Dermatologist Recommendation Please.

[MUSTYJACK]

I am in the UK at the moment but will be travelling to Thailand next week and staying for just over 2 months.

I have a small lesion on my left elbow, it has been there for about a month, which the UK dermatologist I saw earlier this week suspects could be a squamous cell carcinoma.

It can be removed on the NHS in about 3 to 4 weeks time, but he told me it could wait until I return to the UK in July as squamous cell carcinomas rarely metastasize.

I would rather get it removed and analyzed before then, i.e. whilst in Thailand.

I will be in Bangkok and would like a recommendation for a competent ethical dermatologist who will remove this lesion with a 5mm margin it and have it properly analyzed and give me both the slides and the results to bring back to the UK without having to jump through hoops, i.e. go through many tests, be sent on a tour of all the hospital departments, be sent to see other doctors, and rack up a huge bill, before it is removed.

Bumrungrad, Bangkok Hospital or BNH would be fine, if fact anywhere where there is a competent, ethical dermatologist with experience of these things, (ie. not a botox filler cowboy with a ferrari and three wives to support)

Many Thanks for any help given.

[lopburi3]

Getting biopsy and removal should not be a problem but it will cost if done in private hospital setting by plastic surgeon. My last (which was removed by laser but biopsy confirmed BCC) had a fixed price of 30,000 baht which included full OR and there must have been 20 stitches for the small wide margin removal on lower arm. Expect some of your mentioned hospitals might be more costly.

Be aware skin cancer is very rare in Thailand so few doctors will have any practical experience if they have not worked outside Thailand or actively involved with foreign patients. As your doctor advised time is not normally critical with these types of cancer so waiting might be a better option if it is just suspect.

[Sheryl]

Your problem is that you need more than a competent dermatologist, you also need a competent pathologist who will give an accurate reading of the sample. Excision is not hard but I have some doubts, based on my experience, for the latter.

If you are determined to have this done in Thailand, I suggest Dr. Niyom at Bumrungrad but be sure to bring all the slides back with you. And yes, it will be costly.

[gamini]

Bumrungrad and other private hospitals specialise in cosmetic surgery and are not the best places to go for treatment. Siriraj Hospital has a huge 8 story dermatology department with world class dermatologists, Squamous cell carcinoma removal with proper pathology should cost you not more than Bt1,500. I have been having treatment there for many years for skin cancer.

You have to go there and register then get an appointment. You will be given a date and time.

[MUSTYJACK]

Many thanks for the replies.

Regarding Siriraj, is it a difficult process for a foreigner to register there, and approx. how long is the wait for an appointment?

Can you recommend a doctor there.

Edited April 22, 2016 by MUSTYJACK

[JMWPACIFIC]

Travel to Pattaya and see Dr. Anna (can't recall last name) at Bangkok Pattaya Hosp. who is highly respected, lived in the U. S. for a long tome and was either schooled or taught at Stanford University.

[Sheryl]

I would have suggested Dr. Anna if there was a need to evaluate the lesion (indeed she is the only doctor I would suggest for that) but as it has already been examined by a dermatologist in the UK and recommended for excision, this is not a consideration. The issue is to get it properly excised (not difficult) and a reliable path exam carried out (much more difficult).

Not all dermatologists at Bumrungrda and other private hospitals specialize in cosmetic procedures, though the majority do. Dr. Niyom recommended specializes in dermatological diseases and trained in the U.S. He would be fine for the excision (unless it so large an area as to warrant referral to a plastic surgeon). Besides Bumrungrad, he is also at Siriraj and on their faculty.

Sirirtaj itself is also an option, though less conveniently located, and has a private wing where you can easily make appointment by phone or email http://www.siphhospital.com/en/index.html Among their fauclty, Dr. niyom mentioned above is the one with the most experience in skin cancer. While it is further to travel, excision will cost less at Siriraj than Bumrungrad and path exam may be more reliable.

As mentioned, imperative that you get all the slides for repeat opinion in UK, do not rely in path report done here.

Personally I would wait and have it done back in the UK.

[gamini]

I would have suggested Dr. Anna if there was a need to evaluate the lesion (indeed she is the only doctor I would suggest for that) but as it has already been examined by a dermatologist in the UK and recommended for excision, this is not a consideration. The issue is to get it properly excised (not difficult) and a reliable path exam carried out (much more difficult).

Not all dermatologists at Bumrungrda and other private hospitals specialize in cosmetic procedures, though the majority do. Dr. Niyom recommended specializes in dermatological diseases and trained in the U.S. He would be fine for the excision (unless it so large an area as to warrant referral to a plastic surgeon). Besides Bumrungrad, he is also at Siriraj and on their faculty.

Sirirtaj itself is also an option, though less conveniently located, and has a private wing where you can easily make appointment by phone or email http://www.siphhospital.com/en/index.html Among their fauclty, Dr. niyom mentioned above is the one with the most experience in skin cancer. While it is further to travel, excision will cost less at Siriraj than Bumrungrad and path exam may be more reliable.

As mentioned, imperative that you get all the slides for repeat opinion in UK, do not rely in path report done here.

Personally I would wait and have it done back in the UK.

I cant understand why you think it is necessary to get a second opinion done in the UK if it it is done at Siriraj? I find Siriraj better than any Hospital I have been in to in England including the London Clinic where I was a patient for two weeks. The UK NHS is so bad that I always seeked private treatment when I was there. I have had the procedure mentioned done here with a very professional pathology report.

[johnatong]

I would have suggested Dr. Anna if there was a need to evaluate the lesion (indeed she is the only doctor I would suggest for that) but as it has already been examined by a dermatologist in the UK and recommended for excision, this is not a consideration. The issue is to get it properly excised (not difficult) and a reliable path exam carried out (much more difficult).

Not all dermatologists at Bumrungrda and other private hospitals specialize in cosmetic procedures, though the majority do. Dr. Niyom recommended specializes in dermatological diseases and trained in the U.S. He would be fine for the excision (unless it so large an area as to warrant referral to a plastic surgeon). Besides Bumrungrad, he is also at Siriraj and on their faculty.

Sirirtaj itself is also an option, though less conveniently located, and has a private wing where you can easily make appointment by phone or email http://www.siphhospital.com/en/index.html Among their fauclty, Dr. niyom mentioned above is the one with the most experience in skin cancer. While it is further to travel, excision will cost less at Siriraj than Bumrungrad and path exam may be more reliable.

As mentioned, imperative that you get all the slides for repeat opinion in UK, do not rely in path report done here.

Personally I would wait and have it done back in the UK.

I cant understand why you think it is necessary to get a second opinion done in the UK if it it is done at Siriraj? I find Siriraj better than any Hospital I have been in to in England including the London Clinic where I was a patient for two weeks. The UK NHS is so bad that I always seeked private treatment when I was there. I have had the procedure mentioned done here with a very professional pathology report.

How does one distinguish a " very professional" pathology report from an "unprofessional" report?

Total word count or just the number of big "professional words" used ?

Details please.

[Sheryl]

Pathologists in Thailand simply do not see that many specimens of skin malignancies. It is better to have the result re-checked by a pathologist who does.

I have personally encountered inaccurate path reports in Thailand on more than one occasion.

[MUSTYJACK]

I had a malignant melanoma on my shoulder 4 years ago, and thanks to an inaccurate pathology report from a Thai hospital it was mis-staged as a very advanced malignancy (stage 4) and I very nearly underwent invasive and life changing surgery. The doc told me that over 90% of those with stage 4 melanomas are dead within 5 years.

Thanks to my insurance company, who advised that the biopsy be re-examined at Bumrungrad, it was found to be a stage 1A and it only needed a wide excision, followed by pathology of the borders of the excised skin, as opposed to the butchery proposed by the first hospital. No chemo or radio was needed and there has been no recurrence or spread. The biopsy slides were re examined in the UK, who confirmed it as a stage 1A with little chance of spread or recurrence.

Needless to say I am very wary of the sun now, and Thai doctors.

Staging is determined partly on the depth into the epidermis that the malignancy has advanced to, and partly by the degree of mitochondrial action present in the cells. The UK biopsy was much more detailed on the mitochondrial part.

Even though I was told last week by the UK dermatologist that the lesion looked like a squamous cell carcinoma with little chance of spread and it could wait a while before excision, because of my previous experience with skin cancer, for my own peace of mind I am anxious to get this albeit very small lesion removed sooner rather than later.

Thanks again for the replies.

Edited April 24, 2016 by MUSTYJACK