Now really, what is your doctor not telling you?

Currently, many dermatologists operate under a “fee for service” system. This means they get paid for the volume and procedures done instead of getting paid for the way they provide care by consultation. As a result, some practices can perform a surgical procedure faster than they can counsel a patient on non-invasive, long-term options.

• The Time Bias: Procedures are "time-efficient" for the clinic.
• The Profit Bias: Invasive operations typically command higher reimbursement rates from insurance providers than "medical" management. When financial and logistical benefits align for the provider, the patient’s right to a less invasive, lower-cost alternative can be unintentionally sidelined.

An increase in "over-treatment" for dermatology patients has occurred recently with respect to patient's diagnosis of low-risk basal cell carcinoma (BCC) or early stage lesions. Mohs surgery is a pioneering approach to removing basal cell carcinoma (BCC) located on facial structures or at higher risk sites but has been expanded to include other areas of the patient’s body that have lower risk (e.g., curettage, topical chemotherapy). When dermatology practitioners use Mohs surgery as a "sole" option without consideration of the risk profile associated with a particular lesion, they deny their patients the potential benefit of avoiding scarring or physiological impacts from a more invasive surgical procedure.

Restoring autonomy means moving toward a model of Shared Decision Making (SDM). Patients must be empowered with the medical literacy to ask critical questions:

• "What are the risks of 'watchful waiting' for this specific lesion?" * "Is there a non-surgical alternative that fits my lifestyle and values?" By providing clear, honest educational materials that break down the "ABCDEs" of detection alongside a menu of treatment tiers, we can transition the patient from a passive recipient of care to an active participant in their own healing.

Addressing the lack of transparency in skin cancer treatment requires a two pronged approach: clinical integrity and systemic reform. We must advocate for a shift toward Value-Based Care, where providers are incentivized based on patient outcomes and satisfaction rather than the number of procedures performed. Only by decoupling financial gain from surgical intervention can we ensure that the "knife" is used as a clinical necessity, not an economic convenience. Transparency is the first step in ensuring that the skin we are treating belongs, first and foremost, to the patient.