point made still applies. Suturing a small wound on one’s forearm or even mid cheek is quite different than reconstructing a nose, ear, eyelid, or lip. So my recommendation is that if you are having a procedure on your nose, you have seen lots of patients who have had their nose operated on by that surgeon or seen many photos of work performed at that same location.

So, who is the best surgeon to treat one’s skin cancer? There is not a single factor that one can use, but several. You should seek out the most skilled, first and foremost, who is also experienced. Do your homework and find someone who meets those criteria. It may be a Mohs’ Surgeon. It may be a Plastic Surgeon. It depends on who is in the area that you are researching. I have scrubbed with the most talented Mohs’ surgeons and some who I would recommend another profession to. I have scrubbed with Plastic Surgeons who are extremely talented, some whom are not, and some who perform a lot of “boob jobs”, but have little experience in skin cancer reconstruction.

Robert S. Bader, M.D., Dermatologist