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Skin Cancer

What to Expect at Your Doctor Visit

At some point you will probably go to a specialist in cancers of the skin. Typically, this will be a dermatologist. If the cancer is very large, you might find yourself in the office of a surgeon who specializes in head and neck cancer. This could be a surgical oncologist, head and neck surgeon or a plastic surgeon. Just be sure the surgeon has an interest and experience in treating skin cancers. Remember, removing a cancer is not the same as removing a little mole you just don’t like the look of.

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face or mouth?
  • Do you have any lumps or bumps in your neck?
  • Are you losing weight?
  • Do you have any other medical conditions?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the head and neck?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in skin cancers, you will get a thorough physical examination focused on the area of concern. This means your doctor will obviously look at the skin lesion.

However, he or she will also feel around your neck and your face for any lumps or bumps that might be lymph nodes. The doctor will then probably check your cranial nerves by asking you to move your face, stick your tongue out, lift your shoulders, follow his or her fingers around with your eyes, do some simple hearing tests and test your sense of touch all over your face.

Depending on where the area of concern is, a few special things to expect in your physical exam might include ear examinations, hearing tests and feeling in and around your mouth. A dermatologist might even examine your entire body to look for any other suspicious areas.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

References

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16 Young JL, Ward, KC, Ries LAG. Chapter 30: Cancers of Rare Sites. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

17 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20.

18 Wang TS, Byrne PJ, Jacobs LK, Taube JM. Merkel Cell Carcinoma: Update and Review. 2011 Seminars in Cutaneous Medicine and Surgery: 30(1):48-56.

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31 Marrazzo G, Thorpe R, Condie D, et al. Clinical and Pathologic Factors Predictive of Positive Radiologic Findings in High-Risk Cutaneous Squamous Cell Carcinoma.

32 Gupta SG, Wang LC, Penas PF, et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: The Dana-Farber experience and meta-analysis of the literature. Arch Dermatol 2006;142:685-690.

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