Where to get a lump ( Lipoma ) removed in Phuket?

[sikishrory]

A small Lipoma about an inch in diameter on shoulder.

Had an ultrasound on it at Phuket Bangkok Hospital which was about 10,000 baht or something which confirmed it was Lipoma. A benign lump of fat.

• They then quoted me 28,000 baht to remove it.
• Messaged Kathu Dermatology that I had heard about in another thread here. They seemed to want to avoid detailing fees. Just saying "laser start at 3000 per lump" or something. Which obviously does not apply and raised some red flags.
• Messaged Dr. Pat clinic with photos - Consultation starts 500-1500 and they cannot give estimate. Despite them saying in google reviews "the price for everything will be informed to you before making an appointment or having the consultation".
• Messaged Nikorn Clinic (คลินิกหมอนิกร จ.ภูเก็ต) in town. Quoted about 3500 which I imagine is the normal price as it should be. The issue is they only open 6pm - 7.30pm and had a queue of about 12 Thais waiting at the door each time I went.
• Found a place Aspire Clinic - Quoted a clear 10,000 baht.
• Walked into another Thai clinic in town and showed them - "Oh nooo mister you go hospital better na"

 

Anyone have any other contacts or places to try with reasonable prices?

 

[Sheryl]

You should get this done at a hospital  not a clinic. And it should be biopsied after removal.  Although it appeared on ultrasound to be a lipoma  cannot be 100% certain without biopsy.

 

Cost depends on size and depth. 28k is quite low for that hospital so  they must think they can remove it as an outpatient under local anesthetic. I also question whether this this quote includes the path exam of the removed lesion, it is probably just the surgical temovsl. 

 

Mission Hospital will almost always  cost less than Bahgkok Hospital.

 

https://m.facebook.com/profile.php?id=100063785131090

 

Do not bother messaging them as doctor needs to physically examine it and review the ultrasound finding to know what will be involved in removal. Anything the clerks who handle emails tell you will just be a guess and may well be wrong.  Go in person, see a general surgeon, and bring with you the ultrasound film and report. 

[retarius]

I've had a couple of lipomas over my lifetime. The first was in my thigh, and I was worried sick at the time thinking it was some kind of cancerous tumour. My US doctor told me it was just excess fat. I asked him if it was on his leg would he have it excised and he said no. So I left it...probably 35 years ago. It is still there unchanged. I also had one on my back, which just went away after a few years. 

 

On pricing. I had a couple of basal cell carcinomas cut out last year and biopsied at Bumrungrad.....about 15,000 baht each. Expensive but very good and professional. I now have another on my arm. I went this past week to Bangkok Hospital and was quoted 25,000 from a surgeon there. When I questioned the price, the surgeon explained to me that he was a surgeon and did excisions which were 0.5 cm beyond each side of the lesion and 0.2 cm deep and needed suturing (he made a big deal of suturing and the need for two appointments, with the second appt being to removed the sutures!). 

In the past I have been told (in the US) that biopsies are curative for all but extensive basal cell lesions, but the doctors here at Bumrungrad and BKK seem to dispute that, telling me that they may spread unless surgically excised. Like much in Thailand one is told things that do not jive with what people have told you previously or elsewhere, and you don't know whether medical practice has changed or people are trying to rob you. Since the current lesion on my arm I have decided to watch and wait and if it starts growing again I'll have it cut out (if it was near my eye or on my face I would have it cut out immediately).

From my perspective as an elderly person with not too much longer to live, it seems logical to me to spend my healthcare dollars on interventions that will improve my quality of life now, rather than achieve a cosmetic result but not make me feel any better. 

[sikishrory]

Thanks Sheryl and Retarius.

I've had this for a couple of years with no issues and also heard they don't really need to be removed unless they cause issues. It is just starting to look a bit weird.

[Sheryl]

3 hours ago, sikishrory said:

Thanks Sheryl and Retarius.

I've had this for a couple of years with no issues and also heard they don't really need to be removed unless they cause issues. It is just starting to look a bit weird.

If it is indeed a lipoma, then removal is optional.

 

But I hesitate to advise this based an a diagnosis made here (especially at an upcountry hospital). While risk of it being other than a benign lipoma is small, it is not zero, and it would be wiser to get it excised and biopsied. ThUs both removing the annoyance and getting a 100% sure diagnosis.

 

See what Mission Hospital quotes you, I suspect substantially less than the other quote you got.

 

 

[Sheryl]

3 hours ago, retarius said:

 I had a couple of basal cell carcinomas cut out last year and biopsied at Bumrungrad.....about 15,000 baht each. Expensive but very good and professional. I now have another on my arm. I went this past week to Bangkok Hospital and was quoted 25,000 from a surgeon there. When I questioned the price, the surgeon explained to me that he was a surgeon and did excisions which were 0.5 cm beyond each side of the lesion and 0.2 cm deep and needed suturing (he made a big deal of suturing and the need for two appointments, with the second appt being to removed the sutures!). 

In the past I have been told (in the US) that biopsies are curative for all but extensive basal cell lesions, but the doctors here at Bumrungrad and BKK seem to dispute that, telling me that they may spread unless surgically excised.

 

A biopsy is curative only if the entire lesion was removed, with clear margins all round. There is never any guarantee of this, though it could have worked out that way for you in the past.

 

Usual procedure is to do a "punch biopsy" which may or may not yield clear margins. If it does not, options then are a wider surgical excision OR Mohs surgery, the latter being preferred if there is any cosmetic concern or if the lesion is located in a spot where wide excision is difficult (e.g. side of the nose -- I am scheduled for Mohs surgery tomorrow for that reason, nodular BCC on side of nose).

 

It sounds like the surgeon you spoke to at Bangkok Hospital was proposing to do a wide excision rather than a punch biopsy. Maybe because he felt the likelihood of it being cancerous was high based on your history and the appearance of the lesion, who knows.

 

in any case you can get what you need done at a tiny fraction of that cost at the government skin hospital near Victory Monument:

 

https://www.iod.go.th/en/

 

I suggest not trying the "after hours" channel as they often will not do procedures there,  and just make you come back via the public channel; the "after hours" route  is useful only for other (non-surgical) types of issues....and also costs much more. Also, while there will be some waiting, it is not as crowded here as at  some government hospitals. It is helpful to have a Thai speaker with you but if you do not, can manage with Google Translate etc. With the lesion being on your arm, easy to just point to it, but be sure to add that you have had BCC in the past. (you will be seen first at a triage desk by a nurse, who likely won't speak English, and she will then decide which doctor to send you to). Prepare that phrase ("I have hsogtory of skin cancer, Basal Cell Carcinoma, in the past" on your phone in Thai.  The staff are helpful and the hospital sees few enough foreigners that they are still a novelty  and thus get extra help.  The senior doctors will speak at least some English

 

They will do a punch biopsy and then the results will determine whether or not further excision is needed. (Same as anywhere else, including US).  You should expect to wait a few hours so bring some reading materials, and it is possible that you may have to attend on a subsequent day for the actual biopsy (odds of getting it all done same day are greater if you go there early morning). It will take a month or more to get the biopsy results, but they can be emailed to you on request if you want to save what might be an unnecessary follow up visit.  Obviously this is all vastly slower than in a private hospital but with a BCC there is no great rush and the savings are well worth it. The hospital has a Line App account and there is an English speaker who responds on it, so once you have a hospital number you can use that for future communications.

 

I forget exactly what my punch biopsy cost but I think it wasn't much more than 1,000 baht including path charge.

 

 

[retarius]

Thank you Sheryl, good luck with your Mohs procedure tomorrow. I'll look into the IOD when I get back from my holiday. I leave on Wednesday and took the decision to wait until I came back before moving on the lesion. 1000 baht represents quite a saving over what I have discussed. Once again, Thanks for your help. 

[Sheryl]

34 minutes ago, retarius said:

Thank you Sheryl, good luck with your Mohs procedure tomorrow. I'll look into the IOD when I get back from my holiday. I leave on Wednesday and took the decision to wait until I came back before moving on the lesion. 1000 baht represents quite a saving over what I have discussed. Once again, Thanks for your help. 

When I get home again, I'll check the receipt and tell you exactly. Possible it was a bit more, I just know that I considered it very reasonable and it was a huge savings compared to private hospital rates for the same thing.

 

Also given how rare skin cancers are in Thais, this is probably the best place in Bangkok to have this done, in terms of having the biopsy read by someone with experience in examining skin cancer samples.

[Sheryl]

On 5/20/2024 at 5:20 PM, Sheryl said:

When I get home again, I'll check the receipt and tell you exactly. Possible it was a bit more, I just know that I considered it very reasonable and it was a huge savings compared to private hospital rates for the same thing.

 

Also given how rare skin cancers are in Thais, this is probably the best place in Bangkok to have this done, in terms of having the biopsy read by someone with experience in examining skin cancer samples.

@retarius  I'm home now and checked the earlier receipt. 710 baht for biopsy including path report.

 

I had 2 additionsl biopsies yesterday, each cost under 1000 though slight difference between them  based on size of the lesion. 

 

in addition I had an excision at the site of prior positive biopsy --- after review of the path report it was determined a single wider excision would suffice and no need for Mohs.  This also cost under 1000. 

 

Government hospitals always cost less than private but usually by a factor of 2-4 fold. For some reason it is more than 10 fold difference for biopsies/excisions of skin cancers,  at least if the Institute of Dermatology is used. Add to that, IOD is easier/less time consuming to use than the much more crowded and chaotic  public general hospitals. 

[sikishrory]

For anyone from the future viewing this. I ended up having it removed at Aspire clinic phuket for 10,000.

This included the removal, medication and pathological analysis.

The funny part is that I spent a few weeks deliberating if to get it done at kathu dermatology for 17.5k or aspire. Then one evening upon closer inspection I realised both clinics operate with the same surgeon just different pricing.