People diagnosed with a skin cancer often make this decision quickly, because the word cancer creates a sense that any delay is dangerous. A few days spent choosing carefully is rarely the thing that changes an outcome, and it frequently changes the quality of the result. The choice you are actually making is not only who removes the lesion, but who plans the repair of the gap that removal leaves. Those two decisions belong together, and this article is about assessing the person who will make them.
What qualifications should you look for?
Look for formal training in plastic surgery, which in India usually means M.Ch. Plastic Surgery or DNB Plastic Surgery obtained after a general surgical qualification, together with current registration with the state medical council. Ask which degree, from which institution and in which year. These are ordinary questions. For reference, Dr. Ashutosh Shah at Elegance Clinic in Surat is a plastic, reconstructive and cosmetic surgeon with more than 22 years of surgical experience, holding M.Ch. Plastic Surgery from The Maharaja Sayajirao University of Baroda and DNB from the National Board of Examinations, New Delhi, with microvascular and replantation training.
Why does it matter who plans the removal and the repair?
Because the two decisions pull against each other unless one mind holds both. Clearance must not be compromised to make closure easier, and closure must not be designed as an afterthought once a defect already exists. A surgeon who does both, or who works closely and routinely with the person doing the other half, can plan the incision so the clearance is adequate and the scars still fall where the face naturally creases. Ask directly: who removes the lesion, who reconstructs, and are they discussing your case before the day of surgery.
What should you ask about margins and pathology?
This is the question that separates a thorough plan from a hurried one. Ask what margin is planned around the lesion. Ask whether the tissue will be sent for examination, and when the report is expected. Ask what happens if the pathologist finds disease reaching an edge of the specimen, since margins may then need re checking and further tissue may need to be taken. Ask whether the reconstruction will be done immediately or delayed until the margins are confirmed, and why that choice suits your case. A surgeon who has already thought through the answer to the awkward version of this question is the one you want.
What range of techniques should be available?
The right reconstruction depends on the site and on what the clearance leaves, so a surgeon whose practice offers only one answer is limited. Direct closure, skin grafts of different thicknesses, local flaps that move neighbouring tissue on its own blood supply, and for larger or deeper defects tissue brought from further away, are all part of the range. On the hand and lower leg, where tendon and bone sit close beneath thin skin, the repair also has to allow movement afterwards. Ask what options are being considered for your defect and why each might be chosen, and expect to hear more than one.
What should you ask to see and hear?
Ask to see the surgeon’s own results for similar defects in similar sites, at a stage late enough for the scars to have settled rather than at two weeks. Ask how they plan facial repairs, and listen for whether they talk about the natural lines of the face and the borders between its units. Ask what they would expect the area to look like at six months and at a year. An answer that includes what will still be visible is more trustworthy than one that offers a clean sweep. Nobody can promise you an invisible scar.
What warning signs should make you pause?
- A promise that the scar will be invisible, or that one operation will certainly finish everything.
- No mention of pathology, margins, or what happens if the margins are not clear.
- An offer to burn, freeze or laser a suspicious lesion without obtaining tissue for examination.
- A fixed reconstructive plan described with certainty before the lesion has been examined.
- Pressure to book immediately, or discouragement from seeking another opinion.
- No written estimate, or reluctance to explain what is and is not included.
- No arrangement for follow up or for monitoring your skin afterwards.
Who else should be involved?
Depending on the diagnosis and the site, your care may involve a dermatologist, a pathologist, an oncologist, and for lesions near the eye an ophthalmic specialist. Ask who is coordinating and how the decisions are being made. Ask who reviews you if the surgeon is unavailable and how you reach the team between appointments. For a treatment that may involve more than one operation and continuing follow up, the reliability of the team around the surgeon matters as much as the operating itself.
What about cost, travel and follow up?
Ask for an estimate in writing that makes clear what it covers, including whether further surgery for margins or later refinement is included or charged separately. At Elegance Clinic, a written estimate is given before admission and enquiries reach the team on WhatsApp. Whether a health policy contributes varies by insurer and by policy wording, so confirm that with your insurer directly. Consider travel too, since dressing changes, suture removal and follow up visits are repeated events. A surgeon you can reach easily may serve you better through a long treatment than a distant one seen once.
Is it reasonable to take a second opinion?
Yes, and it is common in reconstructive practice. Take the same written list of questions to both, and compare the answers rather than the atmosphere. Notice who explained the limits of what surgery can achieve, who described the pathology pathway clearly, and who gave you a plan in writing. A surgeon who is unbothered by your questions and honest about uncertainty is giving you the firmest ground on which to decide.
What should you bring to the first appointment?
Bring the biopsy report and any earlier reports, a note of previous treatments to the same area, a list of your medicines including anything that thins the blood, and details of conditions such as diabetes that affect healing. Bring a photograph if the lesion has been changing over time. Write your questions down beforehand and bring someone with you if you can, because two people hear a consultation differently and one of you will remember what the other missed.
