Skin Cancer - getting the right doctor

Discussion in 'Northern Thailand - General Discussion Forum' started by DavidFL, Nov 8, 2014.

  1. As some of you probably know I've spent most of my life riding motorbikes, being in the sun & being guilty of not always using sunblock; & as life goes on it's finally starting to catch up to me - my skin is not the best as you all should have noticed.


    So I finally popped along to Ram hospital to get it all checked up & ended up with the duty dermatologist, who performed a biopsy on the 3 worst spots.

    A couple of weeks later the results are in & as to be expected they are all positive.
    No big deal the doc says we just cut them all out, but the big lesion on your temple needs a skin graft & the plastic surgeon doctor is all ready to do the work.

    I was ushered straight across the corridor & sure enough there was a plastic surgeon all ready to go (next week) if I agreed.
    Now I was a bit taken aback, because the doc had already decided it was all go without seeing me. The deal must have been done with his mate the dermatologist.

    Not impressed I decided to do some research & find out who the best doctors were - you want the ajarns who teach at Suan Dok Hospital, but have a clinic at Ram or outside even.

    The nursing staff at Ram were too Thai (greng jai) to suggest another doctor or who was the best.

    So I got onto my mate Dr Sudhee, the bone doctor.

    His recommendation was Dr Somboon Chaisrisawadisuk, the Associate Dean of Chiang Mai University Faculty of Medicine.

    [attachment file="Ram-DrSomboon.jpg"]
    Dr Somboon has been in Japan & the USA.

    After consulting my file & skin Dr Somboon says that in his experience the skin graft & surgery on the big lesion is a waste of time.
    I have so many future lesions coming on that I would need to cut up my whole face eventually.
    Surgery for this in your case is only a last resort.
    There is a cream for treatment which should work given time.
    So I need to go back to see a dermatologist again, but I don't want the same original doctor I consulted.
    You have 3 dermatologists at Ram who is the best?

    Oh that would be Dr Vachiraporn
    [attachment file="Ram-DrVachiraporn.jpg"]
    she has trained in the states.

    But it would be better if you saw her at her private clinic & not here now, because it will cause conflict with the other doctor - poaching patients. I will ring her & make an appointment for you at her clinic.
    Somboon rings Vachiraporn & she is at Ram now & if you wait she says she will see you now.
    OK I'm happy to wait & get it all sorted.

    The 2 doctors & I get together for a joint consultation.

    Vachiraporn takes a close look & agrees with Somboon that there is NO need for surgery & skin grafts on the big lesion - Bowen's disease.

    Bowen's disease:
    Bowen's disease is a very early form of skin cancer, which is easily curable. The main sign is a red, scaly patch on the skin.
    The abnormal growth takes place in the squamous cells – the outermost layer of skin – and Bowen's disease is sometimes referred to as "squamous cell carcinoma in situ".
    Sometimes, the cancerous cells spread along the skin's surface, but it is usually very slow-growing and may not change for years.
    Only occasionally (in 3-5% of patients) does Bowen's disease invade the deeper layers of skin and turn into a more serious type of skin cancer. However, this is only a risk if it's left undiagnosed or neglected.

    The other 2 spots, yes we need to cut them out.
    Somboon says Vachiraporn can do the surgery but she then defers to Somboon & says no, you are# 1 you can do it. I will look after the Bowen's disease & you (Somboon) do the surgery.
    So now all good news as far as I'm concerned.
    Next week I'm under the knife for a couple of hours.

    Somboon is a gem of a doctor. Very similar to Dr Sudhee. He takes his time with his patient, explains exactly what is going on & what all the options are.
    Vachiraporn too, took great care to examine & explain clearly what is going on.

    So I'm highly impressed & very happy with what is going on.

    I post this because I know there are a few guys going to Ram hospital for skin cancer treatments & it's good to know who the best doctors are.
    Fortunately for me I got the inside line on who were the top guys there.
    Dr Vachiraporn for dermatology.
    Dr Somboon for plastic surgery.

    Highly recommended. Consult with them if you need skin cancer treatment.

    You all take care out there.
  2. What type of surgery do they have planned? I had something similar and the dermatologist froze the areas [ Cryotherapy ]. My friend just had a similar treatment. What I had frozen wasn't near as large as the red area on you but it definitely worked for me on smaller places. Just a suggestion.
    Good luck.
  3. Thanks for the response. Yes I understand that the cryotherapy maybe one of the options for some of the Bowen's disease lesions.
    BTW the other two chunks to be cut out are basal cell carcinomas & need removing properly.
    Whatever I now have faith in the 2 good doctors (Somboon & Vachiraporn) I've consulted, as opposed to the first two guys.

    Researching I found this site
  4. Good luck David. I had Mohs surgery five years ago. Done under local anesthetic in a day surgery in Sydney.
    They had three "goes" at cutting the cancer, then testing to see if they had got it all in their on site lab. Finally got the all clear after a few hours. They took out quite a "chunk" as per the attached pics but due to the skill of the surgeon, there is absolutely no scarring at all. Don't put it off guys, get checked every year.

    (Not sure why but I cant upload the to pics. Any suggestions?)
  5. Useful information, Thanks and Good Luck!
  6. David this may or may not help - expats can be oddly parochial! My fussy KL based mate had his successfully treated in a KL hospital Prince Court. He's said good treatment and not expensive. Gladly put you in contact if you are interested. In any event good luck with it.
  7. Good luck with the treatment David, hope you can avoid the dreadful Chemo........rgds, FR
  8. Hope it goes well!
  9. As you know David, I've already had a couple of lesions cut out by Dr Vachiraporn and will very likely have more in the future. Her needlework is excellent.
  10. And our parents used to yell at us to go outside and play during those long summer holidays, before anyone had heard of sunscreen.
  11. Hi David, They did biopsies on all the suspected areas? That needs to be done just in case, usually squamous cell cancer needs to be cut out once it gets to that stage. It does sound like you are on track with doctor's now though. I had a spot looked at by a dermatologist at Bumrungrad and he just froze it but it never healed right so I went to another doctor at Khon Kaen Ram Hospital a year later and it was a squamous cell that needed cutting out, maybe if I had it cut out when I first noticed it they wouldn't have to had gone so deep. I have had a few other spots done over the years and I'm sure I will have more but that just goes to show you diagnosis will vary from doctor to doctor, in the USA I had one area that was treated by 5 different doctors before the last one finally cut out a golf ball sized divet with MOHS surgery. Skin check ups are mandatory for me now. It's the price we pay for many years of living in the tropics I guess. Good Luck!
  12. Thanks for all the input guys - much appreciated.

    I'm confident with the doctors I'm finally dealing with; & it's no real big deal I guess as millions of people have had this problem to sort out - it's nothing new.

    But yeah sunblock is a must all the time now the doc says.

    I often use it, but not all the time & one of the problems I have found many times is late afternoon riding into the sun, or riding at a slow pace entering a town is getting hot in the helmet, sweating & then the sweat running down my forehead to sting - burn my eyes; such that I have to stop, take off the helmet & wipe off the sweat & sunblock.
  13. A speedy one night in hospital


    and back in business.

    I would like to say though that I thought the bill was a bit of a surprise: 100,809 baht = I think the hospital is taking the mickey out of the insurance companies. The good doctor's fee was a mere 50,000 baht!

    So a bit of a reminder - if you're riding around uninsured get yourself insured as you never know when you're going to need it it & believe me health care costs in the hospitals here are sky rocketing IMHO.

    The GTR Group health insurance policy covers you for general health - medical, motorcycle accidents & SOS evacuation from overseas (outside Thailand) & brings you back to base in Chiang Mai / your home in Thailand.

    If you're riding around uninsured, please do yourself & family a favour - get insured.
    The GTR group health insurance does not require a medical examination, you simply fill out the form with a medical statement & your covered.
    Get in before 60 & you can stay covered until at least 65, subject to review.
    If that does not work, then there is an option for private health insurance with the Wealthy Healthy policy up until 80 years of age.
    Check it out to protect yourself.

    Cheers one & all. Keep riding & enjoying life here.
  14. Over the years have had about 10 basals surg. removed,some needing plastic surgeon. Usual cost 5-7000 baht. Biopsy done before and after to make sure removed area is clear. Health ins. covered, Thai Health group ins. about 14,000 baht yr.
  15. Thanks for the feed back.
    That seems like a steal. Where was it, what hospital? Was it outpatient only, or inpatient?
    I was offered a choice - local anaesthetic outpatient or "the works" .. so I wimped out because they were working on my head, & took the full anaesthetic & a night in hospital.
  16. At Inter-medical hospital in Phitsanulok, Dr. Somsak. Go in morning,local anest. 5 on face, 1 in ear,required skin graft,cpl on leg,cpl on arm Out about 2 hrs later,all not done same day,over 5-6 yrs,stiches out 7 days later.
  17. I was treated in Isan (Sakon Nakhon) for chronic sinus infection (sinusitis) by regular doctor for over 3 months. He was very friendly, respectful and caring. Then he told me, that he knows some specialist who is specializing in sinusitis. And he wanted I start visiting him. First visit he didn't even bother asking me anything, like about symptoms, how it went since last appointment with other doctor etc. I had to ask him 3 times!!! if one of the symptoms is related to this illness. Because he wasn't answering me. He was just ignoring me. It was first and last visit.

    Asians are polite and respects authorities. So some doctors here doesn't bother to speak with you, listening to your opinion or consulting what will follow.

    In my case I should sit quiet and not ask him any questions (being respectful to authority). In your case they didn't bother to making appointment with plastic surgeon. Because they, gods, decided what will happen to you. And you should politely accept your faith without asking questing. At least Asians would do it.
  18. YES, you are very right David! In Thailand MDs are no better nor worse than anywhere abroad, they are just humans. Hospital equipment are usually good and prices are affordable, so choosing the right doctor becomes a crucial (maybe lifesaving) choice. Getting advices from friends that you trust is great, and having names in advance helps in emergency situations.

    Your hint to look for a Suan Dok ajarn, with a private clinic, is a very good starting point. I had a similarly positive experience for my hip operation and I think that doctors who dedicate their life to teaching and, in addition, spend their evenings to heal people, are really motivated to help.

    Another good experience was my visit to your “friend” Dr.Sudhee and, finally, I am happy that I had already chosen, two years ago, Dr Md Vachiraporn, for a couple of minor interventions (Cryosurgery).

    At least for northern Thailand residents or visitors, these information are really useful. Thank you for sharing them.
  19. Bump for Ron Webb asking

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