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dermatology faq

Why should I Insist on a Specialist Dermatologist?

Dermatologists are medical professionals who have undertaken specialist training focusing exclusively on the treatment of skin complaints, such as acne, rashes and various skin lesions. In Dr Rutherford’s case he has completed additional super-specialised training in the field of surgery of the skin, laser as well as various cosmetic treatments, which requires a minimum of 14 years training. His training was undertaken in Melbourne, Singapore and Perth.

What is a Basal Cell Carcinoma (BCC)?

Basal cell carcinoma is the commonest form of any cancer in Australia and can occur at any age, but is more common with increasing age. BCCs typically occur where the skin has had lots of sun exposure such as the face, neck, back, shoulders and arms. Whilst these cancers are unable to spread to other parts of the body, they need to be treated seriously. Patients whose cancers have been neglected or incompletely treated previously may find that their tumours have invaded widely or deeply.

Basal cell carcinomas are often not identified by patients themselves until they have been present for several years, generally because the tumours can mimic harmless spots and enlarge very slowly. Often they are diagnosed by a doctor on a routine skin check or a friend or relative who has had one previously themselves.  To the untrained eye BCCs may not look very sinister and generally do not cause pain, however they do tend to bleed more easily than normal skin.

There are multiple treatment options available for BCCs including several types of newer treatments that use either creams or combinations of cream and light. Unfortunately these are useful only for a small minority of BCCS (probably fewer than 5%). Dermatologists are skilled in the range of surgical and non-surgical treatments that allow customisation of therapy to suit each individual patient.

What is a Squamous Cell Carcinoma (SCC)?

Squamous cell carcinoma is a skin cancer that occurs more commonly in older patients.  SCCs typically occur where the skin has had lots of sun exposure such as the face, scalp, neck, hands and arms. SCCs have the ability to spread to other parts of the body and therefore need to be treated seriously. The risk of spread is greatest for tumours on the lips, ears and genitals.

Squamous cell carcinomas are often identified by patients who notice an enlarging fleshy painful lump that is tender when pinched or knocked. The tumour may have a surface ‘crust’ or scaliness and sometimes can appear with alarming speed – over only a few weeks. Generally SCCs slowly enlarge over several months. Any tender enlarging lump that lasts for more than a week or two should be examined by a medical practitioner to exclude a squamous cell carcinoma.

Due to the ability of SCCs to spread, treatment options are few. Wide surgical excision or tissue-conserving Mohs Surgery remain the preferred treatments, however radiotherapy can be used successfully in select individuals. Dermatologists are skilled in the range of treatments that allow customisation of therapy to suit each individual patient.

What is a Melanoma?

Melanoma is a less common type of skin cancer than BCCs and SCCs, but accounts for a relatively higher proportion of skin cancers seen in young adults. It is dangerous because of its ability to spread throughout the body and may be fatal, with approximately 1200 Australians dying from melanoma annually.  Fortunately, however it is nearly always curable when diagnosed and treated early. Most melanomas start in the top layer of the skin and slowly spread outwards within the top layer of skin before moving into the deeper layers where the cancer cells can enter the lymph channels and bloodstream.

Melanomas can occur on any part of the skin including relatively sun protected sites, but most often they happen on sun exposed parts. In men they more often occur on the torso whilst in women they are more common on the legs.  Half will develop from a pre-existing mole with the other half arising from normal skin.

Rates of melanoma are rising, although the greatest increase is amongst elderly males. While melanoma can occur at any age, they are more common in older people. However, because cancers in general are less common in young people, melanomas are one of the commoner cancers of young adults.

Melanomas should be suspected if there is a changing mole or new onset mole. They will enlarge over weeks to months but are rarely symptomatic and only cause pain or bleeding if they are advanced. Examination of changing moles with illumination devices such as a dermatoscope can aid in the diagnosis, but the diagnosis can only be made with 100% certainty after the excision of the lesion.

Treatment always involves surgery, but the extent of surgery depends on how advanced the melanoma is. Most melanomas do not require any other treatment but advanced melanomas may require additional tests and treatments such as radiotherapy or chemotherapy.

What are Solar Keratoses?

Solar keratoses are common small areas of scaly red skin that may bleed slightly when the scale is picked off. They are generally not painful but may sting slightly after sun exposure or long showers/swimming. They occur on areas of lifelong high sun exposure such as the backs of hands and forearms, face, lips, ears, scalp or neck and if the legs were regularly in the sun they may occur there also. The risk of each individual keratosis turning into a skin cancer is very low, but if multiple solar keratoses are present, particularly if on the lip, scalp or ears the risk is greater. It may take years for an individual spot to turn into a skin cancer.

Vitamin D is an important vitamin that is required not only for the maintenance of healthy bones but is also believed to play a role in the prevention of various internal cancers and some diseases related to the immune system.

What is the Significance of Vitamin D?

Vitamin D is unique in that it is naturally produced by the human skin in response to sunlight. Although most people can maintain adequate levels of the vitamin from day to day sun exposure, many people in Australia are deficient either due belonging to a group that is at high risk such as the elderly and those with dark skin. Increasingly, fair skinned people who are simply vigilant with sun protective measures are also found to be deficient. In many people casual everyday sun exposure is inadequate to maintain their vitamin D levels.

Adequate vitamin D is unlikely to be achieved through dietary means alone for most Australians. To maintain adequate vitamin D levels it is recommended that the hands, face and arms be exposed to 5-15 minutes of sunlight 5 times a week. A greater frequency is required for those who are older or have darker skin. Alternatively, particularly for patients who are vigilant with sun protection, a vitamin D supplement of at least 400 IU (10 ìg) per day can be taken (those who are found to be deficient in vitamin D on testing require higher doses).  There are many commercially available supplements that contain vitamin D, several of which also contain calcium.

What is the Best Treatment for Skin Cancer?

Treatments for skin cancers vary, with the ultimate goal being complete tumour removal with the least effect on form or function. Dr Rutherford is experienced in all types of skin cancer treatments including the latest non surgical techniques and Mohs Micrographic Surgery, which offers the highest cure rate of all skin cancer treatments. Dr Rutherford is trained and experienced in advanced reconstructive surgical techniques to minimise scarring.

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