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Topic Title: Overtreatment of skin cancers
Topic Summary: With under qualified personnel
Created On: 11/21/2017 11:35 AM
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 11/21/2017 11:35 AM
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ww

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Physician's assistants and such assessing possible skin cancers and doing biopsies.  Lots and lots of surgeries.  What could go wrong?    For those with access, NY Times.  

My dermatologist does things quickly, lousy bedside manner, but he got into an elite college that I plainly couldn't have and he's been freezing bad spots on my forehead for years.  Nothing bad since a basal cell meant having a messed-up tip of my nose.  

 11/21/2017 12:29 PM
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Central Floridave

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good article, thanks for the link. I see a PA and it is like a herding cattle. When squamous cell was found then the doctor came in and removed it. However, mostly all PA. Burn the spots off with liq-nitrogen.

from article:

Ms. Rought said it was not unusual for a skin check to lead her to to freeze as many as 30 precancerous lesions called actinic keratoses on a patient during a single visit. Actinic keratoses are called precancerous because they can sometimes turn into squamous cell carcinoma. Ms. Rought said her "rule of thumb" was that 20 percent of actinic keratoses progress to cancer.

While that might once have been the popular understanding, research now suggests otherwise. Dr. Martin A. Weinstock, a professor of dermatology and epidemiology at Brown University, reported in a 2009 study of men with a history of two or more skin cancers that were not melanomas that the risk of an actinic keratosis progressing to skin cancer was about 1 percent after a year, and 4 percent after four years. More than 50 percent of the lesions went away on their own.

Dr. Lim said the dermatology academy's position is that actinic keratoses should be treated, as it is impossible to know which ones will turn into cancer, but some specialists are questioning whether that's necessary.
 11/21/2017 01:04 PM
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bus

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mixed on wether there is too much treatment. 

While in the Sunshine State. I had a few Basal and Squamous cells removed, several AKs frozen and some left. 

Just had, this past summer a quarter-sized around(about 1/4'' deep) squamous removed. And today started a chemo cream for yet another Basal cell. Both of these being AKs that I left untreated.

On the otrher hand the dermotologist that I visited in FL where quick to draw that nitro gun. Sometimes leaving me a stand-in for a surfers of meth photo shoot. 

My dr up here seems more pragmatic in her approach. Then again, I didnt show up to my appts after a daylong summer session without sunblock.

No melanoma yet.  

 

 

 11/22/2017 05:59 AM
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Cole

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I've had them burn off scars thinking they were something else, but other than that, they have been pretty good.

I'm not too sure how I feel about biopsies. Taking part of something opens a wound and the wound opens a route into the bloodstream. If you are going to mess with it, take it all.

-------------------------
Dave doesn't like me.
 11/22/2017 07:46 AM
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RegularJoe

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Had all my exams, 2 basal cell removals, and numerous spots frozen off, all by the PA.

I've never seen the derm MD in about 15 years of visits, other than a complimentary "aesthetic consult" about the sun damage on my face.

Originally posted by: Cole
I'm not too sure how I feel about biopsies. Taking part of something opens a wound and the wound opens a route into the bloodstream. If you are going to mess with it, take it all.


I worry about that as well. After the biopsy on my mom's brain tumor, one doctor described to me a phenomenon known as "wounded tumor syndrome" but it was more in the context of brain hemorrhaging than metastasis of the tumor. I guess if you have a bad tumor in your brain, having is metastasize to other parts of your body is the least of your worries.

For breast cancer, the technique had gone from local lumpectomy to total radical mastectomy, severely disfiguring patients in the process of "making sure they got it all." But they eventually discovered that by the time those were detected, most had already metastasized anyway, so they were still missing parts, and doing unnecessary damage.

For skin cancer, it is most often localized, and depending on the body part, not super complicated to remove (especially if a PA can do it with an electrocautery tool, implying non-Mohs).

As such, it should also be cheap enough for insurers to cover (or patients to pay out of pocket, if considered elective). Take the whole damn thing out, biopsy that, and if the margins still don't look good, or it was identified as melanoma, then order a PET scan for the rest of your body.

But leave it to patient choice, fully informed... Most patients would not choose to be overtreated surgically.



 11/22/2017 04:53 PM
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ww

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My dermatologist, Neil Heskel, freezes my actinic keratoses as they show up.  They're tiny and mostly on the left forehead.  As a practical matter, it's nice not to have them.  

 11/22/2017 05:26 PM
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dingpatch

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Now, with the VA, I see the Doc and the PA every 6 months; it has been long enough since my melanoma that they say I no longer need a skin check every 3 months. OK by me.
Previously, at the Health First doc, I did occasionally see the MD, but otherwise my main "treater" was his PA. She was very attentive and was otherwise very good at what she did. Her father had been a skin cancer dermatologist and he had trained her well. Out of the many, many, biopsies she did on me only 2 or 3 came back as not cancerous. Better safe, than sorry.

As the MD told me the first time I went to him many years ago: "Dingpatch, Florida surfers need to be very, very, careful with having had so much exposure, and burning from the sun. You MUST be aware of any changes you might see. At even being detected a couple of weeks too late, Melanoma can be a Death Sentence."
 01/17/2019 01:07 PM
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ww

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I saw the dermatologist once about a small cyst or boil or whatever on the left ear lobe. He thought it non-cancerous. Then it ruptured and wouldn't stop oozing. I was patient. After a routine visit to the internist, who didn't like it, back to dermatologist. He wasn't excited and didn't think a biopsy was essential, but that it would be a good idea. And I should work harder at applying medication, bandages, and take an antibiotic. Biopsy back, squamous cell carcinoma. That's not a real big deal. Will be treated. This, like much of skin cancer, seems to be largely a problem for older people. My only other skin cancer was back around 2001, a basal cell. Lots of actinic keratoses frozen off since.
 01/31/2019 04:03 AM
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ww

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Went to the dermatologist at 8:10. Left about 11 with most of the ear lobe gone and a big bandage. Returned to the office at 1 pm for stitches (no-stitch healing would have taken longer; going to a plastic surgeon could look better, but there isn't much on the ear to assemble a new ear lobe from. Maybe trim the other one? I dunno. I might be able to get my ear wet on Feb. 11.
 01/31/2019 06:28 AM
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Central Floridave

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just got back from donating skin this morning. Actually just burned a couple spots. When in doubt cut it out.

Sorry WW!
 01/31/2019 07:23 AM
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SurferMic

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got melanoma spotted and removed early...1 little cell in the inside of my ear looked like a freckle, Dr. got it before it set root, Hooray!!! I am still on this earth chasing waves (thx Dr. Bishop). It was in a spot you would have to push sunscreen into your ear canal to protect....Good advice from my last Dermo visit...it was recommended to document through pictures all body spots EVERY month. They need a record of growth rate, shape change, etc.... I recommend everyone do this (just keep them to yourself please). Long term photo documentation is so easy now with cams on every phone.
 01/31/2019 03:35 PM
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ww

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Oddly, my last regular dermatologist visit was the first in a long time with no spots frozen. I'm pretty happy to have had only one basal and one squamous, so far. A grandmother's family came from around Vaasa, Finland.
 03/01/2019 01:49 PM
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surfthecoochie

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My Girlfriend had Basil cell carcinoma (sorry spelling) on her eye lid 9 years. She could not get insurance unless she became homeless and paid for Obama no-care. She finally got it removed by a doctor in Miami. Afterwords, it spread like wildfire. She got like a months notice when it hit her lungs and liver and then died last sept. I think she would still be alive if she had never had it removed from her eye lid in the first place. The government was still fighting against her disability up till the day she died.

Edited: 03/01/2019 at 01:52 PM by surfthecoochie
 03/04/2019 01:28 AM
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ww

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    Very sorry to hear that. I lost a chunk of nose to basal cell carcinoma about 17 years ago; no further problem.
    A neighbor recently found out he has a weird squamous cell carcinoma that started in the neck and has spread a bit. The main problem is that the cancerous mass has grown fairly big and if left alone would eventually choke him. The cure is a combination of simultaneous chemo and radiation. The docs promise that he'll be sick but cured. And it's an unusual case.
    My dermatologist in Vero encourages people to come in, insurance or not.


Edited: 03/21/2019 at 12:34 AM by ww
 03/17/2019 05:47 PM
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JBSURF

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Been here done this...

http://www.oneanswertocancermo.../bill_oleary_story.htm

-------------------------
I've decided to accept the fact - I'll always be a big kid!
 03/18/2019 05:26 AM
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RiddleMe

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listed on every quack site. supported by no science. might get lucky with something superficial or might be your death. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132006/
 03/18/2019 02:01 PM
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RustyTruck

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Clickable:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132006/


Get your skin check and follow your doctor's advice.

-------------------------
…for beauty is nothing
but the beginning of terror,
which we can just barely endure,
and we stand in awe of it as it coolly disdains to destroy us. Every angel is terrifying.

Edited: 03/18/2019 at 02:10 PM by RustyTruck
 03/18/2019 02:28 PM
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JBSURF

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Ever hear of a cure to any big issue or disease not getting ridiculed, shut down or silenced? Figured... so many protocols that stop, reverse and eliminate cancer aren`t AMA excepted so you have to cross the border to get them,,, scare tactics work on so many... I`ve used this and shared it, works only on abnormal tissue, not normal, so none of your healthy skin gets removed, just the bad...

Dr. Mohs used black salve in the early 1930`s to help him find the cancer and since he was a surgeon he chose to cut it out, after it was apparent... hence began his procedure.

I`ve had friends that did have melanoma surgically removed and later asked me if I had any of that black salve stuff, they thought that the spot seemed to be indicating maybe they didnt get it all and wanted to try this,,, the surgically removed spot lite up and reacted, meaning they Hadn`t gotten it all and pretty much was a death sentence leaving just one pissed off cell behind,,, the salve reacted, expelled the cancer and healed up very nicely...

Also have done the same with a co-worker that had spots frozen, twice and were told just don`t go in the sun you`ll be fine. They also thought something maybe growing there, and they were correct, one application and a substantial reaction to a spot previously frozen, quite a large growth under the skin was killed and eliminated from their face, also healed nicely.

The Quack scare posts are Gnarly and make one think, but I was turned on to this stuff before internet and proven many many times to work without issue, those quack posts kinda freaked me too when I`d first seen them... I`m proof positive that it works and well, I`ve done spots on my lip, arms, ears, back, legs... I get them when they`re small and if nothing is abnormal, nothing happens... Good luck in your choice, I`ve mentioned just 2 people that went the Doctor route and, well, you read what happened. Just sayin`

I did have another co-worker that also had melanoma removed from the back of his leg too, they didnt get it all and it metastasized and spread threw out his body and they killed him, he`s gone and should still be here with us...



-------------------------
I've decided to accept the fact - I'll always be a big kid!

Edited: 03/18/2019 at 02:35 PM by JBSURF
 03/19/2019 05:06 AM
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RiddleMe

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037693/
high cure rates achieved by Mohs technique are attributable to the complete histological assessment of excision margins and not the anticancer action of S. canadensis
Bloodroot harvested from separate geographic locations can exhibit significant alkaloid profile variation with individual rhizomes having an up to 15-fold difference in sanguinarine concentration
A pilot progressive cohort study of 149 patients, treated with the Hoxsey cancer treatment at the Tijuana Bio-Medical clinic, was conducted in 1992. Only 43.6% of records contained pathology reports with the 5 year vital status only assessable for 57% of patients. At 5 years, 11.4% of patients were alive, 45.6% had died and the outcome of 42.9% of patients was unknown
Indiscriminate cytotoxicity is of concern relating to black salve use.
One in vitro study has suggested sanguinarine has a concentration dependent therapeutic window with a 2 ?M concentration showing preferential cytotoxicity to the A431 squamous cancer cell line compared to normal keratinocytes, this discriminating ability being lost at a 5 µM concentration [285]. Other studies however have not supported this finding, with sanguinarine having equivalent cytotoxicity between tumor and normal cell lines [24] or actually having a greater cytotoxic effect on skin fibroblasts than the same A431 cell line [155]. Even if a sanguinarine therapeutic window exists, it is doubtful that natural therapies derived directly from S. canadensis rhizomes with their variable alkaloid composition would be able to target such a narrow pharmacological sweet spot.
concentrations of key cytotoxic ingredient variable from one source location to the next. no regulation or guarantee of concentration from one formula to the next. some home remedies even lacking the key ingredient all together. failed to cure cancer in slightly less than half, at least, of the cohorts in an observational study, resulting in their death. proven in multiple studies to not be discriminate to cancer cells, resulting in similar cytotoxicity between cancerous and healthy cells. total vodoo medicine and a crap shoot. use at own risk, all i got to say. personally, i would side with this not being a global coverup and smear campaign conspiracy by big pharma, the evidence from multiple sources globally speak for themselves. glad you got lucky jbman, but not a risk i would take with my life or someone i loved

Edited: 03/19/2019 at 05:12 AM by RiddleMe
 03/19/2019 05:20 AM
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RiddleMe

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sorry if it looks like i am picking on you jbman. just as a former medical professional and someone who had skin cancer and a spouse that has had it, this is a hot topic issue for me
FORUMS : NPNR : Overtreatment of skin cancers

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