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Don't forget the sunblock.

Chuck

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I mentioned earlier that I'd been diagnosed with a spot or two of skin cancer. I wouldn't normally post anything about my health issues, but since this is something that us cyclists need to be concerned about, thought I'd pass along what I've learned in case it might help someone here.

1. It doesn't seem Japanese doctors are well versed in skin conditions of people with white skin. My local dermatologist said it was just a blemish. When I returned a month later since it hadn't healed, he again said it was just a blemish. That diagnosis delayed my treatment for months. Lesson learned.

2. There is a procedure for treating skin cancer called the 'Mohs' procedure. This is where they remove the cancer and an extra 2mm of skin around it. They then test the skin taken, and if they got it all, it's job done. If not, they take a bit more till the tests show no more cancer cells. It is 99% effective with no recurrence and takes the least possible amount of healthy tissue. Unfortunately, in Japan's medical establishment, such a procedure is not available. The reasons for this are astounding, but I won't go into it. Just know that if you have white skin no Japanese doctor within the medical system will provide the Mohs procedure and it is not covered under the Japanese health system. (FYI, It is standard of care in the US and is covered by their health system.)

3. What is the standard of care offered by my hospital? The doctors at the major hospital I go to, intended to remove a 10-14mm diameter patch of skin from my nose and fill the wound with some kind of coagulant that they told me would eventually disappear. Skin graft was not an option. State-of-the-art medicine in Japan seems to be 'the shotgun approach' where they remove lots of healthy skin IOT to be sure they get all the cancer. They seemed unconcerned with leaving me with a large, weird looking scar on my nose. They were unfamiliar with the Mohs procedure and also unconcerned with my concern about having such a scar. Literally, no skin off their noses.

4. Did research online and found one doctor who does the Mohs procedure and that's where I'll be having my surgery done. Not covered by insurance and is quite expensive. OUCH! (Could have bought a couple really nice bikes. Nuts!!) He told me that he gets people from Misawa air base referred to him. Seems he's one of the only people in Japan that can deal with white skinned people.

Bottom line, best thing is not to get skin cancer, so use that sunblock! But if you have white skin and you are covered by Japanese health insurance, you will be given no option but to either go with the 'shotgun approach' and the resulting disfigurement, or pay out of pocket and go to someone who knows the Mohs procedure.

Looks like my case is going to be OK, so no need for anyone to be concerned for me. Just posting this in case anyone else can benefit from knowing what I wish I'd known months ago. I'll update this after my surgery in late August in case anyone is interested to know how it went.
 

jdd

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Synchronicity, I just watched this:


I had a couple moles taken off one arm, the bigger one tested positive. Went a skin doc/clinic first, was referred to local daigaku byoin for the excision--and it was covered as usual. It would never really heal up, even had to be careful with toweling off after a shower.

Mentioned before, I wear long sleeves exclusively (it's cooler), and a cap or other cover under your helmet blocks UV coming thru the slots. And go out early.
 

luka

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thanks for sharing. very informative for sure, although one can only hope the info won't be applicable to oneself... I have pretty decent young dermatologist I've been seeing for some other minor issues, and will ask him to run a full body check or something just to be sure
 

Chuck

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@jdd Good video from GCN.

@luka I've been put off of relying on Japanese dermatologists, but YMMV. While researching my case, it seems standard practice for US dermatologists to do a full body check, especially if a cancerous lesion has been found. I mentioned this to the docs at my hospital and they dismissed the idea out of hand. The hospital is St. Mariana. I won't be going back.
 

luka

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yeah my experience with doctors here, fortunately pretty limited, is kinda the same. mostly waste of time. but this guy was somewhat different: efficient, culturally sensitive, professional. the issues I had were minor and esthetic, so nothing big. it remains to be seen how will he perform if I throw the curve-ball of full body check at him. worst case scenario, I take it somewhere else I guess...
 

kiwisimon

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what do bad moles look like?
I went to the doc in NZ everytime I go home and he just says normal moles nothing to worry about.
Haven't been home for a few years now.
 

luka

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I see this comment under the above GCN video, and already sense that treatment he describes won't be readily available here...

Arnie Peterschmidt
Arnie Peterschmidt 1 day ago

I am a senior life long cyclist and I just returned from the dermatologist's office a half hour ago where I had about a dozen pre-cancerous spots frozen off my skin with a jet of liquid nitrogen. I have to go through this twice each year because of sun damage from a history of not protecting myself from the sun. I have been lucky so far and have not developed a cancer needing specialized and invasive treatment thanks to my dedicated dermatologist. Protect yourself now so that you don't have regrets later.
 

jdd

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Not sure if it was liquid nitro or not, but in one or two of the followups after getting the ones cut off my arm I asked about another couple spots--one on my scalp (top rear, that I could only feel), another on my forehead in plain sight. The doc said both were no worry but then asked if I wanted them treated, I said yes, and he went and got some of the cold stuff and used a long Q-tip like stick to dip in the liquid and then sizzle them a little. These were rechecked at the next followup. Again, covered normally by insurance. (not a doc, but I'm not sure how "a jet of liquid nitrogen" would work)

A local skin doc also had the super cold liquid, used it to 'burn' off corns (魚の目).
 

Chuck

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Catch it early and you have more options. Catch it late you will likely need some surgery.

When I asked my docs as St. Mariana why this procedure wasn't available here, I was told it is because it is only needed for "hakujin" and is therefore rare. I was told that Japanese people's lesions are well defined so they can easily discern where the boundary of the cancer is. When I said that, even if the procedure is rare, as a 'hakujin,' my only option is to accept a disfiguring surgery, their response was, 'Them's the breaks.'

The guy I'm going to trained in Boston and when I asked him why the Mohs procedure isn't available here, he kind on went off on the Japanese medical establishment. He said that Japanese people do get lesions that are not well defined and would benefit by having a procedure that is less destructive of healthy tissue. He, in fact, treats many Japanese with this condition. He also said the established OBs of the medical community prefer only procedures developed in Japan and stifle new techniques, regardless of how beneficial they may be.

Has me rethinking the value of my Japanese health insurance and my willingness to submit myself to a system that seems far behind the times. YMMV.
 

Half-Fast Mike

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May 22, 2007
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a system that seems far behind the times
Always has been. JMA are the most conservative and protectionist bunch you can imagine. For decades they resisted public deployment and use of AEDs, and would only allow ambulance crews to use them if in live contact with an M.D. It was only after the then-emperor's cousin, Prince Takamado, died of VF during a squash lesson at the Canadian Embassy in 2002 that they started to loosen their grip on that particular thread. But there remain many, many treatments considered routine best-practice in other countries that are not approved in Japan - either because they weren't invented here or because there are no confirmed trials on Japanese people (who, as we all know, have special long intestines, etc.)

Hard luck, @Chuck. At least we can afford to go private. Not ideal, but a choice.
 

jdd

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I know someone here, a sometimes riding buddy, who is in remission due to a new treatment. Sorry I don(t know what it is, but it's new and has been super effective on what he has/had. Quandary is that they don't know what will happen if they stop the treatment--so instead have reduced its frequency to every other or every third month.

Tho it took a while, I think the treatment for my broken pelvis (and the acetabular fracture, the bad part of it--and the artificial hip) was as good as it gets. No, not 100% of what I was, but more than I expected. Separately, I have a new aortic valve (pig?) which seems to be working fine. Also the lung thing, they took out my upper right lobe (losing ~20% of capacity :( ) and it did test positive, staged as 1a, same thing as would have been done in the states.

So I'm out on a bike a lot these days, and not a cripple and/or dead. I couldn't be more satisfied with the docs.

edit: this is just another data point. Good things can happen, as can bad. It's not all black and white.
 
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Chuck

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I had good luck with a specialist who worked on my knee. But I've had increasingly bad experiences with the attitude of the docs at St. Mariana. Perhaps once docs get in a large bureaucratic organization headed by older men who are possibly set in their ways and inflexible (plus used to being obeyed), the impetus to keep learning and stay abreast of state of the art methods is lost. I don't really know. And, of course, your (@jdd ) experience shows that the system can be good. As for me, from now on if I think the docs aren't on top of things, I will be much more likely to get a second opinion or just walk. Anyway, I'm done with St. Mariana. Again, YMMV.
 

Nuff

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For anyone who don't like to reapply sunscreen I've found that there's only one sunscreen here that lasts all day (tested up to 8 hours so far) it's water resistant too. Downside it's expensive, but a little goes long way and it's a PITA to remove it after the ride, which is also it's strong point.

Amazon product

They sell it at Y's road or most outdoor stores. Since I only get to ride during peak UV times.

Few other things to watch out for and things that I forget, lips and ears. Lips have no melatonin so they get blasted pretty hard.

I also have a long sleeve summer jersey, but if the temps get higher than 32-35C I need short sleeves.
 

Chuck

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If someone wants to develop a UV face protector that has cutouts for nostrils and mouth, I'll buy the first run of your product. The ones I have that cover my nose and mouth become unbreathable when wet. Maybe a good new business?
They sell it at Y's road or most outdoor stores. Since I only get to ride during peak UV times.
I see it is also sold on Amazon.
 

TheAussieinJapan

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@Chuck thamks for sharing this with everyone, it’s a topic I don’t think we talk about enough in Japan, or have any sun safety messages.

I also have a similar story, was diagnosed with melanoma, one of the most aggressive and dangerous skin cancers but luckily caught kind of early. I’d ignored a changing mole even though I knew better as an Australian. It was on my shoulder blade and since I rarely take off my shirt in Japan outdoors, I ignored it as wrongly thought not being sunburnt meant it wouldn’t be linked to cancer. My mother and wife got through to me, went and got it checked.

First doctor told me to not worry about it, but it had all the signs of being skin cancer according to the picture @luka posted. Another doctor looked at it, and had it cut out. Felt like it was being sawed out, they took a massive circle and depth around the mole. This was at Ochanomizu University Hospital dermatologist. Similar to Chuck’s experience, doctors had to consult quite a few other doctors and took a while to come back with diagnosis. Was given a 85-90% survival chance over 5 years (so a 10-15% chance of not surviving?? If it spread and worsened etc).
Scared the hell out of me.

Had to get PET scans, CT scans every 6 months, monthly check ups for 5 years. This was because the cancer cells had reached 1.1mm depth, just deep enough to be a more dangerous level. So go early folks, if I’d gone the few weeks earlier maybe it’d have been less than 1mm not needing as much follow up.

Anyway I’m all clear, but I dont go anywhere without SPF 30-50 Banana Boat from iHerb https://iherb.co/p8iTZQJ UV arm covers, and try to reduce skin damage. Doctors said that the damage was done in the years before, probably from childhood onwards in Australia.


Summer is here, going to get hotter and more UV so slip slop slap as we used to say in Australia.
 
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Chuck

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@TheAussieinJapan I'm a bit surprised to hear that the docs gave you a 10 to 15% chance of "being dead." What I'm told, by using the Mohs procedure there is a 99% success rate. Guess I'll know soon enough. Will talk to my doc about this protocol for follow up, but at this point, have not been told about any need for frequent PET or CT scans. Thanks for the info. At least now I know enough to ask about it.
 
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