Basal Cell Carcinoma

[OccamsRazor]

Several months ago I had a bump on my neck like a pimple and thought it was an ingrown hair. Over a long period of time it became elongated and looked like a light pink rash. Later, could feel very small bumps under the skin and was a problem shaving as it would often get cut.

Went to the dermatologist and last week she took a piece for biopsy and suspected Basal Cell Carcninoma. Went in today to get the lab results and sutures removed and the lab report confirmed it. I've already researched it quite a bit to check what is available for treatment. She said it should be surgically removed as the best case of total removal. Too deep for cryo freezing but could be done but require several treatments.

I asked who would do it and she said a surgeon. Asked to clarify if it was a general surgeon or cosmetic surgeon and she said I could decide but the cosmetic surgeon would be at least twice as expensive. It is probably about 1 cm long and 5mm wide.

The skin on my neck is rather loose and she felt general surgery would be fine and would close ok.

Any thoughts about which way would be best regarding surgeon type or others experience with this? Sheryl, FBN?

This is at Chiang Mai Ram hospital.

Thanks in advance.

[lopburi3]

A plastic surgeon will have experience with such removal (although they are few and far between for Thai - one cancer they normally don't get much) and I suspect will be worth the extra cost as he will likely make the margin wide enough to remove all with more skill than a doctor normally concerned with removal of specific defined part. But that is my non medical take after having several such procedures done over the years (first time over 30 years ago). That skin is loose will be helpful as they do have to take quite a large area even for a small spot as you hope to be sure it is all removed.

[OccamsRazor]

Thanks for the feedback. Will have to see how to work in the cosmetic surgeon as there are only two at CM Ram and only a few hours a week. Perhaps a consult with a general surgeon first to clarify the pros/cons.

[ProThaiExpat]

Within the last year, I have had more than one squamous cell removed as well as some basal cell ones. Dr. Ekachai at RAM is a general surgeon but quite experienced in removing cancerous lesions and you would be in very good hands with him. He did one on my throat just above my windpipe with no problem. Others on less dramatic parts of the body.

I had a very large squamous removed from the inside of my left knee and one almost exactly opposite side of same knee at the same time at Lanna Hospital where the Ram Plastic Surgeon said my costs would be twenty five percent cheaper. They were, however his fee was very high in my opinion, 15k Baht for both lesions in the same session. Plastic man required operating room, where Ekachai does it in the ER, much cheaper. My last Ekachai squamous removal cost 3500 baht including everything in the ER and also Ekachai's fee, which was 1500 baht.

When I expressed shock at the size of the Plastic Surgeons fee, he explained that a plastic surgeon gets a lot more than a general surgeon. This plastic man works mostly at NakonPing Government Hospital but moonlights at RAM and Lanna. My surgical result was no less pleasing and I feel Ekachai would have done as good a job for much less. Most doctor fees have gone up noticeably in the past year, so Ekachai probably charges more now, but I would not expect more than 3K for his fee. He is happy to quote you a fee for any procedure before he does the work.

Ekachai is sensitive to the cosmetic result of his work and does try to hide scars in skin folds, not a problem in a neck with loose skin.

I have had plastic surgery in the US and I felt the work done there may justify the cost if the work is done on the face, but for a simple squamous cell removal scar on the neck, why spend the money? You will not be disapointed in Ekachai, he has a world of experience in removing skin lesions and knows full well how wide the margins must be to ensure a completely negative biopsy report when he is finished.

Do let us know how your removal goes and the details and I am sure I will be facing another one next year.

[OccamsRazor]

Within the last year, I have had more than one squamous cell removed as well as some basal cell ones. Dr. Ekachai at RAM is a general surgeon but quite experienced in removing cancerous lesions and you would be in very good hands with him. He did one on my throat just above my windpipe with no problem. Others on less dramatic parts of the body.

Do let us know how your removal goes and the details and I am sure I will be facing another one next year.

Great information and I thank you for that. Specific experiences and doctors is always very helpful.

[Sheryl]

If cost is a concern I suggest you go to Suan Doc (Sripat -- part of CMU hospital) rather than a private hospital. Many of the docs at CM Ram are on staff at Suan Doc as well.

As to whether to go with a general surgeon or cosmetic surgeon, either one will do the job in terms of getting the lesion removed, but you'll be better assurred of a minimal scar/best appearance with a plastic surgeon, up to you how much this is worth. Healthwise the same.