Sun & Skin News

Is It Time to Seek a Second Opinion?

By Ali Venosa • April 16, 2021
Senior female patient in discussion with doctor during check up in exam room

Though it may feel awkward, getting a second opinion can be a great tool to help you take control of your health and find peace of mind.

A skin cancer diagnosis might make you feel anxious, confused or scared. You might ask yourself, Was this the right diagnosis? Am I sure about going ahead with the treatment my doctor recommended? Am I comfortable with my medical team, and are they giving me all of the information I need?

These are common concerns, and one way to address them is to get a second opinion. You may want another physician to confirm your diagnosis, help you understand the pros and cons of the proposed treatment plan or explore a different treatment plan altogether. A second opinion may be particularly helpful if you have been diagnosed with an aggressive or advanced form of the disease. Some common scenarios include:

When you’re not confident about your diagnosis. Your dermatologist looked at a spot that was worrying you and assured you it was nothing to be concerned about. Still, you can’t shake the feeling that something is “off” about it. There’s nothing wrong with getting a second opinion, even if just to confirm that the spot is benign.

“I’m asked to provide a second opinion several times a week,” says Ali Hendi, MD, a board-certified dermatologist and fellowship-trained Mohs surgeon practicing in Chevy Chase, Maryland. “Most of the time I agree with the diagnosis of the previous physician.”

Though many second opinions may match, be similar to or marginally differ from an initial physician’s evaluation, there are certainly times this is not the case.

Maritza I. Perez, MD, senior vice president of The Skin Cancer Foundation and a board-certified dermatologist practicing in New Canaan, Connecticut, recalls one occasion when a patient came to her questioning the diagnosis of skin cancer. “They asked for a second opinion, so I rebiopsied. I got the pathology back and there was no skin cancer.”

Dr. Hendi warns, however, that a negative result from a second biopsy may not always be definitive. On the other hand, a patient with a nagging suspicion about a lesion or mole may be told the spot is harmless by one physician but receive a second opinion with a suggestion to biopsy. Dr. Hendi says he will generally perform a biopsy for a patient if they are anxious the lesion may be cancer, even if he’s pretty sure the mole in question is harmless. “What I tell patients in my practice is: ‘I am very confident the lesion is benign, but if you will lose sleep over it, I am happy to do a biopsy.’”

When you’re uneasy about the proposed treatment plan. There are many treatments for skin cancer. Determining which one is right for you depends on many factors, including the type and stage of your cancer, the location of the tumor, your age and your lifestyle. But if your doctor has proposed excisional surgery, for example, you may be curious if another treatment — like Mohs surgery or a topical — might be an option.

Sometimes, a second physician will agree wholeheartedly with your primary dermatologist’s plan. Other times, there may be a disagreement. “This isn’t to say the initial provider was wrong,” Dr. Hendi says, “but rather that doctors may have different valid opinions on how to treat the same skin cancer.” He occasionally finds that the treatment plan he proposes differs from that of the previous doctor. When this happens, Dr. Hendi does his best to diffuse any frustration or confusion the patient might feel. There can be different approaches, based on training and experience, that can lead to equally good outcomes.

When you’re worried about the cosmetic outcome and possible scarring. One of the most common reasons skin cancer patients seek a second diagnosis is for potential reconstructive surgery, says Dr. Perez.

“I always suggest a patient get a second opinion when they ask if a plastic surgeon will do a better job in closing the wound.”

Dr. Perez notices this mostly when patients hear that they need surgery that could result in scarring or other undesirable cosmetic results. “If the patient has a large, neglected lesion in a cosmetically sensitive area like the nose, reconstruction may be long and difficult,” she says.

While it’s understandable that a patient may not be happy with this news, Dr. Perez says that most of the time, a plastic surgeon sought for a second opinion will send her patient back to her for Mohs surgery. She stresses that it’s imperative to have clear margins (no cancer cells left in the skin) before reconstructive procedures can begin.

Dr. Hendi also estimates that about half of the time he is asked to offer a second opinion, it has to do with the reconstructive treatment plan suggested by a previous physician. “Often this occurs with a provider in a different surgical subspecialty,” he says. “I have found some colleagues may choose reconstructive options I believe are overly complicated or aggressive. I was trained to do the simplest reconstructive repair that gives the most elegant yet reproducible results.” He notes that sometimes more complicated repairs must be done because unfortunately, there is no better or simpler option.

When you feel unsure or uncomfortable. If you are apprehensive about your doctor or you feel uncomfortable approaching them with your concerns, you can certainly ask a second dermatologist for their professional opinion. Keep in mind, though: While most physicians will support your decision to get a second opinion, if you find yourself shopping around excessively, you can get in the way of your own best care. There’s a difference between securing a second opinion for peace of mind and just seeking a doctor who will tell you what you want to hear. Finding a medical professional you can trust and comfortably converse with is key.

Featured in The 2021 Skin Cancer Foundation Journal