Mohs Surgery for Skin cancer on nose

[phuketorigins]

Last week I did a biopsy on a spot on my nose and it came back as basal cell carcinoma. Does anyone know of a good Doctor Who performs Mohs surgery? Or who is the best person to perform surgery on this spot on my face. I’m afraid it will be disfiguring or they won’t get all the cancer if the person performing the surgery is not top-notch. Thanks in advance for any assistance.

 

 

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[timendres]

I had my basal cell removed by surgery by an extraordinary plastic surgeon at Samitivej Sukhumvit 49. I do not know if they do Mohs, but I would think they do, and I highly recommend Samitivej.

[madmen]

I had the same and opted for cancer cream. Took 6 months but nailed it without surgery

[steveb0711]

My partner had the same cancer near the lip. make sure you get a minimum of two opinions from surgeons. The first surgeon we went to said he needed to take a huge "margin" which would have resulted in a disfigured face. 

 

The next surgeon we visited got all the cancer and a small margin (which was enough). You can hardly even see the scar. 

[phuketorigins]

I had the same and opted for cancer cream. Took 6 months but nailed it without surgery

Wow that sounds like a great option. This spot is relatively small. Do you know the name of the medicine that was in the cream?


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[phuketorigins]

My partner had the same cancer near the lip. make sure you get a minimum of two opinions from surgeons. The first surgeon we went to said he needed to take a huge "margin" which would have resulted in a disfigured face. 
 
The next surgeon we visited got all the cancer and a small margin (which was enough). You can hardly even see the scar. 

Yes I am really leery of surgeons because they like to cut and raise the bill


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[timendres]

1 minute ago, phuketorigins said:

Yes I am really leery of surgeons because they like to cut and raise the bill

My surgeon had to remove a subcutaneous tumor the size of a small fish cake (2+ cm diameter, 5mm thick). When I awoke the from the surgery, I did not even need a Tylenol, as there was no pain (clean cutting). A skin graft was required. This was a serious amount of removal. Three months later, I had to point directly at it for people to even see it, and all they saw was a slight difference in skin color. An extraordinary surgeon. He has also removed moles from my face with perfect results.

 

That said, if it is truly small, the cream may work, and should be tried first (imo). Mohs is also a good choice. But I can say that my surgeon was able to perform extreme surgeries with near perfect results that are utterly unnoticeable.

[phuketorigins]

My surgeon had to remove a subcutaneous tumor the size of a small fish cake (2+ cm diameter, 5mm thick). When I awoke the from the surgery, I did not even need a Tylenol, as there was no pain (clean cutting). A skin graft was required. This was a serious amount of removal. Three months later, I had to point directly at it for people to even see it, and all they saw was a slight difference in skin color. An extraordinary surgeon. He has also removed moles from my face with perfect results.
 
That said, if it is truly small, the cream may work, and should be tried first (imo). Mohs is also a good choice. But I can say that my surgeon was able to perform extreme surgeries with near perfect results that are utterly unnoticeable.

That’s very encouraging. Thank you for sharing your experience.


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[Sheryl]

Where in Thailand are you?  If In Phuket options are limited, could you travel to Bangkok?

[madmen]

19 hours ago, phuketorigins said:

Wow that sounds like a great option. This spot is relatively small. Do you know the name of the medicine that was in the cream?


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Its called Aldara

[BRUFC]

Is Aldara available over the counter or by prescription only?

[madmen]

17 minutes ago, BRUFC said:

Is Aldara available over the counter or by prescription only?

over the counter and from memory its 250-300 baht for a very small dispenser that should last a week approx. If you go this route make sure you continue to use the cream for a few weeks even after its cleared up because it will come back if not 100% destroyed

I said 6 months but it actually took 9 months and now just a tiny little scar on the side of my nose, can barely see it

[BRUFC]

Thanks madmen. I've been prescribed Efudix(Efudex) in the UK several times..did the job great, but biggest local pharmacy here (town, not city) couldn't find it in her book of drugs/ medicines so I was resigned to going to the quack, nice husband and wife team, but probably with less experience of skin cancer (from what I've read on here) than I have myself. I also considered going to the quack and asking for Cryo, but again this forum considers Thai GP's experience as minimal.

[lopburi3]

Aldera has to be carefully applied and is at best a very slow process - but believe currently the best alternative to surgery.  I never had much luck using it but believe it is often used on Oz.

 

The packets are designed to be used one time and if that is done it is extremely costly.  Believe most doctors here advise to use a tiny bit until packet empty but not sure how safe that is at Thailand temps.  You must protect non infected skin and it is a put on/wash off time and may not be every day.  A very complex process for some of us.

 

My last nose BCC was about 15 years ago and general surgeon removed and did not notice any disfigurement but if a younger women might have been more critical.  

[4MyEgo]

21 hours ago, phuketorigins said:

Yes I am really leery of surgeons because they like to cut and raise the bill


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Depends where you are, I had basal cell carcinoma on my cheek removed at a public hospital at Khon Kaen by a plastic surgeon, original scare was 80cm, now 2 years later, you would be lucky to see a 10cm scare.

 

Sheryl on this forum was really helpful tracking down the plastic surgeon and hospital for me, maybe send her a private message if you haven't already had a response from her.

 

My procedure cost 6,000 baht and took about 20 minutes all up.

[madmen]

52 minutes ago, lopburi3 said:

Aldera has to be carefully applied and is at best a very slow process - but believe currently the best alternative to surgery.  I never had much luck using it but believe it is often used on Oz.

 

The packets are designed to be used one time and if that is done it is extremely costly.  Believe most doctors here advise to use a tiny bit until packet empty but not sure how safe that is at Thailand temps.  You must protect non infected skin and it is a put on/wash off time and may not be every day.  A very complex process for some of us.

 

My last nose BCC was about 15 years ago and general surgeon removed and did not notice any disfigurement but if a younger women might have been more critical.  

True takes a long time. The amount used depends on the size of the growth . If its early stages then only need enough to cover which a reall small application

 

cost me 9k for 9 months application

[lopburi3]

5 minutes ago, madmen said:

 

cost me 9k for 9 months application

But if using per instructions it would likely be many, many times that (believe only the packet type is available here).

Quote

If you are using the single-use packets, use a new packet for each dose.

https://www.webmd.com/drugs/2/drug-1207/aldara-topical/details

[daeumtnaot]

My doctor recommended me to have Mohs surgery about 5 years ago.  At that time I wrote to many Thai hospitals and none of them said they do Mohs surgery.  The only choices were Philippines and Singapore, so I ended up going to Philippines.

[TSF]

I was given Fluorouracil, a chemo cream, to use on my arms as I had numerous small lesions, it has cleaned up my arms very nicely with no need for any cutting, however, I wouldn't advise buying it OTC and DIY as it's pretty potent stuff. My skin cancer specialist in Australia gave my specific instructions for usage + a specific time to use and cease. So my recommendation is try it but have a skin cancer specialist monitor the use.

[xylophone]

28 minutes ago, lopburi3 said:

But if using per instructions it would likely be many, many times that (believe only the packet type is available here).

https://www.webmd.com/drugs/2/drug-1207/aldara-topical/details

My surgeon in NZ recommended an alternative methodology for applying Aldara and also in helping keep down the cost.

 

The very small sachets of Aldara can be punctured at the top with a pin and a very small amount eased out onto the edge of a cotton bud, which is then applied carefully to the cancer. This way, the sachet lasts a long time and it should be kept in the fridge until it is all used up.

 

He recommended I used it every day for five days and then stopped for two days before starting the regimen again and to do this for a couple of months although I believe application periods vary depending upon the size and type of cancer, and I believe it works best on superficial cancers rather than deep-rooted ones, where excision might well be the best bet. 

 

Obviously best to get a surgeon's opinion on this, however beware those who may want to make money by performing procedures that are not necessary as happened to me here when a skin specialist recommended excision of a small "spot" on my nose, followed by a small amount of plastic surgery, all at a cost of between 11 and 18,000 baht which I thought was quite extortionate for what I had.

 

So I used Aldara and it worked and have had no recurrence of this at all.

 

PS. I also use Aldara for frequent solar keratosis.

[lopburi3]

17 minutes ago, xylophone said:

excision of a small "spot" on my nose, followed by a small amount of plastic surgery, all at a cost of between 11 and 18,000 baht which I thought was quite extortionate for what I had.

Probably not excessive in my experience of any wide margin plastic surgery being 25 to 30k even on my old arms where quite easy to find enough skin to cover.

[xylophone]

2 minutes ago, lopburi3 said:

Probably not excessive in my experience of any wide margin plastic surgery being 25 to 30k even on my old arms where quite easy to find enough skin to cover.

The small spot was no more than about 1 mm in size and to me the price 10 yrs ago seemed high.......anyway the Aldara did the trick, so all is well!!

[lopburi3]

2 minutes ago, xylophone said:

The small spot was no more than about 1 mm in size and to me the price 10 yrs ago seemed high.......anyway the Aldara did the trick, so all is well!!

Indeed at 1mm not sure I would even be able to see it.  And 10 years ago would likely equate as mine were only about 3-4 years ago.

[TSF]

I should also add when I was put on Fluorouracil treatment, there was a prep period of about 3 weeks when I applied another cream daily to my arms before starting on the Fluorouracil. One more reason not to DIY.

[ericg1953]

If you are willing to go to Bkk for treatment then Dr Niyom at Bumrungrad is a Mohs trained surgeon as well as being an excellent choice for skin issues. I’ve seen him for large mole removal as well as he’s highly thought of on this forum.  

[Denim]

As I write I am lying in bed in our hotel having just returned from Phayathai 2 hospital where  I had a cell carcinoma removed from the side of my nose.

 

It was diagnosed as  carcinoma by my regular dermatologist at the Paolo Kasetsart hospital. He said he could remove it  but that he didn't really want to do it as he thought it would leave a disfiguring scar in a very noticeable place.

 

He recommended a plastic surgeon at the Phayathai hospital as although more expensive the resultant scar would be almost unnoticeable.

 

His charge was going to be around 10,000 baht. The cost of removal at Phayathai by the plastic surgeon wad 37,000 baht. Very expensive.

 

However, it turned out to be a bigger thing than I thought and I was in surgery for an hour. Operating table, two helping nurses

 

Total time from going into theatre and emerging was 2 hours !! 

 

Have to return next Sunday to have stitches removed. Much bigger scar than I thought but doctor said it will not be noticeable after a while.

 

I live in Petchabun and a local fast option was not available. This way only involved 2 nights 8n Bangkok and I killed two birds with one stone and got my desktop fixed too.

 

It is said of Phayaithai hospital that they have excellent doctors but they don't come cheap. I think that is about right. If you are not in a hurry you might f8nd a better deal. As for the scaring I will post again in a months time.

[Sheryl]

What type of carcinoma? Basal cell? Squamous cell? Melanoma?

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[lopburi3]

I seem to recall BCC mentioned but may have been another poster.  As said I also had one removed about 15 years ago and indeed mine was also a lot more than expected and almost had to search elsewhere to obtain enough skin - but were able to stretch to fit.  I did not use a plastic surgeon but never noticed much scar (but not too vain).  Price does sound about right as my last removal from arm (less work) was 30k about 3 years ago.  Plastic surgeons are not cheap.

[phuketorigins]

As I write I am lying in bed in our hotel having just returned from Phayathai 2 hospital where  I had a cell carcinoma removed from the side of my nose.
 
It was diagnosed as  carcinoma by my regular dermatologist at the Paolo Kasetsart hospital. He said he could remove it  but that he didn't really want to do it as he thought it would leave a disfiguring scar in a very noticeable place.
 
He recommended a plastic surgeon at the Phayathai hospital as although more expensive the resultant scar would be almost unnoticeable.
 
His charge was going to be around 10,000 baht. The cost of removal at Phayathai by the plastic surgeon wad 37,000 baht. Very expensive.
 
However, it turned out to be a bigger thing than I thought and I was in surgery for an hour. Operating table, two helping nurses
 
Total time from going into theatre and emerging was 2 hours !! 
 
Have to return next Sunday to have stitches removed. Much bigger scar than I thought but doctor said it will not be noticeable after a while.
 
I live in Petchabun and a local fast option was not available. This way only involved 2 nights 8n Bangkok and I killed two birds with one stone and got my desktop fixed too.
 
It is said of Phayaithai hospital that they have excellent doctors but they don't come cheap. I think that is about right. If you are not in a hurry you might f8nd a better deal. As for the scaring I will post again in a months time.

Thank you so much for that information! I hope it all turns out good


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