Drug for Basal Cell Carcinoma

[suzannegoh]

This is a longshot, but does anyone here know if the skin cancer drug  Erivedge is available?

[darksidedog]

A link to a site which does not allow us to use such has been removed.

From forum rules:

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[norbra]

Has your BCC  been confirmed,?

If you are lucky enough to get access to fluorouracil cream be prepared for ugly red scabbing of lesion for many weeks.

As a very long term sufferer of skin carcinomas(100+ in cluding melanoma) I would suggest excision for your best long term outcome

[suzannegoh]

29 minutes ago, darksidedog said:

A link to a site which does not allow us to use such has been removed.

From forum rules:

26) The Bangkok Post and Phuketwan do not allow quotes from their news articles or other material to appear on ASEANNOW.com. Neither do they allow links to their publications. Posts from members containing quotes from or links to Bangkok Post or Phuketwan publications will be deleted from the forum.

Here's a link on the same subject on a neutral Thai site:
https://www.thailandmedical.news/pages/drugs/erivedge

[suzannegoh]

1 minute ago, norbra said:

Has your BCC  been confirmed,?

If you are lucky enough to get access to fluorouracil cream be prepared for ugly red scabbing of lesion for many weeks.

As a very long term sufferer of skin carcinomas(100+ in cluding melanoma) I would suggest excision for your best long term outcome

Yes, it's confirmed.  Excision might be an option but since it involves multiple spots over a large area it would not be a trivial surgery.

[norbra]

29 minutes ago, suzannegoh said:

Yes, it's confirmed.  Excision might be an option but since it involves multiple spots over a large area it would not be a trivial surgery.

I've had  a couple of patch surgeries, normally done in the procedure room an area about the size of an eclair can be done in 30-40 minutes, mine were all squamous cell carcinoma and have some lasting scaring.g

[Sheryl]

The manufacturer has not registered the drug (which is still under patent) in Thailand so no, not available unless some private hospitals have privately imported it

 

It is also extremely expensive - between that and the fact that skin cancer is not common in Thais I doubt the manufacturer will  register it here any time soon

 

It is only indicated when treatment by surgery or radiation is not possible

 

OP you might inquire about electron beam radiation as an alternative to surgery. If the individual lesions are small, cryosurgery (liquid nitrogen spray) might also be an option.

 

the most important thing is to have a doctor experienced in treatment of skin cancer, of whom there are very few in Thailand.

 

Where/by whom are you being treated?

[kidneyw]

I had a great deal of success with a cream called Efudex. It was given to me by my dermatologist, but is unavailable in Thailand.

Maybe you know someone who can bring it in for you.

[KannikaP]

1 hour ago, norbra said:

an area about the size of an eclair

Is that a chocolate eclair or another flavour?

[suzannegoh]

20 minutes ago, kidneyw said:

I had a great deal of success with a cream called Efudex. It was given to me by my dermatologist, but is unavailable in Thailand.

Maybe you know someone who can bring it in for you.

Here dermatologists seem to prescribe Aldara (imiquimod) instead of that.

[suzannegoh]

52 minutes ago, Sheryl said:

 

 

Where/by whom are you being treated?

I've consulted with many.  The doctor that I talked to at Siriraj Hospital was the only one in Thailand that seemed to have any depth of experience with cases like this.  Erivedge was mentioned to me by a doctor in the US who has only seen pictures of the affected area but has not examined me.

Edited March 10, 2022 by suzannegoh

[Sheryl]

4 hours ago, suzannegoh said:

I've consulted with many.  The doctor that I talked to at Siriraj Hospital was the only one in Thailand that seemed to have any depth of experience with cases like this.  Erivedge was mentioned to me by a doctor in the US who has only seen pictures of the affected area but has not examined me.

The number one expert in skin cancer in Thailand is Dr. Anna at Bangkok Pattaya Hospital and she is with the trip

 

(I myself have driven 3 hours to be treated by her)

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=7&depid=2

 

She worked for many years in the US and skin cancer is her speciality

[lopburi3]

13 hours ago, suzannegoh said:

Here dermatologists seem to prescribe Aldara (imiquimod) instead of that.

As one who has used will say it is both very expensive (although normally advised to reuse one use packets) and a very long and involved process (you start/stop/go/check/repeat).  And for me was not of much use.  Surgery has been much easier and more effective.  As for cryosurgery many places do not even have available (cheap at those that do have but few seem to know how to use properly in my experience).  In US this seems to have been the standard for many generations but as said skin cancer is not common in Thailand and few have experience treating it.  

 

The good news is BCC is generally not life threating or likely to spread quickly.  So you have time to made decisions.  As you quickly learn once the "C" word is found the costs of cancer treatment is a major factor for drug makers - but in BCC case no treatment might be an option at higher age range (in my non medical opinion).  

[mackayae]

Is Aldara available locally? I used to buy it at Lazada, but they no longer stock it.

[Sheryl]

58 minutes ago, mackayae said:

Is Aldara available locally? I used to buy it at Lazada, but they no longer stock it.

Yes. Any large pharmacy should have it

[MichaelHunt]

On 3/10/2022 at 7:01 PM, suzannegoh said:

Here dermatologists seem to prescribe Aldara (imiquimod) instead of that.

This is the one that I have used - with good results.

[hellohello]

On 3/10/2022 at 11:19 PM, Sheryl said:

The number one expert in skin cancer in Thailand is Dr. Anna at Bangkok Pattaya Hospital and she is with the trip

 

(I myself have driven 3 hours to be treated by her)

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=7&depid=2

 

She worked for many years in the US and skin cancer is her speciality

hi again Sheryl,!   do you know if she does moh's surgery ?    having a hard time finding that treatment here.  thank you in advance.

[suzannegoh]

31 minutes ago, hellohello said:

hi again Sheryl,!   do you know if she does moh's surgery ?    having a hard time finding that treatment here.  thank you in advance.

 

Dr. Rungsima at Siraraj Hospital in Bangkok does Moh's surgery but I don't know anyone who has been treated by her. 

[Sheryl]

Even the doctors trained in Mohs here do not seem to do it. The hospitals aren't set up for it. It requires immediate turn around from pathologist and close coordination between path lab and the doctor. And would only be as reliable as the pathologist, Few pathologists in Thailand are really skilled in detecting skin cancers and errors abound. I believe Dr. Anna sends her samples elsewhere, might even be out of country.

[suzannegoh]

1 hour ago, Sheryl said:

Even the doctors trained in Mohs here do not seem to do it. The hospitals aren't set up for it. It requires immediate turn around from pathologist and close coordination between path lab and the doctor. And would only be as reliable as the pathologist, Few pathologists in Thailand are really skilled in detecting skin cancers and errors abound. I believe Dr. Anna sends her samples elsewhere, might even be out of country.

That's a good point about Moh's outcomes being dependent upon the quality of the pathology.  I had errant pathology here in which they were apparently unable to distinguish between Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).  And then I had a recurrence after having that cancerous skin removed by Wide Excision, despite the pathology saying that the the margins were clear.

[Denim]

I have had a lot of trouble with skin cancer on my head. A few Squamous Carcinomas and pre cancerous keratosis.

 

The squamous carcinomas were surgically removed. Some of the worst kearatosis spot that looked like developing into something worse were treated with lazer therapy ( see the result in the attached picture as the scabs recovered)

 

However, I was still left with the rest of the keratosis. After searching the web I came across this discussion.

 

(Pasted text removed by Moderstor). 

 

 

Based on this I got some Klyzen Gel from my Pharmacist  which contains 1g Diclofenac Sodium. The result on using this has been the almost disappearance of the keratosis and my skin in the affected area is about 95% improved. 

 

 

It may not be peer reviewed but it seems to work.

 

 

 

[Sheryl]

4 hours ago, Denim said:

I have had a lot of trouble with skin cancer on my head. A few Squamous Carcinomas and pre cancerous keratosis.

 

The squamous carcinomas were surgically removed. Some of the worst kearatosis spot that looked like developing into something worse were treated with lazer therapy ( see the result in the attached picture as the scabs recovered)

 

However, I was still left with the rest of the keratosis. After searching the web I came across this discussion.

 

( Not sure if providing a link to the thread from Thaiger is permissible.

 

In Australia a product called Solaraze is prescribed though it is not available in Thailand.

The active ingredient diclofenac sodium is also used in Voltaren Extra as diclofenac diethylamine.  Only the 'Extra' strength Voltaren works on skin spots as it's strength is close to that of Solaraze.

My Pharmacist put me onto this and has to order it in @ 340bt for a small tube.

 

I asked my pharmacist about this, as I've had a problem with a minor melanoma on my cheek for years and I can't find anywhere that will do freeze or laser treatment (which I've had before) even in Khon Kaen or Udon.

She suggested using 'normal' diclofenac cream, which isn't so strong and is normally used for minor muscle strains or sports injuries - Painoren, but there are countless other brands - four or five times a day. Just a small amount, followed by TA cream (0.02%) when it started to clear.

I was very dubious, even though she's an excellent pharmacist, but after a month it's worked - not just reduced, but completely gone without a trace.

Thanks.  Extraordinary. 

 

Based on this I got some Klyzen Gel from my Pharmacist  which contains 1g Diclofenac Sodium. The result on using this has been the almost disappearance of the keratosis and my skin in the affected area is about 95% improved. 

 

 

It may not be peer reviewed but it seems to work.

 

 

 

There is no such thing as a "minor" melanoma. Only melanomas stages 1 -4. And even stage 1 is nothing to take any chances with, as it can advance to stages 2-4 and these are very serious/life threatening.

 

If what you have on your cheek is an actual melanoma, it needs to be excised urgently. Freezing and laser are never advised as it is essential to be able to do a full path exam on what is removed to ensure clear margins. It is sometimes necessary to biopsy nearby lymph nodes.

 

Solarze (diclofenac) is used to treat actinic keraotses. It is never used to treat melanoma.

 

 

 

[Sheryl]

5 hours ago, suzannegoh said:

That's a good point about Moh's outcomes being dependent upon the quality of the pathology.  I had errant pathology here in which they were apparently unable to distinguish between Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).  And then I had a recurrence after having that cancerous skin removed by Wide Excision, despite the pathology saying that the the margins were clear.

Path mistakes regarding skin lesions - in both directions - are very common here.  The Thai pathologists in most cases simply do not have enough experience with skin cancers.

[suzannegoh]

8 minutes ago, Sheryl said:

Path mistakes regarding skin lesions - in both directions - are very common here.  The Thai pathologists in most cases simply do not have enough experience with skin cancers.

Do you think that the pathology in Thailand is more reliable for the big cancers - lung, brain, etc?

[Sheryl]

15 minutes ago, suzannegoh said:

Do you think that the pathology in Thailand is more reliable for the big cancers - lung, brain, etc?

Yes, of course. The issue with skin cancer is that it is so rare in Thais.

 

But of course it varies with the individual doctor. You can't choose your pathologist but you can choose your surgeon and the really good doctors take care what pathologists and (anesthetists) they use.

[Denim]

1 hour ago, Sheryl said:

If what you have on your cheek is an actual melanoma, it needs to be excised urgently.

Thank you Sheryl but if you check back , it is not me who had the melanoma. 

 

(Link temoved)

 

My own problem has been two squamous carcinomas ( both successfully removed with surgery )  and Keratosis.

 

I personally found that the locally available Klyzen Gel  (active ingredient 1g Diclofenac Sodium ) has performed a miracle on my keratosis which has now completely disappeared, 

 

My skin doctor here prescribed Aldara but not enough to be effective and rather expensive. The Klyzen worked better, was cheaper and does not turn the skin red.

[Sheryl]

It is indeed not allowed to post links to Thaiger (their rule not ours) and even also not allowed to cut and paste exact quotes without attribution .

 

I have edited both your posts accordingly. I think people can still get the gist i.e. that diclofenac gel can be used for keratoses and is worling well for you.

 

Which is useful info. How long did you have to use it and how many applications a day? 

[KannikaP]

On 3/10/2022 at 6:57 PM, KannikaP said:

Is that a chocolate eclair or another flavour?

Exactly a year late with your answer.

[Denim]

25 minutes ago, Sheryl said:

Which is useful info. How long did you have to use it and how many applications a day? 

I started using it after my last lazer session as soon as the scars had dried out. I started seeing results after a few days. Two applications a day. Once in the morning and once in the evening. Not a cream , a gel. A little goes a long way. 

 

You can get the stronger 5 g medication as mentioned on Lazada , imported from Australia , but pretty expensive at 2500 baht a tube if my memory serves me correctly.

 

As I said , the combined treatment has been very effective, I now use a little of the gel every day ( evening only ) as a preventative against any return of keratosis. Miss the odd day just to give the skin a break.