Basel cell, mohs surgery

[champken]

I have a smallish basel cell on my ear that needs removing by mohs surgery. BPH want 19000b for the procedure which i thought sounded a bit steep especially considering i already have confirmation from a previous biopsy that it is indeed a basel cell.

 

While i appreciate that Dr Anna at BPH is a sound choice of Doctor to do this surgery, i am hoping somebody may come up with a cheaper alternative even if it means going a bit further to get it done?

Edited March 6, 2018 by champken
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[Sheryl]

Not many Docs in Thailand able to do Mohs.

You can try Dr. Niyom at Bumrungrad but I'm not sureit will be much cheaper if at all.

If you are willing to forego Mohs and accept a less cosmetic result then there are govt hospital options.

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[champken]

Thanks Sheryl, from a cosmetic point of view considering where the basel cell is i am leaning towards the simpler excision surgery as opposed to the much more expensive mohs sugery. 

[Sheryl]

Yes, simple excision will be much cheaper. Mohs is an expensive procedure since multiple iterative biopsies are required, and few doctors with the necessary training.

 

As it sounds like you are in Pattaya are I suggest you contact

 

Dr.Nitivadee Teeyapan-Songdej, M.D.
La Nitivadee Dermatology & Aesthetic Laser Center

 

www.lanitivadee.com

 

About 2 years ago she gave me a quote of 8,000 baht for excision of a facial BCC inclusive of surgery, doctor fee and pathology for determining free margin.

 

 

[champken]

Thanks so much Sheryl,  that sounds just what i am looking for.

[wpcoe]

Won't Dr Anna do a simple excision?

[bumofdabeach]

Mohs in my experience is not worth the trouble. I've had 3 for the same area. It keeps coming back. Just get it cut out. My first one ended up being a 3 inch circle on my forehead but a plastic surgeon with a vivid imagination moved it to the top of my head lol. I still get outbreaks in the original spot.

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[jerry921]

I had a spot of Basel cell carcinoma on my shoulder removed in the US using mohs. I'd gone into see a new demitologist since it had been ten years and I had had some worrying moles in the past that had been taken off. I figured it was time for another full body scan. Anyway, this doctor saw a spot on my shoulder he didn't like, took a sample and it came back Basel cell carcinoma, and he recommended Mohs, without really giving me any other options.

 

It was larger than OP's ear spot, mine was about the size of a large coin (a US quarter, e.g.). The doctor's office was in a large hospital, and the biopsy was done in "real time". That is, they cut some off and put a temporary bandage in place and put me back out in the waiting room while the biopsy was done. At the time I thought the biopsy was being done right in that dermatologist's office, but I suppose there might have been a lab in another office on another floor or something. Anyway, after 40 minutes they had the result, and it looked like he'd taken a big enough scoop the first time, so they stitched me up and that was that.

 

I certainly wouldn't bother with Mohs if they were going to be doing the biopsy off-site and calling you back for multiple iterations of the surgery on different days.

 

In my case the doctor probably recommended Mohs because he could do it and get paid more for it, but his claim was it was more reliable than just guessing how much to take and hoping it was the right amount. I wouldn't bother with it just for cosmetic reasons, especially on your ear there since you can just grow your hair a little longer and cover it up.

 

The important thing is to do whatever provides the best chance of getting rid of it permanently.

[wpcoe]

On 3/8/2018 at 6:39 AM, wpcoe said:

Won't Dr Anna do a simple excision?

 I was mis-remembering what mohs was, and after googling it, I realize now that Dr. Anna can do a regular excision -- that's what she did with my BSC.  So, @champken, (a) why do you feel yours needs "needs removing by mohs surgery" and (b) did you ask at BPH for the price of a regular excision with biopsy results later.

 

[champken]

4 hours ago, wpcoe said:

 I was mis-remembering what mohs was, and after googling it, I realize now that Dr. Anna can do a regular excision -- that's what she did with my BSC.  So, @champken, (a) why do you feel yours needs "needs removing by mohs surgery" and (b) did you ask at BPH for the price of a regular excision with biopsy results later.

 

It was her that suggested either mohs surgery or she did say that as a cheaper (11,000b)  but less likely to succeed option i could have it basically shaved (at least that's what i thought she said, but that is what i think she did to it 18 months ago and it has now come back. At no time has she mentioned a regular excision, for what reason, i don't know.

 I will be calling into BPH to book one of their health check up pakages next week so while i am there i will ask the question at the Dermatology reception, for them to ask Dr Anna how much and if it is possible to have a regular excision there because unless there are medical reasons why, then that is what i would prefer to pay to have done. Where the bcc is located, i am really not concerned with having a scar ot even a hole there afterwards.

[bumofdabeach]

It was her that suggested either mohs surgery or she did say that as a cheaper (11,000b)  but less likely to succeed option i could have it basically shaved (at least that's what i thought she said, but that is what i think she did to it 18 months ago and it has now come back. At no time has she mentioned a regular excision, for what reason, i don't know.
 I will be calling into BPH to book one of their health check up pakages next week so while i am there i will ask the question at the Dermatology reception, for them to ask Dr Anna how much and if it is possible to have a regular excision there because unless there are medical reasons why, then that is what i would prefer to pay to have done. Where the bcc is located, i am really not concerned with having a scar ot even a hole there afterwards.

Question if mohd was gonna be 11k baht how much for the regular cut n stitch. I'm gonna need one removed before it gets much bigger. I'm no fan of mohs as have had 3 already they all returned.

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[Sheryl]

The 11,000 was not fot Mohs. It was for shaving it off. A full excision drpending on where you have it done will be around 15k.

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[bumofdabeach]

The 11,000 was not fot Mohs. It was for shaving it off. A full excision drpending on where you have it done will be around 15k.

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Thanks for the clarification. Still way cheaper than the states

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[jerry921]

1 hour ago, Sheryl said:

The 11,000 was not fot Mohs. It was for shaving it off. A full excision drpending on where you have it done will be around 15k.

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Do you mean the price varies depending on which hospital performs the operation or on what part of the body the excision is made?

 

Just for comparison, for the mohs procedure I had on my shoulder blade area in the US about 3 years ago the doctor billed insurance over US$4000, but of course I didn't pay that. And what the doctor asks insurance for isn't what he actually gets, either. US payment system is such a complicated mess. There were several office visits including follow up, and I had a $30 copay for each of those, but don't remember what I had to pay for the operation itself. It might have been covered 100%, or I might have had to pay $400 or so, not more than that, not counting what I was already paying for the insurance.
 

[Sheryl]

I meant the hospital. Some are more expensive than others.

If this is a suspected or confirned skin cancer be aware that few Thai doctors have experience with it as skin cancer is rare in Thais. Dr. Anna Jaruwan at Bangkok Pattaya Hospital is best for this, she trained in US and worked there for many years and skin cancers are her specialty.

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[champken]

I have to admit to anybody who is interested that as yet i still have not had my offending BCC removed and my excuse is that because my son was on a long holiday from school, which would and did mean lots of swimming and trips to the beach, and it was sensible to wait for a more convenient time.

 

I did however go and see the Doctor Sheryl suggested who in the end quoted me 9500b for a regular excision, plus i was charged 700b for a 2 minute consultation which took place in  the reception area in front of other waiting customers. I will say that i think she was under the impression that i was having the procedure done there and then, this was maybe because i had previously called for a quote which was then 8500b and that might explain the padding on the quote. 

 

In her defense, the above Doctor did seem to know her stuff and would probably have been competent in removing the BCC. I just got the feeling rightly or wrongly that there was a little opportunism going on there and i don't like that even if it is for small amounts

[lopburi3]

14 hours ago, jerry921 said:

Do you mean the price varies depending on which hospital performs the operation or on what part of the body the excision is made?

Expect to pay a lot more for plastic surgeons.  I have had wide margin removals costing both 25k and 30k from plastic in hospital OR for several removals.  Wife had removal in office by regular dermatologist (who called in same plastic surgeon to stitch as was more complex than expected) for a fraction of cost as surgeon was not paid his normal fee.

[Sheryl]

Yes, above is correct - if a plastic surgeon is needed because of concern for scar (for example, large/deep lesions on the face) cost will be much more.

[Sheryl]

15 hours ago, champken said:

I have to admit to anybody who is interested that as yet i still have not had my offending BCC removed and my excuse is that because my son was on a long holiday from school, which would and did mean lots of swimming and trips to the beach, and it was sensible to wait for a more convenient time.

 

I did however go and see the Doctor Sheryl suggested who in the end quoted me 9500b for a regular excision, plus i was charged 700b for a 2 minute consultation which took place in  the reception area in front of other waiting customers. I will say that i think she was under the impression that i was having the procedure done there and then, this was maybe because i had previously called for a quote which was then 8500b and that might explain the padding on the quote. 

 

In her defense, the above Doctor did seem to know her stuff and would probably have been competent in removing the BCC. I just got the feeling rightly or wrongly that there was a little opportunism going on there and i don't like that even if it is for small amounts

You won't get it excised for much less than this except at a government hospital.

 

In addition to the excision there has to be a biopsy to ensure the margins were clear (i.e. whole BCC removed). So the price is not only for the excision for also for the histopathology examination of the tissue.

 

Wherever you end up going, need to be sure that whomever removes it does so sufficiently to yield clear margins, otherwise you end up needing a second excision.