Friday, June 16, 2017

The Fung Shui Nevus

Presented by: Micah Ashkenazi
Root Town, Ohio

The patient is a 19 year-old American-born, Chinese college student living in Ohio.  Her mother brings her in for an office visit regarding a nevus..  The 2 mm in diameter lesion has been present near the bulb of the nose for years with no worrisome changes.

Diagnosis:  Acquired melanocytic nevus.  Possibly a blue nevus.

Discussion:  I reassured the patient's mother that this is a benign lesion and can be safely observed.  The mother only speaks Cantonese.  She and her daughter have a longish conversation in Chinese.  The daughter tells me that her mother believes that moles on this part of the nose have bad fung shui.  In that case, I acquiesced and agreed to remove the mole which can be done with a 3 mm punch.  A shave may leave some residual pigment and that would be unacceptable to them.

The patient and her mother take fung shui seriously and want the lesion removed.  This will be scheduled at a propitious time as decided by their astrologer in Chinatown.

Clearly, this is a cultural issue, not a medical one.  Failure to consider that might have led to a disconnect between the patient, her family and the physician. How many other similar scenarios have I missed over the years?

Reference:
PubMed is strangely silent on Feng Shui; however there are many references on Google.

Face Reading Feng Shui in Chinese Five Arts.  It says, " If there is a mole on the nose, it will be bad luck between 40 to 50 years old."

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

6 comments:

  1. Fascinating! Great to think about going forward in different parts of the world. Thank you for sharing.

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  2. Dear David I discussed this case with my wife who is chinese and she agrees that if the family feels so strongly then please remove it . . I also agree that if there is a shave bx and then a recurrence of pigmentation in the scar this may present with even more problems, Regards Dr Chris Tyson .

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  3. Dear David: Thanks for posting this. I was aware of this phenomenon - I remember reading about it and looked to see what my nevus above my left eye meant. I guess it wasn't so bad because I didn't have it excised! Your presentation is the essence of cultural competency. I looked for the article I mentioned but could not find it. I did, however, come across a related topic - superstitions related to melanoma. See below. Sincerely, Warren

    Postepy Dermatol Alergol. 2016 Oct;33(5):329-335. Epub 2016 Oct 21.
    "Better do not touch" and other superstitions concerning melanoma: the cross-sectional web-based survey.
    Gajda M1, Kamińska-Winciorek G2, Wydmański J3, Tukiendorf A4.
    Author information
    Abstract
    INTRODUCTION:

    To the authors' best knowledge, there are no data regarding the prevalence of superstitions concerning melanoma among internet users.
    AIM:

    To evaluate the prevalence and identify reasons for superstitions associated with excision of pigmented skin lesions as well as to assess the frequency of this procedure.
    MATERIAL AND METHODS:

    Readers of the scientific portal were invited to complete a fully anonymous e-questionnaire. After collection of questionnaires (5,154) and eliminating incomplete ones, 4,919 surveys were analysed.
    RESULTS:

    A total of 4,104 (83.4%) respondents have been aware that the total surgical excision is the only efficient way of melanoma treatment. This familiarity was related to increased skin cancer awareness but was not linked to regular skin self-examination. Over half of the surveyed agreed that "it is better not to touch naevi". Moreover, 3,510 (71.3%) individuals believed that naevi located in "harmed places" may turn into melanoma.
    CONCLUSIONS:

    Superstitions associated with surgical treatment of melanoma are widespread. Conducting educational campaigns is necessary, particularly among young people, whose dangerous tanning behaviours are important risk factors for melanoma occurrence in their later life.

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  4. This is an incredible and interesting case. It truly highlights the cultural component of dermatology.

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  5. AnonymousJune 16, 2017

    from Malaysia: "
    Regarding this patient with a mole on her nose, interestingly and cleverly named Feng Shui mole by the author, we can discuss it from different angles:-

    1. Dermatological consideration:-
    All will agree that it is most likely benign melanocytic nevus by ABCD's to rule out melanoma. But then years ago, the skin department, St George's Hospital, Tooting Broadway, London, UK, where I started my skin training, has published an interesting report in BMJ that even though the consultants are more accurate than registrars under them in diagnosing melanomas, nobody got 100 percent correct! This has been my guide. I'll tell the patient though it is 99.9% benign, but as a human, I cannot guarantee it is so 100%. Patient can then make a decision whether to excise it with narrow margin, or watch it under the watchful eyes of dermatologists!

    In this case under consideration, though patient and her mother want it out for FengShui, how dare we to say no?
    The histopathological report is the acid test that it is benign and need no further management.

    2) culturally, as a Chinese myself, I can still remember in elementary school, one of my classmate was better known as Tai Lak Mak, which means a big mole!
    Most did not know his actual name....

    I don't believe in Fengshui anymore, after I know the Lord during my second year in medical school, but moles in Fengshui can be divided into lucky and unlucky ones, believe it or not.

    What if patient's mother got it wrong, will the attending dermatologist be sued if he or she goes along with Fengshui theory and " wrongly" removes a good luck mole; and should misfortune later unfortunately strikes, may I call it double Murphy's Law. So it is better to stay clear of the Fengshui people's way. Of course we should try to grant them their wishes, e.g. the "auspicious time" to do the surgical operation.

    Fengshui is like worshiping idols, for people who disbelieve in them, it is powerless. For people who believe, forces may act through them to deepen their beliefs. I dare venture this far for a potentially sensitive area! Thank-you, Dr. Ong Cheng Leng

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  6. AnonymousJune 25, 2017

    Chinese do agree that moles around the side/alar of nose is not a good omen but on the tip of nose is a good sign! did you 3mm punch biopsy it eventually? one stitch sufficient to close the wound? BB. Foong, Ipoh, Malaysia

    ReplyDelete

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