Melanoma check in Bangkok

[OzMan]

Any recommendations on where to get a melanoma checkup in Bangkok? A few years ago I visited Bangkok Hospital in Pattaya, but was put off by their excessive charging and greed.

[VocalNeal]

I have been to Bangkok Christian Hospital just follow the signs for Skin Care. 

[userabcd]

I usually see Dr. Niyom at Bumrungrad to check out skin cancer spots.

 

Assoc.Prof.Dr. Niyom Tantikun|Bumrungrad International Hospital

[VocalNeal]

I'm sure Bumrungrad is OK but it may also be the most expensive hospital in Bangkok.

 

OP was put off by excessive charging and greed at Bangkok Hospital in Pattaya

Edited October 12, 2022 by VocalNeal

[Sheryl]

While i understand the issues regarding BPH, nowhere in Thailand will you find the same level of experience and expertise regarding skin cancers than Dr. Anna at BPH.

 

You need to consider the costs (both financial and physical) of an inaccurate diagnosis further down the line

 

Personally I go only to Dr. Anna, despite the BPH costs and ambience, and that it is a 6 hour round trip drive for me.

 

If you insist on nonetheless doing this in Bangkok, understanding how little experience Thai doctors have with this, I suggest you attend the skin tumor clinic at Chulalongkorn. It is a government hospital so costs will be minimal but waits long and considerable (and confusing_ red tape, you should have a Thai speaker with you

 

https://chulalongkornhospital.go.th/kcmh/en/dept/department-of-dermatology/

 

 

 

 

[crouchpeter]

No one in the world has more experience than Australian dermatologists. The melanoma clinic at RPA in Sydney has many French Spanish Irish doctors who've come to learn. A skin check there is about $300; free if you're a pensioner. So that's 7,500 baht, plus your airfare is, say, 20,000 baht. For Dr. Anna to cut out 2 non- malignant naevi at BPH was 23,000 baht. So I think it's worth a trip home to Oz. Of course you have to make an appointment weeks and weeks ahead.

[OzMan]

On 10/26/2022 at 10:47 AM, crouchpeter said:

A skin check there is about $300; free if you're a pensioner. So that's 7,500 baht, plus your airfare is, say, 20,000 baht. For Dr. Anna to cut out 2 non- malignant naevi at BPH was 23,000 baht. So I think it's worth a trip home to Oz. Of course you have to make an appointment weeks and weeks ahead.

An American doctor friend in Bangkok needed a hernia operation. The difference in the prices quoted at private hospitals in BKK was huge.  In the end, he returned to the U.S. for the operation. Even without U.S. health insurance, it was cheaper to get the operation done there and the difference in cost paid for a business class ticket home. Who says that private hospitals in Thailand are not a racket.

[CanNot]

Recently I was at a skin cancer screening in my home country. They used a camera and checked each mole. The doctor explained me what to look for and because of the camera zoom and a huge monitor it was easy to identify suspicious moles. 

 

Not a lot experience seem to be required. Do I miss something? 

[Startmeup]

On 10/26/2022 at 10:47 AM, crouchpeter said:

No one in the world has more experience than Australian dermatologists. The melanoma clinic at RPA in Sydney has many French Spanish Irish doctors who've come to learn. A skin check there is about $300; free if you're a pensioner. So that's 7,500 baht, plus your airfare is, say, 20,000 baht. For Dr. Anna to cut out 2 non- malignant naevi at BPH was 23,000 baht. So I think it's worth a trip home to Oz. Of course you have to make an appointment weeks and weeks ahead.

I was back in Australia at Christmas. I had three biopsies after carrying out a skin check. I think the skin check cost $180 excluding rebate if you have medicare. Less than $100 for me. Since I have come back to Thailand I have been informed one of them is a melanoma and two are pre-melanomas. All three need to be cut out with the melanoma needing to be done with urgency. 

I have been weighing up options of what to do. Right now I can't see flights for less than $1000. The cost to cut out is $350 each, so that's another $1000.Depending on your personal circumstance it could be another couple $k in expenses while there. So min 50k baht to fly back to Australia in my case excluding any other costs and loss of income etc. I dont have health insurance to cover any of the costs in Thailand.

Does Dr Anna do surgery herself? If so, dependent on the urgency and her schedule and she is very highly regarding then it would make sense to get it done with her, surely?

Im just off the phone with my Australia doctor today and he said the hardest part is to recognise that there is an issue in the first place. The surgery after that should be the easier part for any surgeon with experience in skin cancer issues/surgeries. 

I am booked into Samitivej for an appointment this weekend. 

I have been given a recommendation for Dr Pamela at Bumrungrad, link below.
She has western experience. Bumrungrad have not responded while Samitivej has been very responsive. 

https://www.bumrungrad.com/en/doctors/Pamela-Chayavichitsilp

Reading the reviews on both hospitals on google, this checks out that Bumrungrad in general see patients as walking ATMs that they want to extract the most money from. 

Would be interesting to hear experience of others who have needed these types of check ups and surgeries and how they found it

 

Edited January 18, 2023 by Startmeup

[Startmeup]

On 10/12/2022 at 12:41 PM, Sheryl said:

While i understand the issues regarding BPH, nowhere in Thailand will you find the same level of experience and expertise regarding skin cancers than Dr. Anna at BPH.

 

You need to consider the costs (both financial and physical) of an inaccurate diagnosis further down the line

 

Personally I go only to Dr. Anna, despite the BPH costs and ambience, and that it is a 6 hour round trip drive for me.

 

If you insist on nonetheless doing this in Bangkok, understanding how little experience Thai doctors have with this, I suggest you attend the skin tumor clinic at Chulalongkorn. It is a government hospital so costs will be minimal but waits long and considerable (and confusing_ red tape, you should have a Thai speaker with you

 

https://chulalongkornhospital.go.th/kcmh/en/dept/department-of-dermatology/

 

 

 

 

What are the issues regarding BPH, what does Dr Anna/BPH charge for a skin check, does she do surgeries and why do you hold Dr Anna in such high regard?

[Startmeup]

On 10/11/2022 at 7:02 PM, userabcd said:

I usually see Dr. Niyom at Bumrungrad to check out skin cancer spots.

 

Assoc.Prof.Dr. Niyom Tantikun|Bumrungrad International Hospital

This guy was up there towards the top of my list when I done research of who to use if I wasn't going to fly back to Australia. Bumrungrad just seem to be a nightmare to deal with. Still waiting for cost estimates back from them which I doubt I will get. Have not had one response after emailing three days ago but with Samitivej I have had about 15 emails back and forth answering my question over that same period.

Speaking to my Australian Dr today. I forwarded some names to him to look at their bios to see what his opinion was. He wouldn't comment on specific doctors but he said if a doctor/surgeon is qualified in MOHs surgery such as the guy you have linked and such as 

https://www.samitivejhospitals.com/doctor/detail/paritas-sukriket

Then they should have no problem in carrying out a normal excision procedure. He said MOHs surgery is far more delicate, usually reserved for sensitive areas such as face/neck etc and its specific surgery for skin cancers. This shows they are experienced in this realm. I sure hope so anyway.

[Startmeup]

On 11/4/2022 at 1:34 AM, CanNot said:

Recently I was at a skin cancer screening in my home country. They used a camera and checked each mole. The doctor explained me what to look for and because of the camera zoom and a huge monitor it was easy to identify suspicious moles. 

 

Not a lot experience seem to be required. Do I miss something? 

I asked my Aus doc about this Fotofind machine that I have seen mentioned in a few places on Thai websites. He said he doesn't use that but has heard of it. He said it's not any better than anything else available and it's only really good if the user is able to use the machine proficiently.

He said it still comes down to the professional to spot any issues. I thought the same as you, see a dark/suspicious spot, press the gun against it, get the pic on the screen and look at it closely to identify if it's potentially risky or not. Beats me.

[Sheryl]

1 hour ago, Startmeup said:

What are the issues regarding BPH, what does Dr Anna/BPH charge for a skin check, does she do surgeries and why do you hold Dr Anna in such high regard?

Issue with BPH is simply the cost, which is similar to Bumrungrad. And (not all the doctors, but the hospital per se) excessive profit-seeking behavior (ditto).

 

Dr. Anna is the only -- and I emphasize, the only -- doctor in Thailand who specializes in skin cancer and has decades experience treating it. (She worked for a long time in the US).

 

In your case as a melanoma has already been diagnosed such experience is less important, you just need a surgeon to excise it  and -- here is the rub -- a pathologist experienced with melanomas to check for clear margins. Dr. Anna has one she trusts (she may actually send specimens abroad, not sure on that - but she knows which pathologist to use). Remember how rare these conditions are in Thailand.

 

Dr. Anna does simple surgeries herself but whether she would excise your melanoma or refer you to either a plastic surgeon (e.g. if on the face or otherwise concerned about scarring) or a general surgeon will depend on the size and location of the lesion.

 

Although there are doctors (a few) trained in Mohs here, none of them as far as I know actually do it. Last time anyone checked, this was also true of Dr. Niyyom.

 

If you really want Mohs better go to Australia for it. But if the lesion is not on your face and you are not too concerned about scarring, a regular incision with generous  margins would suffice and is not at all technically hard to do, as mentioned the key issue is the path exam of the margins and then follow-up care.

 

 

 

 

[RubenRemus]

Plus 1 on Dr Niyom at Bumrungrad. He was very quick and thorough with the cold gun but it wasn't cheap. Maybe THB 5k-6k for about 10 minutes of his time and gun action? It'd like to find a cheaper option TBH.  

[Sheryl]

3 minutes ago, RubenRemus said:

Plus 1 on Dr Niyom at Bumrungrad. He was very quick and thorough with the cold gun but it wasn't cheap. Maybe THB 5k-6k for about 10 minutes of his time and gun action? It'd like to find a cheaper option TBH.  

Liquid nitrogen (the "cold gun") is not appropriate to OP's situation which is a confirmed melanoma. Needs to be excised, and generously.

 

But since you asked, Dr. Donna at medconsult does liquid nitrogen for a fraction of that cost. Need to call ahead to make sure it's in stock before you go, sometimes they run out.  https://www.medconsultasia.com/gp-consultation/

 

 

 

 

[Fraser Brown]

Circa twelve months ago had a BCC identified and removed at Samitivej. All the staff were professional, helpful and caring. Quoted fee included the initial bandage change 48 hours after the procedure, and subsequent removal of stitches.

May assist your considerations.

 

[Startmeup]

1 hour ago, Fraser Brown said:

Circa twelve months ago had a BCC identified and removed at Samitivej. All the staff were professional, helpful and caring. Quoted fee included the initial bandage change 48 hours after the procedure, and subsequent removal of stitches.

May assist your considerations.

 

You got a quote before carrying out the procedure and that was accurately reflected in final bill? Ive read many people saying quotes from Bumrungrad have come in over 50% more than quoted. Do you mind asking how much you were charged? Who did you see in Samitivej? Was there was a follow up appointment after outlining the results from a pathologist report stating all the cancer had been removed?

 

Edited January 18, 2023 by Startmeup

[Startmeup]

4 hours ago, Sheryl said:

Issue with BPH is simply the cost, which is similar to Bumrungrad. And (not all the doctors, but the hospital per se) excessive profit-seeking behavior (ditto).

 

Dr. Anna is the only -- and I emphasize, the only -- doctor in Thailand who specializes in skin cancer and has decades experience treating it. (She worked for a long time in the US).

 

In your case as a melanoma has already been diagnosed such experience is less important, you just need a surgeon to excise it  and -- here is the rub -- a pathologist experienced with melanomas to check for clear margins. Dr. Anna has one she trusts (she may actually send specimens abroad, not sure on that - but she knows which pathologist to use). Remember how rare these conditions are in Thailand.

 

Dr. Anna does simple surgeries herself but whether she would excise your melanoma or refer you to either a plastic surgeon (e.g. if on the face or otherwise concerned about scarring) or a general surgeon will depend on the size and location of the lesion.

 

Although there are doctors (a few) trained in Mohs here, none of them as far as I know actually do it. Last time anyone checked, this was also true of Dr. Niyyom.

 

If you really want Mohs better go to Australia for it. But if the lesion is not on your face and you are not too concerned about scarring, a regular incision with generous  margins would suffice and is not at all technically hard to do, as mentioned the key issue is the path exam of the margins and then follow-up care.

 

 

 

 

Exactly right. Alot of what you are saying is what my Doc in Oz told me over the phone today. If you read my post above he is of the opinion if they are good enough to be MOHs qualified (dedicated skin cancer surgeries specialists) then a normal excision should not present an issue. I don't need MOHs procedure.

In regards to the pathologist this is something we talked about on the phone also. Not all pathologists are equal. He said it's so common in Australia that basically all the pathologists could be trusted. Thailand might be a different scenario. It's something I intend to bring up on Saturday at the hospital but im not sure how I can do anything in this regard?

Would I somehow be able to get in touch with Dr Anna to ask her where I should get it sent or will the hospital even entertain this?

There are international guidelines regarding excisions, according to my doc, I would think between a team of dermatologists in a big hospital that has done this before that they will be sufficiently qualified, especially one who done a fellowship at Yale with a MOHs qualification.

"The surgeon will need to adhere to the international guidelines on the recommended margins:
Invasive melanoma should have a 10mm margin, and for SDN, we recommend a 5mm margin."

What are the costs for a skin check or anything else you might have encountered while seeing Dr Anna at BPH? I have to get a check every three month for at least two years going forward so I might have to book in with her soon. 

Ive also had a recommendation of Dr Pamela at Bumrungrad which is why I emailed them in the first place. Are you aware of her in any way?

https://www.bumrungrad.com/en/doctors/Pamela-Chayavichitsilp

Edited January 18, 2023 by Startmeup

[Fraser Brown]

13 hours ago, Startmeup said:

In my case the actual bill came in under the initial estimate, recall around THB1,000. The confirmation of the Pathology Report was conveyed at the appointment when the stitches were removed.

 

 

Edited January 19, 2023 by Fraser Brown

[Sheryl]

14 hours ago, Startmeup said:

Exactly right. Alot of what you are saying is what my Doc in Oz told me over the phone today. If you read my post above he is of the opinion if they are good enough to be MOHs qualified (dedicated skin cancer surgeries specialists) then a normal excision should not present an issue. I don't need MOHs procedure.

In regards to the pathologist this is something we talked about on the phone also. Not all pathologists are equal. He said it's so common in Australia that basically all the pathologists could be trusted. Thailand might be a different scenario. It's something I intend to bring up on Saturday at the hospital but im not sure how I can do anything in this regard?

Would I somehow be able to get in touch with Dr Anna to ask her where I should get it sent or will the hospital even entertain this?

There are international guidelines regarding excisions, according to my doc, I would think between a team of dermatologists in a big hospital that has done this before that they will be sufficiently qualified, especially one who done a fellowship at Yale with a MOHs qualification.

"The surgeon will need to adhere to the international guidelines on the recommended margins:
Invasive melanoma should have a 10mm margin, and for SDN, we recommend a 5mm margin."

What are the costs for a skin check or anything else you might have encountered while seeing Dr Anna at BPH? I have to get a check every three month for at least two years going forward so I might have to book in with her soon. 

Ive also had a recommendation of Dr Pamela at Bumrungrad which is why I emailed them in the first place. Are you aware of her in any way?

https://www.bumrungrad.com/en/doctors/Pamela-Chayavichitsilp

Doctors here trained in Mohs are not skin cancer specialists at all. In fact most have limited experience  with skin cancer. Just took a course in Mohs at some point (and likely never put it to use in Thailand -- it requires quite a bit more than a trained surgeon e.g. path lab on standby etc. ). Listing of Mohs training is not a reliable indicator. 

 

Skin check with Dr.  Anna (excluding biopsy if needed and any mefications) about 2,000 baht.

 

You are unlikely to get reliable information on excision costs by emailing or calling hospitals. The people who handle such mails are clerks who simply refer to charts and will have fifficulty knowing (guessing is more like it) what item on a rate scale this would fit. Further, costs vary greatly depending on size and depth to be excised. This could be anywhere from an office procedure using lidocaine to a 1-2 night hospital stay  involving use of OR and general anesthesia.

 

You need an in person  consultation with the doctor who will do the excision so he/she can see it, read the path report etc from Australia and develop a treatment plan. Only then  can cost be estimated. 

[GinBoy2]

Cant remember the Doc's name

 

But I had a sore on my face which I was convinced was some kind of dermatitis

 

One of the downfalls of Thai pharmacy is that you can basically buy anything over the counter, and you self 'diagnose

 

I ended up up buying the strongest steroid cream I could, bad move made everything really angry.

 

On a trip to BKK I decided to go to Brumrungrad to see a real doc.

 

Turned out I had Bowens disease, a mild form of skin cancer.

 

All good I had the lesion removed and I'm fine, but I a lot more aware now of unexplained skin eruptions

 

 

[Startmeup]

21 minutes ago, Sheryl said:

Doctors here trained in Mohs are not skin cancer specialists at all. In fact most have limited experience  with skin cancer.

That's quite the statement, how can you say that with confidence?

MOHs by definition infers they are skin cancer removal specialists, whether they have experience doing it is a different matter. The same can be said for any professional. Again I dont need MOHs which is a much more delicate procedure but the fact that in a hospital where there are 30+ dermatologists and only one is qualified to carry out a MOHs procedure shows to me it's not simply a matter of doing a course.

 

31 minutes ago, Sheryl said:

You need an in person  consultation with the doctor who will do the excision so he/she can see it, read the path report etc from Australia and develop a treatment plan. Only then  can cost be estimated. 

This is what Im booked in to do Saturday. Depending on how I feel they respond to things my doctor has told me will decide whether Ill be comfortable going forward with the excision here.

[Startmeup]

45 minutes ago, Sheryl said:

This could be anywhere from an office procedure using lidocaine to a 1-2 night hospital stay  involving use of OR and general anesthesia.

In Australia it would be carried out in the same place the biopsies were carried out, basically a local GP office that is dedicated to skin checks using a localised anaesthesia split over two days (because there is three excisions) due to local anaesthesia limitations.

The doctor also said if he felt it was an aggressive or has spread quite alot then he would recommend I returned back to Australia to carry it out

Edited January 19, 2023 by Startmeup

[Sheryl]

1 minute ago, Startmeup said:

That's quite the statement, how can you say that with confidence?

 

MOHs by definition infers they are skin cancer removal specialists, whether they have experience doing it is a different matter. The same can be said for any professional. Again I dont need MOHs which is a much more delicate procedure but the fact that in a hospital where there are 30+ dermatologists and only one is qualified to carry out a MOHs procedure shows to me it's not simply a matter of doing a course.

 

 

I can say it based on some 30 years experience with health care ibn Thailand, my own, that of friends and feedback from peopel on this board.

 

I have directly consulted several of the doctors in question.

 

In no possible way does simply having been trained in MOHs mean one is a skin cancer removal specialists. The only pre-requisite is being a dermatologist.

 

"skin cancer removal specialist" is not a recognized medical specialty.

 

While in Australia and most other Western countries, any dermatologist (unless solely involved in cosmetic work) will have had experience with skin cancers, and most general surgeons and plastic surgeons will have had experience removing melanomas,  this is not at all the case in Thailand.

 

Pathologists also have limited expereince in the area and I have seen a lot of path mistakes here. That should be your main concern.

 

If you could get this done almost free in Oz, and airfare is about US  $1,000 I doubt you will save much money by trying to treat this in private hospitals here and you may well end up spending more, with less assurrance of quality.

[Sheryl]

4 minutes ago, Startmeup said:

In Australia it would be carried out in the same place the biopsies were carried out, basically a local GP office that is dedicated to skin checks using a localised anaesthesia split over two days (because there is three excisions) due to local anaesthesia limitations.
 

 

There are no such facilities in Thailand, GP or otherwise.

 

A world of difference. Skin cancer is  very common in Oz, very rare here.

 

In Oz as well as anywhere else, with melanoma the area that needs to be excised can sometimes be lareg and deep enough to warrant general anesthesia. Depends entirely on the individual case. And in Oz and elsewhere, if there is concern about scarring a plastic surgeon may be needed. Possible neither is true in your case, but it can be in others.

 

 

[Startmeup]

27 minutes ago, Sheryl said:

If you could get this done almost free in Oz, and airfare is about US  $1,000 I doubt you will save much money by trying to treat this in private hospitals here and you may well end up spending more, with less assurrance of quality.

Flights are an absolute nightmare right now back to where I need to go in Australia, I dont know why. Singapore air booked out until he middle of Feb, after middle of Feb they are 41,000 baht. Cost in Australia would be out of pocket around 23,000 for three excisions. What do you think the charges would be in BPH for this?

I have still no written off going back to Australia to do it but would rather not. I also have to get a skin check every three months for the next two years so what go back to Australia every three months for the next two years?

I have no worries about scarring, my back, upper arm and stomach are location of the three excisions. 

Edited January 19, 2023 by Startmeup

[Sheryl]

1 hour ago, Startmeup said:

Flights are an absolute nightmare right now back to where I need to go in Australia, I dont know why. Singapore air booked out until he middle of Feb, after middle of Feb they are 41,000 baht. Cost in Australia would be out of pocket around 23,000 for three excisions. What do you think the charges would be in BPH for this?

I have still no written off going back to Australia to do it but would rather not. I also have to get a skin check every three months for the next two years so what go back to Australia every three months for the next two years?

I have no worries about scarring, my back, upper arm and stomach are location of the three excisions. 

 

 

As said before it depends on the size and depth of excison needed as that in turn would shape the surgical approach.

 

With 3 locations, even if each individually could be done under local (which we do not know yet) it might   make more sense, and cost same or less, to just do whole thing in OR under sedation.  In which case either a daysurgery or 1 night stay. Best guess, around 50-60k (including pathology) if they go that route. If done in office under local might need 3 separate procedures at  about 15-20 k each.  But these are very rough estimates.

 

There is a government dermatology  hospital in Bangkok which would cost much less but involve several visits just to get excision scheduled with lots of wait time and red tape (in Thai) and you'd want a Thai speaker to help you navigate the system. https://www.iod.go.th/clinic-and-treatment/คลินิกพิเศษนอกเวลาราชก#

 

While it has many specialty clinics there is none for skin cancers(which alone tells you something).

 

It has an after hours clinic where for about 500 baht you can see a senior doctor (otherwise you will be treated mostly by interns and redidents in training) and that is where you should go if you decide to try there -- ask nurses for an acharn (professor) with exerience treating melanoma. 

 

Personally if it were me, given the seriousness and need for really accurate path reports I would either go back to Oz or go to Dr. Anna (and any surgeon she might refer to).  

 

[Startmeup]

2 hours ago, Sheryl said:

Personally if it were me, given the seriousness and need for really accurate path reports I would either go back to Oz or go to Dr. Anna (and any surgeon she might refer to).  

I have already had a response from BPH today and they will forward my pathologists report to Dr Anna for assessment.

[Startmeup]

On 1/19/2023 at 10:48 AM, Sheryl said:

Skin check with Dr.  Anna (excluding biopsy if needed and any mefications) about 2,000 baht.

Seems like good value. From Samitijev Hospital for future reference for anybody 

 

"Fotofinder which includes Total Body Mapping and Individual Mole Analysis costs 6,500 THB including doctor's fee but exclude service charge around 500 THB."

 

[Sheryl]

2 hours ago, Startmeup said:

Seems like good value. From Samitijev Hospital for future reference for anybody 

 

"Fotofinder which includes Total Body Mapping and Individual Mole Analysis costs 6,500 THB including doctor's fee but exclude service charge around 500 THB."

 

Dr. Anna does not use Fotofinder (or at least did nto when last I saw her, admittedly some years ago).  If she now does cost will surely be more as the equipment is costly. When I saw her it was just a (thorough) visual inspection