Topic: Physician Online Services for Bitcoin: btcdocs (Read 757 times)

Go ahead and cross-post. I didn't want the consult as I knew all of that already, except that there was a punch biopsy (doctor only offered shave or cut). My first two were elliptical excisions, and biopsied benign, which combined with my youth and the appearance of the last one, factored into shaving the last one. It has been years since that one was shaved and I can't tell it was ever there, other than looking at old pictures. I have not been able to learn the results of the shave biopsy as the doctor moved far away and demands an office visit to tell the results (won't even allow a Skype video chat despite having a scan of my driver's license & photo). So effectively, I'll only find out if I go back for another excision, and then the biopsy for the next one will rinse and repeat.

Without going into extreme detail on each remaining one, they are not all perfectly circular, smooth, consistently-colored domes, but some will probably have higher priority than others. Thanks.

Hi TheButterZone!

Thanks very much for submitting the first question to us! Following is sk1nd0c's (a derm specialist) response. Unfortunately sk1nd0c's clinic is not yet able to accept btc re you going to their clinic (we will definitely post if we find any btc-accepting derm clinics).

Would you mind if I cross-posted this on the forum at btcdocs.net ? Any feedback would be appreciated if you have the time (eg if you do go into get some of these moles removed, was having any of the following information helpful?). Thank you again for the question.

-btcdocs

Derm specialist response:
It appears that you have what is called common intradermal nevi, which are benign raised "moles".  Due the the image quality/resolution on some of the later photos, it was difficult for me to be certain 100% that they are benign (and honestly the only way to be completely sure is to perform a biopsy).  There are other tumors that mimic intradermal nevi - blue nevi, spitz nevi, dermatofibromas, juvenile xanthogranuloma, and even malignant tumors like nodular basal cell carcinoma and melanoma.  So with the image resolution lacking, it's difficult for me to appreciate the subtleties that would help me clinically distinguish these lesions and provide the reassurance you desire. Even if your photos had better resolution, moles are an example of a dermatological condition that is still best evaluated in person by a dermatologist (sometimes with the assistance of additional magnification). I wish I could be of more help in this regard, but I do not want to mislead you. 

In determining benign versus malignant lesions, particularly with moles, I teach patients about the ABCD's of melanoma: A stands for asymmetry (we like to see nice round moles - as yours appear to be), B is for border (nice even, not jagged edges), C is color variability (same pigment throughout, without multiple shades of black, blue, pink, etc), D is for diameter greater than a pencil erasor (i'm not particularly fond of this one because some people just grow larger moles).  The E was added - for evolving, and I think that is the most important component - a mole that begins to be symptomatic, is developing new colors within it or growing strange borders. It's estimated that 50% of melanomas arise in pre-existing lesions and the remainder arise as new lesions. 

In regards to removal, I would hesitate to see any physician that offers to remove all of your moles at your first visit.  I usually offer to remove one or two at the first visit, and the purpose of this is to see how patients scar at follow-up and to make sure the patient is satisfied with the cosmetic appearance of the scar before removing more lesions. I cannot predict how each individual patient will scar.  Although I understand the desire to just get them off even if that means trading for a scar, scars can also be "ugly", symptomatic and worse than the original lesion.  It sounds as though you have some experience with shave removal, which is where the skin is numbed and the mole shaved off flush with the surrounding skin, leaving a round scar.  This does leave some possibility of recurrence if nevus is left at the base. Depending on site, size of the lesion, and proximity to skin lines, I may also offer a "punch" excision or regular elliptical (football-shaped) excision which require sutures and leave linear scars. 

Again I wish I could be of more assistance to you, I hope the information I have provided has been helpful for you. Rashes like psoriasis, eczema, etc are fairly straightforward, but within dermatology moles are comparatively difficult to diagnose via photography alone (and sometimes, even clinically).  To give you a sense, there was a recent article in a dermatology journal discussing the controversy of iphone apps which allowed users to submit photos of their moles to "determine" whether benign or malignant, and the frequency of wrong diagnosis was quite substantial. 

-sk1nd0c
16SqgezceSdf9weWxpC2UHG7jv1oh52Fut

Anywhere near San Diego County, CA? I'd like to just jump to the shave excisions for my nevi and pay in BTC at a discount (will sign a cosmetic waiver, don't care about scarring if done by interns or PAs at a licensed practice/teaching facility; just use a local, sterile equipment and electrocautery and I'll do the aftercare perfectly as usual. Also if you want to do a before/after photo series for PR, that would be fine too.) I do have a PDF of the 14 really worrying ones with a ruler here, FWIW.

Obviously confidentiality is waived since I'm posting this in public.

Greetings fellow denizens of the net! Tired of over-regulated anti-innovation partisan sick-care? Tired of not knowing if your condition actually requires you to go into see the doctor, paying whatever-unreasonable-deductible and probably having to take time off work? We would like to help offer an alternative. The bitcoin infrastructure along with net pseudo-anonymity are fertile grounds for innovation, patient-satisfaction, profit, and alleviation of suffering.

We have been working up to this for a long while, and figured the time was right to debut our very-preliminary services on the btc forums. We are slowly rolling out internet chat sessions with physicians of various specialties. Initial prices are low given possible technical issues. For the first few sessions we will refund all coins if you are not satisfied with the services delivered. If you want to use escrow with a trusted OTC or forum member we can accommodate that. We appreciate any feedback, thoughts or suggestions! If you have any specifically desired services (e.g. psychotherapy/CBT) please let us know and we will try and accommodate you.

Services available now:

Dermatology consult w/dermatology resident MD - 15 min, BTC0.15, 2 sessions available most saturdays - please contact for times and availability

• you will likely want to photograph any lesions and upload the images (e.g. to imgur) before the appointment
• these prices only apply for the first couple of official session days - please email to verify appointments at these prices still available
• note that for some derm issues it may be recommended that you have a lesion biopsied, or the physician may recommend prescription medicines that they will not be able to prescribe for you online--i.e. for some conditions the physician will recommend going into a derm office

We will send connection details via email, and encourage use of PGP.

If you are a physician interested in working with us, please drop us a line!

Thanks for reading and have a great voluntary day!

Contact us:
[email protected]

our public PGP key:

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