Natural Perspectives: Battling skin cancer — and my HMO

I've been battling skin cancer for the past two months. More accurately, I've been battling my HMO to get my cancer removed.

The good news is that surgery offered a complete cure for this type of cancer, and it is now gone. The bad news is that the surgery left a two-inch-long scar on my face.

When Vic and I were in New Mexico in late December, it became obvious to me that the little "pimple" that I had developed in early December was no pimple. It was growing larger every day, had a crusty, scaly surface, and a pit of dead tissue in the middle. It looked to me like a squamous cell carcinoma, which I have had before.

But this one was amazingly aggressive. In three weeks, it went from being barely visible to being as big as a pencil eraser.

I decided that an aggressive cancer needed aggressive action. I called my primary care physician the day after Christmas. Since I was pretty sure it was a squamous cell carcinoma, I asked for an immediate referral to a dermatologist without visiting my primary care physician.

My doctor knows that I know what skin cancer looks like, and she granted me that referral. That shaved a week off the HMO process, but it took another week to get an appointment with the dermatologist.

The dermatologist did what is called a shave biopsy. Why do that instead of actually removing it? Because my stupid HMO won't pay for a full removal without a biopsy verifying that it is indeed cancer.

The dermatologist said to come back in a month. At first, it looked like the shave biopsy actually got the cancer. But it came back with a vengeance. The wound didn't heal, and I was faced with twice daily wound care with hydrogen peroxide, antibiotic ointment and bandages.

I soon had a lesion the size of a thumbnail on my face. I wasn't about to wait a month. I called the dermatologist and asked for an immediate referral to a Mohs surgeon, and got it.

Mohs surgery is a cryogenic technique whereby frozen and stained sections of the tissue are examined after each cut to be sure that all the margins of the tumor are gone and that the surgeon cut deeply enough to remove all of the cancer's "fingers" or "roots" under the tissue. My HMO doesn't have a Mohs surgeon in their system, so they contract out for this type of surgery.

Here is where it gets complicated.

My HMO won't pay the Mohs surgeon to close the wound. The patient must visit a plastic surgeon in the HMO system for wound closure. That meant two separate surgeries, not even necessarily on the same day, and two separate rounds of local anesthetic injections.

I'll skip right over the part where my HMO decided that this was not urgent and refused to give me an emergency referral. And I'll skip over the language that I used to get them to upgrade it to an emergency.

We'll move right on to having to consult with both the Mohs surgeon and plastic surgeon before the actual surgery could be scheduled. That was another wasted week while the cancer continued to grow.

Cancer cells divide once every 24 hours, and this thing on my face was getting huge. You could see it on Google Earth. By the time of the actual surgery, it was big enough to warrant its own ZIP code. I was freaking out.

Finally, the day of surgery arrived.

The Mohs surgeon "numbed me up." Sounds pleasant, but that involved about eight injections into the tumor in my cheek. Unfortunately, I am hypersensitive to epinephrine, a usual component of local anesthesia that helps constrict the blood vessels and makes the anesthesia last longer.

Since I can't have epi, the anesthesia wears off after about five minutes and I have to be reinjected repeatedly. Not fun.

The first cut got all of the margins of the tumor, but this thing had sunk its roots deep into my tissue and the Mohs surgeon had to do another round of surgery. That meant more injections into my face, which was no longer numb.

Here is where my day got really bad. She hit an artery and blood squirted all the way over to the other side of my body. The doctor had to suture it closed since it wouldn't stop bleeding.

Unfortunately, her assistant gave her the wrong kind of sutures, which the doctor didn't discover until after she had sutured the artery. She had to remove those stitches to put in dissolvable sutures.

Meanwhile, the local anesthetic wore off once again and I felt the suturing. The doctor numbed me up again, and finished the procedure with electrocautery to keep the wound from bleeding until I could see the plastic surgeon. I was left with a deep hole in my cheek the size of a quarter.

I was so upset over the morning's procedure that I forgot to remind the plastic surgeon that I can't have epinephrine. They're supposed to ask you before a procedure if you have any allergies, but no one did.

It was on my chart from the consult the week before, and it just didn't occur to me to mention it again since we had discussed it at length. Big mistake. The plastic surgeon put epi in the anesthetic, and my body went ballistic.

Some people— like me — react to the tiny bit of epinephrine that is in local anesthesia by instantaneously developing skyrocketing pulse and blood pressure, dry mouth, and severe shaking. It can progress to a heart attack or stroke. I know that plastic surgeons, dermatologists, etc., aren't quipped to handle a heart attack, so I insisted that he call the paramedics.

The doctor was rendered non-functional by his mistake. He didn't even take my vitals. I asked for my son, who was in the waiting room, and my son took my pulse. It was 131 lying down at rest. My son then asked for a blood pressure cuff, but the doctor had just moved and didn't even have it unpacked.

The paramedics arrived, took my blood pressure (208/110) and did an EKG. They wanted to take me to the emergency room.

But by then my body was metabolizing the epi and my blood pressure was dropping. It was still catastrophically high, but my EKG was normal. I opted to stay and have the plastic surgeon close the wound, promising to go to the ER as soon as the surgery was done.

My son and I had to settle down the doctor so that he was calm enough to operate. He enlarged the round wound to facilitate a clean closure. That's how I ended up with a two-inch long scar on my face.

My blood pressure was still sky high when I went to the ER after surgery. It didn't return to normal until the next day.

February is National Cancer Prevention Month. Vic and I urge you to see your doctor to schedule whatever screenings your doctor deems necessary. If caught early enough, most cancers are curable. Screening and prompt treatment saves lives.

VIC LEIPZIG and LOU MURRAY are Huntington Beach residents and environmentalists. They can be reached at

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