Bkk: Skin Doctor / Cuting Out Moles (Skin Cancer Potential)

[canardo]

Sorry, but English is NOT my first language as you might have noticed already...

So, a few years ago back home a doctor cut out some of those black moles testing for skin cancer potential.

I am looking for a skin doctor here in Bangkok, who is doing it, professionally and does NOT cost me a fortune as my health insurance wont cover this (I guess)...

Any recos?

Would appreciate, otherwise I would go to Bungrungrad...

Cheers,

C.

[lopburi3]

Are you sure your insurance will not cover it? If done as cancer or pre cancer treatment believe they will - if cosmetic probably not. Do you need biopsy of each excision? Can simple laser removal be used? Laser is not expensive and can be done in clinics as well as hospital settings but if you suspect cancer rather than pre cancer preventive it is likely to be much more expensive. But be aware most doctors do not have a great deal of knowledge about Caucasian skin cancer issues if that is a factor.

[canardo]

Are you sure your insurance will not cover it? If done as cancer or pre cancer treatment believe they will - if cosmetic probably not. Do you need biopsy of each excision? Can simple laser removal be used? Laser is not expensive and can be done in clinics as well as hospital settings but if you suspect cancer rather than pre cancer preventive it is likely to be much more expensive. But be aware most doctors do not have a great deal of knowledge about Caucasian skin cancer issues if that is a factor.

Thx for the comment, I did not checked the insurance yet, it is AIA for 18,000 THB per year for accidents and hospital stay things.

However, if laser removal is safe and gets out the mole entirely and with it the potential cancer cells, I will go for it, but I have no clue and better do not ask a Thai doctor as they tell you whatever brings more money...

Any ideas?

[lopburi3]

I am not a medical person - just a patient. But have not had moles removed yet. Have had both BCC and SCC removals. Wide margin excision several times and a lot of laser of warts and spots that did not appear to be cancer yet. But Laser is not 100% effective so if known cancer best to use CO2 (not many places have here and not always used correctly) or excision. If just possible or a laser removal that has returned there is a 5 week treatment after laser by Aldara cream that is available, and I have used, which should get rid of remaining cells. As provided it is considered single use so would be very expensive but for small size of less than 2cm one single use packet has enough for about 2 weeks treatment.

[Sheryl]

It sounds like you have only hospitalization insurance, this is an outpatient procedure so won't be covered.

While lasers can remove a mole, it is not a suitable method when biopsy is needed. You need surgical excision or (if it is small enough) a "punch biopsy".

As others have noted, it is important to get a doctor who has worked i nthe west and is thus familiar with skin cancers

I suggest one of these:

1. Dr. Paritas at Samitivej (Yale educated, US biard certiified)

2. Dr. Parichart at Saint Louis (trained in Edinborough, MRCP)

The second will be less expensive.

[canardo]

It sounds like you have only hospitalization insurance, this is an outpatient procedure so won't be covered.

While lasers can remove a mole, it is not a suitable method when biopsy is needed. You need surgical excision or (if it is small enough) a "punch biopsy".

As others have noted, it is important to get a doctor who has worked i nthe west and is thus familiar with skin cancers

I suggest one of these:

1. Dr. Paritas at Samitivej (Yale educated, US biard certiified)

2. Dr. Parichart at Saint Louis (trained in Edinborough, MRCP)

The second will be less expensive.

Thx both, guess I will try St. Louis first...

[kyb789]

I have had more than 30 moles removed at various clinics and hospitals. Only 1 looked suspicious and they recommened a biopsy. The others were harmess and easy to remove with laser. It leaves a small scar. But in my opinion, a scar the color of my skin is barely visible and looks better than a brown spots everywhere. I am quite pleased with the results and I wouldn't be too concerned about it. If you don't trust the physician, use another one.

I had most removed at Yanhee Hospital. Make sure they numb you up good because the laser is quite painful if they don't. I didn't like the shot injections for numbing. It still hurt like h#^%. The cream they used an Yanhee was perfect. Didn't feel a thing.

[Sheryl]

Need to distinguish between an ordinary mole ( = been there all/most of your life, no change in appearance or size) and suspicious moles (new or changes in appearance). The latter need to be carefully assessed and often biopsied to rule out melanoma, which is the most serious of all the skin cancers and can be fatal if not caught early. Melanoma is very rare in Thailand and most Thai dermatologists have little expertise in it.

[canardo]

Need to distinguish between an ordinary mole ( = been there all/most of your life, no change in appearance or size) and suspicious moles (new or changes in appearance). The latter need to be carefully assessed and often biopsied to rule out melanoma, which is the most serious of all the skin cancers and can be fatal if not caught early. Melanoma is very rare in Thailand and most Thai dermatologists have little expertise in it.

thx Sheryl, will give it a shot...

[mikebell]

Need to distinguish between an ordinary mole ( = been there all/most of your life, no change in appearance or size) and suspicious moles (new or changes in appearance). The latter need to be carefully assessed and often biopsied to rule out melanoma, which is the most serious of all the skin cancers and can be fatal if not caught early. Melanoma is very rare in Thailand and most Thai dermatologists have little expertise in it.

thx Sheryl, will give it a shot...

Widening the topic slightly, what about liver spots? I am pushing 69 and my skin seems to have become riddled in the last year or two. Is there any preventative medicine (ie no alcohol) or curative treatment like creams/lasers?

[sinbin]

I know that there's a difference, but my story may assist. I had a common wart which was 7-8mm in diameter on my lower abdomen. It occasionally itched and I went to my local government hospital and asked if it could be removed. The doctor said yes and cut it out. She inserted 2 stitches and sent off the wart for biopsy. I was given 10 days worth of antibiotics, and paracetamol for the discomfort, of which I had none.

The procedure was done today and the total bill was 730 Baht. Time taken from consultation to walking out was under 1 hour. I go back in one month for the results of the biopsy

[Sheryl]

Widening the topic slightly, what about liver spots? I am pushing 69 and my skin seems to have become riddled in the last year or two. Is there any preventative medicine (ie no alcohol) or curative treatment like creams/lasers?

First of all, need to be sure they are all just "liver spots" (lentigo in medical terms) and not pre-cancerous lesions.

If they are just lentigo there are a number of options:

Prevention: only sunscreen. Note that even if you become fanatical about using it now, you may still continue to form new spots due to accumulated sun damage in past years. So while you certainly should try to use it, don't expect that by doing so, no new spots will occur.

Cosmetic treatment:

1. Creams containing hydroquinone 4% will "bleach" the spots so that they are the same color as the surrounding skin. They'll still be there if you look closely but be much less apparent. The cream must be applied daily and it takes a few months to see the full result. Any doctor can provide you this cream; it is also legal to buy over the counter under brand names Delanin and Persantina, although I have found these very hard to source. I did find Persatina at the pharmacy near the supermarket ground floor at Central Chidlom. If instead you get from a doctor, avoid the various skin clinics: they'll dole it out in minute amounts, refuse to tell you what exactly it was they gave you, and overcharge to boot. There are a number of sort of "witches brew" bleaching creams in use in Thailand that may not suit western skin types. insist on only hydroquionone 4%, nothing else in it.

Alternately or in addition to hydroquinone, Retin-A (readily available OTC at any pharmacy) may help, this likewise needs a few months to show results. A regimen ofWhen using Retin A the skin becomes more sensitive to sunlight so sunscreen especially important in the area treated.

2. Lasers can remove the lesions. May or may not leave some discoloration behind where the spot had been (usually white or pink in color).

3. Liquid nitrogen treatment (cold thing a dermatologist sprays on) will remove them. Vastly less expensive than laser especially if you have numerous spots. For which reason docs at cosmetically oriented clinics never even mention this option but instead push lasers, as will many docs at hospitals if they are trained in laser. Liquid nitrogen may also leave some slight discoloration behind but in my experience no more than, and usually less than, laser treatment, and at a fraction of the cost.

4. More drastic options would include dermabrasion (not microdermabrasion but real dermabrasion) and chemical peels, both not widely done in Thailand and costly.

My advice for someone with multiple lesions would be to see a dermatologist not specializing in cosmetic procedures to (1) evaluate the lesions to be sure they are indeed only lentigines and (2) assuming yes, treat with either liquid nitrogen or bleaching cream as you prefer.

This is a good read on the problem http://www.mayoclinic.com/health/age-spots/DS00912

[sabaijai]

FDA Proposes Hydroquinone Ban

Medical Author: Melissa Conrad Stoppler, MD

Medical Editor: Jay W. Marks, MD

On August 29, 2006, the U.S. Food and Drug Administration (FDA) proposed a ban on over-the-counter sales of cosmetic products containing hydroquinone, a skin-bleaching (lightening) ingredient. According to the FDA, approximately 65 companies sell over 200 different types of skin-lightening products containing hydroquinone in the U.S. Currently, products that contain up to 2 percenthydroquinone may be sold in the U.S. without a prescription, and prescription skin-lightening products may contain up to 4 percenthydroquinone. Examples of prescription products containing hydroquinone are Lustra, Tri-Luma, and EpiQuin Micro.

Hydroquinone products are popular for their skin-lightening properties in Asian and African cosmetics markets. In the U.S., they also are marketed for reducing age spots and blemishes.

The reason cited for the proposed ban is that studies in rodents show "some evidence" that hydroquinone may act as a carcinogen or cancer-causing chemical, although its cancer-causing properties have yet to be proved in humans. Hydroquinone also has been linked with the medical condition known as ochronosis in which the skin becomes dark and thick. Dome-shaped yellowish spots and grayish-brown spots also are observed in ochronosis among black women and men in South Africa, Britain, and the U.S. Ochronosis has been observed in conjunction with hydroquinone use even in persons who have used hydroquinone-containing cosmetics for a short time. Some studies also report abnormal function of the adrenal glands and high levels of mercury in people who have used hydroquinone-containing cosmetics. For these reasons, hydroquinone has already been banned in Japan, the European Union, and Australia.

Any skin-lightening products containing hydroquinone would be considered new drugs, according to the proposed FDA regulations. The products would require FDA approval before being sold to the public and would only be available with a doctor's prescription.

Following the proposed ban, a four-month comment period is in effect regarding the proposed changes in regulations during which time physicians, skin care companies, and consumers may voice their opinions and concerns about the proposed ban. It is not yet known if and when the proposed ban would take effect.

Reference: Federal Register: August 29, 2006 (Volume 71, Number 167)

http://www.medicinenet.com/script/main/art.asp?articlekey=64167

http://en.wikipedia.org/wiki/Hydroquinone

from Wiki

In 2006, the United States Food and Drug Administration revoked its previous approval of hydroquinone and proposed a ban on all over-the-counter preparations.[4] The FDA stated that hydroquinone cannot be ruled out as a potential carcinogen. This conclusion was reached based on the extent of absorption in humans and the incidence of neoplasms in rats in several studies where adult rats were found to have increased rates of tumours, including thyroid follicular cell hyperplasias, anisokaryosis, mononuclear cell leukemia, hepatocellular adenomas and renal tubule cell ademonas. The Campaign for Safe Cosmetics has also highlighted concerns

[Sheryl]

AFAIK hydroquinone preparations are approved for use in the US (and widely prescribed), just not approved for OTC sale.