Skin Cancer

[fletchsmile]

A couple of years back I went to Bumrungrad for skin cancer. I wasnt impressed with the dermatologist that identified my condition.

But the surgeon and procedures were very good.

I need to get checked out again but prefer to see a different doctor.

Trying to make an appointment at BH over the phone they couldnt identify a skin cancer doctor except telling me who I saw last time.

The website for finding doctors wasnt much help either.

So:

1. Is it better to see a dermatologist for skin or to see an oncologist for cancer?

2. Any recommendations as to hospitals and doctors?

I do like Bumrungrad and they have my history. Just couldnt find the right doctor.

Also went to Saint Louis last time.

Cheers

Fletch

Sent from my GT-I9152 using Thaivisa Connect Thailand mobile app

Edited May 6, 2014 by fletchsmile

[FBN]

Dr. Nyom in Bumrungrad is reported to be fine for this. He works in the Dermatology annex to the main hospital.

Perhaps if you mention where in Thailand you are looking for a referral?

[fletchsmile]

Thanks for that FBN

He was one I was wondering about as I saw he had done Mohs micrographic surgery. The only dermatologist I could link in any way.

I wasnt sure if he was just a surgeon.

Thanks

Fletch

I'm looking in BKK.

Sent from my GT-I9152 using Thaivisa Connect Thailand mobile app

[patient]

guys cld u possibly give an indication of dr. nyoms fees if u have that info or maybe report back afterwards. . i am in udon so if anyone knows /can recommend one up here or say kohn kean great but i will travel to bkk. i need annual checks.

[Sheryl]

+1 for Dr. Niyom.

[fletchsmile]

guys cld u possibly give an indication of dr. nyoms fees if u have that info or maybe report back afterwards. . i am in udon so if anyone knows /can recommend one up here or say kohn kean great but i will travel to bkk. i need annual checks.

The basic consultation fee for a specialist at Bumrungrad seems to be about 800 baht. They then tend to add on service charges for nurses fees/ weighing and measuring you etc, to take it to just over THB 1,000. After that depends on what else they do, eg scan, biopsy, surgery etc

Cheers

Fletch

[Sheryl]

Fees have gone up recently. Most specialists now 1,000 - 1,500. I saw Dr. Niyom quite recently, don't recall w exactly but I think about 1,000 or not much more, and then yes a few hundred baht for the hospital.

@patient - if it is for skin cancer, Thai doctors have little experience with it as not common in the Thai population. So worth traveling to Bkk to be seen by someone who trained/worked in the West.

[patient]

Thankyou Fletch and Sheryl

Appreciate that info and will follow up on it.

Quick follow up question.in your experience/opinion What is likely to be a typical period of time between contacting dr. N and the initial consultation ie how busy is he and also between consult and and further treatment say minor surgery to test a few moles.

Cheers!

Edited May 7, 2014 by patient

[fletchsmile]

Generally Bumrungrad are pretty good at turnaround times.

When I went for a consultation they said I needed a biopsy. They then did one and I got the results shortly thereafter. Think it was all same day if remember rightly within a couple of hours.

For the actual surgery I had to make an appointment a few days later as that took more time and needed an appropriate surgeon.

Turnaround was still quick tho all things considered. After surgery they analysed the cancer and margins etc within a short time frame while I was in the recovery room. So they are quick with their analyses.

I went to Saint Louis for a less serious one. Partly also to get a second opinion and folloe up. Had to make an appointment for check up and separate for removal on another day and then wait a couple of days for results.

One option to consider is just having a lot of them removed by freezing if they dont appear serious. I didnt like the idea of going back every time for biopsy and or possible surgery. The doctor was quite ok with me taking this approach. We picked out about 20 - 30 moles dark spots and he just froze them. I m sure a lot perhaps even all were non malignant moles. I just didnt want to be bothered with keep doing surgery one by one to biopsy and see.

Freezing is quick and less hassle and low cost. The main disadvantages being they cant biopsy them afterwards so you never know. Plus the success rate of completely killing a cancer is lower and higher chance of recurrence.

Hence we just picked high volume low risk. Saint Louis was a cheap option too for this

If more serious though or you are more worried worth paying more at BH for peace of mind and quicker turnaround.

Cheers

Fletch

Sent from my GT-I9152 using Thaivisa Connect Thailand mobile app

Edited May 7, 2014 by fletchsmile

[patient]

Fletch

thankyou. i really appreciate yr detail and observations.the personal experiences cleared that up for me.

i am ahigh risk ozzie...lots of moles. so will take the safe option. i also want to do annual checks as a precaution.

thanks

[Sheryl]

Thankyou Fletch and Sheryl

Appreciate that info and will follow up on it.

Quick follow up question.in your experience/opinion What is likely to be a typical period of time between contacting dr. N and the initial consultation ie how busy is he and also between consult and and further treatment say minor surgery to test a few moles.

Cheers!

Dr. Niyom is in heavy demand but you can usually get an appointment within 24 hrs notice especially if you avoid weekends. Can make the appointment online or by phone.

Once he sees you, he'll schedule follow-up for whenever it is needed, no delays. He is very conscientious.

[patient]

thankyou Sheryl very good to know and have connfirmed he is in high demand...he gets to see lots of moles so has lots of experience

[fletchsmile]

Saw Dr.Niyom today. Very good. Felt like he knew his stuff very thoroughly and also very good manner with patients. Listens. Answered questions. Wrote things down for me without evening asking. He said all of the doctors in this unit cover all the dermatology areas, but he specialises in skin cancer.

Cost for the consultation was THB 1,500

I had a small biopsy done. The cost for that was estimated at THB 8,000, and was done within half an hour of the first appointment. Wait one week for results. The total bill came to THB 6,900-ish though, so I think that if you have something additional done they're not double charging for seeing the doctor, just increasing the scope. My company has a 15% discount.

Yes he has a busy schedule. Saturday morning was booked when I arranged the appointment a couple of days back.

All in all excellent. Thanks to Sheryl and FBN for the tips

Cheers

Fletch

Edited May 10, 2014 by fletchsmile

[lopburi3]

I had a small biopsy done. The cost for that was estimated at THB 8,000, and was done within half an hour of the first appointment. Wait one week for results. The total bill came to THB 6,900-ish though,

Having a hard time getting my head around this but believe you are saying they did the scrap for biopsy within 30 minutes of your request but actual result will be normal few days later? But your 6,900 baht fee does not include the biopsy but consultation and surgery? And it is estimated to be another 8,000 baht for biopsy? I normally pay 1,000 baht for biopsy and use a private hospital (although not as expensive as where you went) and this is billed at time of taking sample and not an estimate. Or have I read wrong and estimate was 8,000 plus but total was actually only 6,900 baht?

[fletchsmile]

I had a small biopsy done. The cost for that was estimated at THB 8,000, and was done within half an hour of the first appointment. Wait one week for results. The total bill came to THB 6,900-ish though,

Having a hard time getting my head around this but believe you are saying they did the scrap for biopsy within 30 minutes of your request but actual result will be normal few days later? But your 6,900 baht fee does not include the biopsy but consultation and surgery? And it is estimated to be another 8,000 baht for biopsy? I normally pay 1,000 baht for biopsy and use a private hospital (although not as expensive as where you went) and this is billed at time of taking sample and not an estimate. Or have I read wrong and estimate was 8,000 plus but total was actually only 6,900 baht?

For a consultation only it would have been THB 1,500. But after the consultation he said they should to do a small biopsy.

Nurse asked me to sign some papers, which included an estimate for THB 8,000. They did it about half an hour later. Lie down on a bed, small injection, then small cut. The results will be emailed in a few days/within the week

At the cashier the lady said my company gets 15% discount if I had anything to show my company ID.

Total bill for everything today was 6,983 for all the above, i.e consultation + biopsy + bactroban ointment all came to THB 6,983. Bill came at the end of everything.

Cheers

Fletch

[lopburi3]

OK now got it - so was signature agreement estimate prior to scrape and turned out to be about 8k total price discounted to lower price and included the office procedure as well as actual biopsy. Thanks.

[scoutman360]

One option to consider is just having a lot of them removed by freezing if they dont appear serious. I didnt like the idea of going back every time for biopsy and or possible surgery. The doctor was quite ok with me taking this approach. We picked out about 20 - 30 moles dark spots and he just froze them. I m sure a lot perhaps even all were non malignant moles. I just didnt want to be bothered with keep doing surgery one by one to biopsy and see.

Freezing is quick and less hassle and low cost. The main disadvantages being they cant biopsy them afterwards so you never know. Plus the success rate of completely killing a cancer is lower and higher chance of recurrence.

Hey Fletch, I would suggest Yanhee Hospital for the best bang for the buck, if mole removal is all you want. They will use laser for minimal scaring. I have done it numerous times there, with maybe 30+ moles removed over the years. Very satisfied. Sometimes they want to use the scalpel for larger ones, but I politely refused, and the laser did the trick without the scar.

I had a similar experience as you at Bumrungrad, where my consulting doctor was not the guy doing the surgery. No complaints, though, as the surgeon was a real pro. I had full recovery for a complicated surgery.

[Sheryl]

Sounds like it was more than a scrape biopsy, perhaps a punch biopsy or incision of the entire lesion and its margins.

I would not recommend Yanhee for skin cancer concerns which is what the OP asked about. Fine for cosmetic derm tho. For possible skin cancer, owing to its low prevalence among Thais, there are only a handful of really skilled doctors in Thailand, Dr. Niyom being prominent among them.

[lopburi3]

The freezing method is quite effective at destroying cancer cells so believe it is recommended for suspect removals unless you have biopsy of each prior to removal. If using laser biopsy is required if any doubt and then further treatment if positive. And as said most doctors here are not qualified to make that judgement on look as they just don't have experience. Laser does not remove deep so not all cancer is likely to be removed. Although agree it is much less ugly looking.

[Tolley]

My experience of the freezing method is not so positive. They usually come back for me after a period of time.

I get better results with pure tea tree oil.

Mind you these are just superficial sun spots anything more suspicious needs to be fully excised with clear margins and biopsied.

[onomataho]

Good information about skin cancer treatment in Bangkok.

I have an additional question for those in the know...

At Bumrungrad do they do sentinel Lymph node biopsies (aka: Lymphoscintigraphy Spect CT) for diagnosing whether melanoma cancer cells have spread to the lymph nodes?

Any other hospitals in Bangkok, Chiang Mai, or Pattaya do this?

[Sheryl]

Sentinel lymph node biopsy is usually done by taking a sample of lymph nodes closest to the cancer to see if any spread to them. Lymphoscintigraphy on the other hand means uses a special technique to map the lymph drainage in order to determine which node that would be, if it is not already evident (which depending in the location of a cancer, it may already be). . It is usually done for breast cancer where the lymph system is large and complex.

Virtually any large hospital can do a sentinel lymph node biopsy, for an type of cancer. I don't know how many can do so using lymphoscintigraphy but frankly in melanoma that would be the least of my concerns. The bigger issue is the skills of the surgeon is recognizing suspicious lesions/nodes and in excising enough tissue, and in the case of melanoma especially, the skills of the pathologists in reading the slide need to be considered. There is very little experience with melanoma in Thailand, only a handful of docs that are really up on it.

If you need a specialist in melanoma let me know, it is quite some time since I last researched this but if I recall, the few there are, were at Siriraj. Please specify if the melanoma has already been confirmed.

[onomataho]

Sentinel lymph node biopsy is usually done by taking a sample of lymph nodes closest to the cancer to see if any spread to them. Lymphoscintigraphy on the other hand means uses a special technique to map the lymph drainage in order to determine which node that would be, if it is not already evident (which depending in the location of a cancer, it may already be). . It is usually done for breast cancer where the lymph system is large and complex.

Virtually any large hospital can do a sentinel lymph node biopsy, for an type of cancer. I don't know how many can do so using lymphoscintigraphy but frankly in melanoma that would be the least of my concerns. The bigger issue is the skills of the surgeon is recognizing suspicious lesions/nodes and in excising enough tissue, and in the case of melanoma especially, the skills of the pathologists in reading the slide need to be considered. There is very little experience with melanoma in Thailand, only a handful of docs that are really up on it.

If you need a specialist in melanoma let me know, it is quite some time since I last researched this but if I recall, the few there are, were at Siriraj. Please specify if the melanoma has already been confirmed.

Yes, initial excision diagnosed as melanoma. Further excision and lymphoscintigraphy to determine possible spreading is the recommended course of action.

What about oncologist Dr. Rattiya Cheewakraingkrai at Chiang Mai RAM Hospital?

[Tolley]

Good information about skin cancer treatment in Bangkok.

I have an additional question for those in the know...

At Bumrungrad do they do sentinel Lymph node biopsies (aka: Lymphoscintigraphy Spect CT) for diagnosing whether melanoma cancer cells have spread to the lymph nodes?

Any other hospitals in Bangkok, Chiang Mai, or Pattaya do this?

I doubt that they do.

Any melanomas over 1mm and they usually do a SNB in Australia which is mapped out via Lymphscintigraphy so they can find the drainage pattern for the sentinel lymph node.

This is done the day before or the morning before surgery so they combine both procedures together.

Any cancer found in sentinel lymph node and the take all the lymph nodes out in another operation.

I don't think Thailand would be the best place for this sort of procedure if they have it at all.

[Tolley]

Sentinel lymph node biopsy is usually done by taking a sample of lymph nodes closest to the cancer to see if any spread to them. Lymphoscintigraphy on the other hand means uses a special technique to map the lymph drainage in order to determine which node that would be, if it is not already evident (which depending in the location of a cancer, it may already be). . It is usually done for breast cancer where the lymph system is large and complex.

Virtually any large hospital can do a sentinel lymph node biopsy, for an type of cancer. I don't know how many can do so using lymphoscintigraphy but frankly in melanoma that would be the least of my concerns. The bigger issue is the skills of the surgeon is recognizing suspicious lesions/nodes and in excising enough tissue, and in the case of melanoma especially, the skills of the pathologists in reading the slide need to be considered. There is very little experience with melanoma in Thailand, only a handful of docs that are really up on it.

If you need a specialist in melanoma let me know, it is quite some time since I last researched this but if I recall, the few there are, were at Siriraj. Please specify if the melanoma has already been confirmed.

They use Lymphoscintigraphy to identify the sentinel lymph node and mark it on the body with a marking pen so the surgeon knows which lymph node to take out for the biopsy.

[Sheryl]

Yes, I know. But it is often fairly obvious which is the sentinel node just from the location of the tumor. This is used mainly for breast cancer where there are many, many lymph nodes and complex anatomy of lymphatic drainage.

As noted, the availability of this specific technology is the least of the worries if trying to treat melanoma in Thailand.

[Tolley]

Yes, I know. But it is often fairly obvious which is the sentinel node just from the location of the tumor. This is used mainly for breast cancer where there are many, many lymph nodes and complex anatomy of lymphatic drainage.

As noted, the availability of this specific technology is the least of the worries if trying to treat melanoma in Thailand.

Not with the melanoma it isn't that is why they use that technique and sometimes there is more than one lymph gland involved.

[Sheryl]

As I said, the technique is most often used for breast cancers and this was what it was first developed for.

Melanomas can be in many different locations, depending on where, identification of sentinal node may or may not be complex.

And sentinel lymph node biopsy - by any technique - is not always indicated in melanoma, it depends on the stage.

[bofhman]

Don't take any doctors word for it. Just simply slap on some Black Salve. If it's any form of skin cancer you will get a reaction and an Escher forming. If not cancer, no reaction whatsoever. The removal of a cancer this way is just about perfect compared to a surgeon with a knife who cannot guarantee they won't miss some cells. By all means get a biopsy before and after but please, use the Black Salve to identify a cancer and destroy it as soon as possible. Then look at alkalising your body tissues to reduce the likelihood of other cancers.

Sent from my iPad using Thaivisa Connect Thailand

Edited May 14, 2014 by bofhman

[onomataho]

Back to my original question...

I've been advised by a top US cancer surgeon to have a sentinel node biopsy concurrently with surgery to remove a melanoma. The location of the melanoma does not foretell which lymph node may be affected.

At Bumrungrad (or any other Thai hospitals) -- do they do sentinel Lymph node biopsies (using a Lymphoscintigraphy Spect CT) for diagnosing whether melanoma cancer cells have spread to the lymph nodes?

Thanks.