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Diagnosed Squamous Cell Carcinoma

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I returned to Thailand 10 days ago on my 2nd METV in 12 months. Just before leaving the US I was diagnosed with a squamous cell carcinoma on my back midway between the top of my shoulder and my shoulder blade. I can see it only in profile in the mirror. This experience unfolded like this -
My version - I got stung by a bee about 2 months ago and look at this big red itchy bump. Is that stem in the middle the stinger? I think so. When you squeeze it you get a clear liquid almost like a blister.

Their version - Hmm, could it be a skin cancer? Let's cut out the middle and find out. Yes, a skin cancer. A stinger? Ahh lemme look again - oh yeah - it had a stinger in it. Lucky for you that bee stung you right in the middle of your skin cancer. Otherwise you might not have known you had it. (Openly discounting the original experience is a big issue for me)


When in Thailand I have been favoring Mission Hospital in Bangkok. I believe they are generally competent and not openly gouging in their billing practices.The dermatologist there made an audible reaction when first revealed to her. "OH!" Then in short order agreeing with pathology. Followed by an attempt at discussion that started off well. She explained that the first page of pathology was speculative for 3 problems, this cancer? that cancer? or bee sting? 2nd page - conclusion - this cancer. Also ignoring the fact that there is a stinger in the biopsy - NOT speculative. Surgery discussion was NOTHING like what one might hope for in a gradual shaving technique. (as I expected) "The surgeon will have to do it. It is too big for me. It is 3 CM and he will take 3 CM around it as well. Will likely skin graft to close it."


So, what do I want from this forum? Perhaps some other recommendation for a specialist. That 3 CM margin of safety and skin grafting is putting me off a much as anything. Perhaps it is apparent that I am having difficulty letting go of the "bee sting factor". I am not entirely convinced that it is cancer. Seeing the doc at Mission was an attempt at a 2nd opinion. I got one but it seemed to just immediately jump to that conclusion. My Thai GF believes that it is shrinking since I arrived. She measured it at 2 CM. I attach a photo. The scab in the center is from the 6 mm punch biopsy performed 5 weeks ago and it was closed with 3 sutures. 


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If you want the most definitive dermatological advice to be had in Thailand see Dr. Anna at Bangkok Pattaya Hospital. Skin cancer is her specialty https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=7&depid=2


But this issue really boils down to the pathologist not the dermatologist. No dermatologist is going to tell you it is not cancer when the path report says it is.  And repeating the path exam, even if it is negative now will not rule it out since much of the lesion was already removed for the biopsy.  You would have to get the actual slides for re-examination and frankly no pathologist in Thailand is as expert as ones in the US for skin cancer. Thought Dr. Anna apparently has one she trusts.


What you can get from a dermatologist like Dr. Anna is a discussion about the extent of excision needed based on the path report.


A normal bee sting will not cause a lesion lasting 2 months. Nor would that lesion, once excised, show malignant cells.


It does not sound to me like the US doctors discounted your original experience. They just did not think it altered the pathology findings, and it doesn't. The presence of a stinger in the sample just means you were stung, it does not change the fact that the cells were malignant. Malignant cells have a totally different morphology than non-malignant ones.





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