User talk:Nickcoop

Welcome!

Hello, Nickcoop, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful:

I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes (~~~~); this will automatically insert your username and the date. If you need help, check out Wikipedia:Questions, ask me on my talk page, or ask your question on this page and then place {{helpme}} before the question. Again, welcome! Twenty Years 10:55, 1 March 2008 (UTC)[reply]

Talk:Monash University

Your edits to Talk:Monash University appear to be disruptive. A proposal for a merge has been made in good faith. Editors can express their opinions. Those opinions should not be deleted. You also deleted the work of a bot that quite properly dated a contribution. Please stop doing this. --Bduke (talk) 07:28, 11 March 2008 (UTC)[reply]

(Copied from talk) - My apologies for deleting Profb21's comments. My own comments had been deleted by Profb21 prior to this. —Preceding unsigned comment added by Nickcoop (talk • contribs) 07:37, 11 March 2008 (UTC)[reply]

Please keep the discussion here. I now have your talk page on my watch list. Your comments have not, as far as I can see, been deleted from this merge discussion. That is all I am concerned about. Your edits to the article have been removed, but that is just a content issue, that you and User:Profb21 should work through in the usual way. I did notice however that some of your edits were rather POV. The merge discussion should not be tampered with. --Bduke (talk) 07:51, 11 March 2008 (UTC)[reply]

Monash University Accident Research Centre

I do not disagree with the reasons you give for adding back the material I removed, but this material can not stay in the article in its present form. I have moved it to the talk pages and given reasons why it needs to be rewritten. Please go there and try to develop a better wording. In particular it needs sources. --Bduke (talk) 22:44, 25 March 2008 (UTC)[reply]

You've got some very good points

And I also detest the claims that Mohs has 99.8% cure rate, and is "better" than radiation. I think realistically, it is probably about 94% to 98% cure. I have not had any recurrences (that I've known of) for primary basal cell cancer in doing Mohs for 7 years - but I am sure there are recurrences that were not reported to me.

You really have to see how it is done before you detest it. It is very objective, and clear - if you performed it using serial sections.

Unfortunately, there are too many (perhaps even 1/3) of the surgeons out there who does only 2 sections - and these are the ones that is likely giving Mohs method the poor cure rate.

Please, keep on digging for facts, but don't throw the baby out with the bath water.--Northerncedar (talk) 15:59, 14 February 2009 (UTC)[reply]

Cost effectiveness?

I've done Mohs surgery on previous excisions and dessication and curettage performed by GP's plastics , and dermatologist that has recurred due to false negative error and narrow margins. These folks are just simply glad to have it done with Mohs - and not recurring.

Cost wise? Locally, our plastics do it under general anesthesia. They charge for flap closure (eventhough most derms simply charge for complex or layered closure). The cost differential is nearly $1500 USD, at least. The same with pilar cyst excisions - we get paid about $150 to do it under local anesthesia. Others have had it done under general anesthesia for $3000. I've just removed some rheumatoid nodules (against my advice, the patient demanded it). I got paid about $130 for the minor excision. He said it cost him over $2000 at the hand surgeon.

We often don't realize the true cost of Mohs surgery is much lower this year in the USA than in the past. We are paid 100% only for the first layer, second, third, and fourth layers are paid at 1/2 price. And closure is paid 1/2 price. It is not as much as it was in the past.... But we still need to offer it because it works well.

I can not even dream of removing any facial cancer without Mohs - to me, it saves me alot of liability, and let me sleep better at night.

Read it, learn about it, ignore the garbages that the selfish US Mohs surgeon says about it - and you'll find it a great tool for ALL of us to use. —Preceding unsigned comment added by Northerncedar (talk • contribs) 16:11, 14 February 2009 (UTC)[reply]

February 2009

Welcome to Wikipedia. It might not have been your intention, but your recent edit removed content from Mohs surgery. When removing text, please specify a reason in the edit summary and discuss edits that are likely to be controversial on the article's talk page. If this was a mistake, don't worry; the text has been restored, as you can see from the page history. Take a look at the welcome page to learn more about contributing to this encyclopedia, and if you would like to experiment, please use the sandbox. Thank you. —Cyclonenim (talk · contribs · email) 16:56, 14 February 2009 (UTC)[reply]

Please stop. If you continue to blank out or delete portions of page content, templates or other materials from Wikipedia, as you did to Mohs surgery, you will be blocked from editing. Please, I realise templating may not be the best way to get through to you, but please discuss your edits on the talk page prior to removing such information. There is consensus against your deletion of content, please review those arguments. —Cyclonenim (talk · contribs · email) 00:19, 15 February 2009 (UTC)[reply]

I do not know enough about the topic to confirm or deny your belief, however, at present, instead of trying to resolve the issue first by talking on the talk page (which is our current practice here) you are removing large sections of text which are largely coherent, sensical and important to the description of Mohs surgey, not just it's effectiveness or price. Secondly, it is not Wikipedia's role to provide advice to patients. In fact, we have a policy prohibiting us from giving such advice. Wikipedia needs to act as an encyclopaedia, and therefore we provide reliable, secondary sources. Randomised controlled trials are not usually classed as such sources unless absolutely needed as a last resort. Instead, we try to use review articles. Please do not revert any chances again until the issue has been resolved through discussion, or the threat made in my previous message will stand. Thanks. —Cyclonenim (talk · contribs · email) 09:26, 15 February 2009 (UTC)[reply]

Basal cell carcinoma

I agree that surgical excision should be placed above Mohs surgery; however, please don't remove large chuncks of apparently good text (about dermatoscopy and such) without an explanation. --Steven Fruitsmaak (Reply) 12:39, 15 February 2009 (UTC)[reply]

Your recent edit

I think you misread the study. While they say that standard excision is fine for most bcc's (which is how I practice), they do not recommended it for recurrent facial bcc due to the higher cure rate of Mohs surgery. MMS is again shown to have high cure rate, even compared to relatively wide excision (4mm margin). Just remember that most Mohs surgeon uses 1 to 1.5 mm margins. I personally have used 0.5 mm margins on nasal tip and nasal ala.

But if cost is a factor, non recurrent facial bcc's can be treated with standard excision (if you follow the guideline they utilized in this study (4 mm surgical margin).

When was the last time you used a 4 mm surgical margin on the face? Not very often, I hope.--Northerncedar (talk) 19:24, 17 February 2009 (UTC)[reply]

Hi nick

I do not wish us to be antagonistic. I don't have anything to sell to anyone about Mohs surgery. I see it more as a task to teach patients, doctors, and others about why standard of care are created. Margin control histology is as old as pathology itself, and Mohs is simply an application of it. Probably abused, and over-sold by profit minded Mohs surgeons. But we must not fail to go back to the old textbooks, read about pathology sectionings, read about statistical errors - and simply think about how you would want a cancer removed from your face. You don't need a Mohs surgeon! Just make sure the darn pathology technician do serial sectionings about 20 microns apart, or ask your friendly pathologist to do frozen section using margin control methods. If you insists on doing excision with 1 or 2 mm free margin, go ahead. Just do it with frozen section histology available, so you don't have to reexcise blindly 1 or 2 weeks later. I would love to visit your country - it must be beautiful weather there right now. I would say if you truly see the volume of skin cancers that I've heard of in New Zealand - you might think about learning frozen section histology - and there is no better way to do margin control processing than Mohs method. Peace ...--Northerncedar (talk) 00:42, 18 February 2009 (UTC)[reply]

Procedure related articles

With the recent tension over the Mohs surgery article, I have started a discussion regarding guidelines pertaining to articles about medical procedures. If available, given your editing history, perhaps you would consider participating in the discussion? kilbad (talk) 01:19, 19 February 2009 (UTC)[reply]

Frozen section

I agree, frozen section has no place in the diagnosis of melanoma. But even with H&E, in a busy practice, they will miscall seb kers as BCC's as well. I don't always trust dermatopathologist. There is no place for frozen section in diagnostic pathology, but for margin determination - most Mohs surgeon prefers fixed histology. As you can see in the articles quoted, fixed histology mohs is better than frozen section for melanoma in situ.--Northerncedar (talk) 15:35, 25 February 2009 (UTC)[reply]

Please read the NCCN's guideline

http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf

Page 6 defined what margin control surgery is. Page 7 is the guideline. The discussion you deleted has all the bearings on "standard of care" guideline in the USA. Please do understand that standard sectioning is not the same as margin control sectioning - which is why the NCCN define it on page 6, and recommends in on high risk tumors on page 7.--Northerncedar (talk) 13:41, 26 February 2009 (UTC)[reply]

Please do not bring this discussion to my talk page again, content disputes should be worked over at the talk page of the article. There are plenty of methods of resolving content disputes, as laid out at WP:DISPUTE. Please follow one of the methods listed there if you feel discussion between the two of you has not worked out. —Cyclonenim (talk · contribs · email) 18:42, 26 February 2009 (UTC)[reply]

November 2009

Welcome to Wikipedia. The recent edit that you made to the page Hone Harawira has been reverted, as it appears to be unconstructive. Please use the sandbox for testing any edits; if you believe the edit was constructive, please ensure that you provide an informative edit summary. You may also wish to read the introduction to editing for further information. Thank you. Cassandra 73 (talk) 20:13, 14 November 2009 (UTC)[reply]