Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What's New in Nonmelanoma skin cancer
Similar to how patient see their primary care doctor for both treatment and prevention of diabetes and high cholesterol, patients see dermatology for both skin cancer treatment and prevention as well. One target are the precancerous lesions called actinic keratosis (scaling pink bumps on the skin). Published risk estimates vary, but has been summarized to be about 8% risk per individual scaling bump of progression to skin cancer. The highest risk is for squamous cell skin cancer, a type that can metastasize if left alone too long. The most common treatment of actinic keratoses is focal application of liquid nitrogen to treat individual lesions. Sometimes, physicians utilize creams, esp. 5-fluorouracil for 2-4 weeks. The creams & solutions do have risks, esp. excessive long-lasting skin irritation, infection, and insurance issues. Practically, I tell patients they may look very red and raw for 1-2 months and the medication can cost hundreds of dollars. Usually patients prefer focal liquid nitrogen application.
That being said, a study has been published that if the 5-fluoruracil is used in conjunction with a medication called calcipotriene, it seems to be effective with just twice daily x 4 days application. The theory is that calcipotriene, which is synthetic vitamin D usually used for psoriasis, induces a protein called thymic stromal lymphopoietin which suppresses skin cancers. It seemed to be tolerated well. However, the major practical concern is cost. Beyond the cost of the chemotherapy 5-fluorouracil, now patients will also have to pay for the calcipotriene that seems to be hundreds of dollars even with insurance. Unfortunately, I would not be surprised if the total cost for the two medications is close to a thousand dollars, even with insurance. Hopefully that will change in the future although it seems insurance is moving the other way (toward higher and higher medication copays for patients). It also appears the “inventors” are patenting this combination, which is quite dismaying from my standpoint, so that may increase costs further in the future. This may cause focal liquid nitrogen to still be the standard of care for many more decades.
If you have sun damage or rashes worrisome for skin cancer, please make an appointment for dermatology consultation at (626) 331-6411 to discuss your options.
Charles Chiang, MD, FAAD
- Karon A. Adding calcipotriene to 5-FU dramatically reduced AKs. Dermatology News 2016
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