Your skin is your largest organ and when it is affected by disease it can cause significant discomfort, in addition to cosmetic and functional disturbance.
General or medical dermatology involves the assessment and treatment of skin disease such as rashes, acne, rosacea, eczema (atopic dermatitis), psoriasis, acne, skin allergy, skin infections (fungal/tinea, viral including warts, bacterial), skin conditions as a result of internal disease or medications, dry skin, itchy skin, and discolouration/pigmentation. Disorders of the fingernails or toenails and hair loss (alopecia) are also treated by dermatologists.
Atopic dermatitis (eczema) and psoriasis are the two most common chronic inflammatory skin conditions. Unfortunately, research to date has failed to reveal a permanent cure for these diseases. However, excellent control of the disease, so you can get on with normal life is a very realistic goal. Treatments range from creams, phototherapy, various tablets, and new biologic injectable medications. The results of controlling these diseases are life-changing.
Acne and rosacea are two other very common skin conditions that cause significant concern. Developing a sensible, evidence-based approach can bring highly satisfying results. Appropriate treatment of acne at an early stage is critical to prevent permanent unsightly scarring.
Skin conditions are often significantly distressing because of itch or discomfort, and because of the obvious visual impact. Many however have struggled for weeks or months with over-the-counter creams and remedies, internet searches, and may also have consulted a number of doctors without sustained relief. Your dermatologist will take a thorough history, examine the skin, and discuss with you the correct approach to start getting your skin back to normal.
Scarring caused by trauma, surgery, or inflammatory skin conditions (including abnormal scarring called hypertrophic or keloid scarring) often leads to concerns with appearance but may be itchy and tender and occasionally cause a disturbance of function. Abnormal scarring can be difficult but improvement is usually seen with a systematic and patient approach.
Skin conditions are not trivial. Let us help you get back to skin health.
All our dermatologists have extensive experience in dermatologic skin surgery. Your specialist will discuss with you the best options for management of skin cancers or non-cancerous lumps and bumps that you may wish to have removed. This may include traditional excision, various other surgical procedures, non-surgical options, or laser surgery. The onsite erbium laser can be a very good option for removal of benign skin lesions and some superficial skin cancers, rapidly, and with excellent cosmetic results.
It is critical you make the correct decision when deciding on your skin surgeon.
Before surgery, an accurate assessment of the skin lesion of concern will be made. A benign or cancerous clinical diagnosis will determine whether the lesion needs to be removed for medical or cosmetic reasons.
If the lesion is malignant, your dermatologist will discuss the pathology (science) and behaviour of your specific condition. The term skin cancer covers a wide variety of different diagnoses and prognoses (outcomes) and careful consideration of this will guide you to the best management strategy. The correct choice, and careful performance of the procedure or treatment, is critical to achieve an optimal outcome from a curative, functional, and aesthetic perspective.
Our specialist dermatologists are best placed to help you in this decision and perform your chosen procedure.
Mohs micrographic surgery is a highly effective and advanced treatment for skin cancer. It offers the highest potential for cure (up to 99%) because the tumour is precisely removed and analysed layer by layer during your appointment, and prior to reconstruction of the wound. An important additional benefit is its ability to minimise the removal of normal tissue surrounding the tumour, leading to a smaller defect and a superior cosmetic outcome.
The term ‘Mohs surgery’ is derived from its founder and creator, Dr Frederic E Mohs, MD. He was a professor of surgery at the University of Wisconsin when he started developing the technique in the 1930s. Since that time, it has undergone many refinements to make the procedure more rapid and comfortable. The name has been retained in honour of its pioneer.
Mohs surgery should not be confused with "surgery with frozen-section margin control". Mohs surgery utilises frozen section tissue processing to provide rapid histological sections for analysis at the time of surgery, but the difference lies in the way the tissue is cut in the laboratory. Surgery with frozen-section margin control utilises the standard "bread-loafing" technique described below. It allows rapid results but does not analyse the tissue in any more detail than standard surgery.
Auckland Skin & Cancer Foundation is New Zealand’s largest group specialising in Mohs surgery.
How does it differ from traditional surgery?
The visible part of a skin cancer is very often only the ‘tip of the iceberg’. So-called thin ‘roots’ of cancer cells unseen by the naked eye, may spread deep and wide and only be visible to examination under a microscope.
With traditional surgery, the tumour is removed along with a moderate margin of normal surrounding tissue. The wound is then closed prior to microscopic evaluation of the tumour or its distance from the edge of the wound. The tissue is sent to the laboratory for a sampling technique referred to as “bread-loafing” where a small number of very thin samples (cross-sections) of tissue are analysed. This technique usually results in less than 1% of peripheral margin of the specimen being evaluated and can miss the ‘roots’ of the skin cancer. This is usually adequate for areas of the body where a large margin of normal tissue can be taken, increasing the chances the whole tumour is removed.
However, for tumours involving the face, head, and neck, it is crucial all tumour cells are removed with the highest accuracy, without unnecessarily sacrificing normal tissue which can worsen the cosmetic result. In this situation, traditional surgery suffers from two major disadvantages:
‣ Tumour cells may remain - if this is detected in microscopic sampling, repeat surgery will be required. If the sampling fails to detect persistent tumour, these cells are left to continue their growth and spread, often masked by the surgical scar.
‣ More than necessary normal surrounding tissue may be removed as part of the ‘safety margin’
During Mohs surgery, your surgeon is also your pathologist who examines and interprets the tissue under the microscope. The direct involvement of your surgeon in every stage of the process allows for the highest degree of accuracy in orientation and analysis of the tissue, and is part of the definition of Mohs surgery.
The Mohs surgery procedure
Mohs surgery is performed under local anaesthetic on-site at Auckland Skin & Cancer Foundation. Due to the processing time of your specimens, it may take 3-6 hours depending on the size and complexity. Most of this time however you are not required in the theatre, and can relax with a book, chat to a friend or relative, use your WiFi device, and enjoy light refreshments.
A dressing is applied to the wound after the first stage has been taken, and you will be informed as soon as your results are available. If tumour cells persist at any margin, a further stage will be taken and the new specimen analysed. Once the area is clear of tumour, you will return to theatre for surgical reconstruction. This may involve the use of a skin flap or skin graft. A final dressing is then applied, and you will be given detailed wound care instructions and an appointment for wound review and removal of sutures, usually six to seven days later.
Please visit the American College of Mohs Surgery website to read more about the surgery, including a step-by-step pictorial explanation of the process:
What are the advantages of Mohs surgery?
‣ By aiming to evaluate 100% of the surgical margin, it provides the highest assurance that all the cancer cells are removed during surgery
‣ The amount of normal tissue loss is minimised
‣ As a result, the functional and cosmetic outcome can be maximised
‣ The pathology (microscopic evaluation) is performed on the day by your Mohs surgeon, so there is no waiting for results following surgery
‣ The surgical repair of the site is performed on the same day, in the vast majority of cases
‣ It can cure skin cancers where other methods have failed
New Zealand's harsh ultraviolet rays places our risk of sun damage and skin cancer amongst the highest in the world. Even in winter, UVA rays are present in doses high enough to cause ageing of our skin and promote the development of skin cancer.
Our dermatologists are highly trained in the assessment of your skin, looking for any suspicious signs. Any new or changing areas of skin, particularly if a lesion has changed shape or colour, or fails to heal should be reviewed promptly. If you have fair skin, particularly if you have a personal or family history of skin cancer, a regular full skin examination is an excellent way of maximising your chances of identifying an early, otherwise undetected skin cancer.
There is no substitute for a specialist dermatologist in the assessment of your skin. With accurate clinical diagnosis you can be saved unnecessary procedures, while ensuring a thorough check to accurately identify any suspicious lesions for early treatment.
Request an appointment now with your dermatologist, it could save your skin.
Your skin is the most visible part of your body. It is not just the numerous medical functions it performs, but it is incredibly important to your appearance and the whole way you feel. Your dermatologist can discuss the care of your skin, including preventive strategies against ageing and sun-damage. A practical, science-based approach is useful in sorting fact from fiction in this area. If required, a specific skin care programme can be formulated, and a range of cosmetic procedures including various lasers are offered at our onsite Auckland Skin Laser Centre.
Your dermatologist will discuss your specific requirements and the best strategies to address these. You can also read more about the cosmetic procedures and services available by visiting www.skinlaser.co.nz
Dermal microneedling (Dermapen) is an excellent, minimally-invasive procedure for acne scarring, surgical scars, stretch-marks, sun-damaged and aged skin. It is also well-suited for preventative skin collagen induction. More information can be found by clicking here.
Silicon scar improvement gel is a well-established, evidence-based medical treatment for the improvement in appearance and texture of new and old scars. See below for details.
The success of silicon products for the improvement of new and old scars is well-demonstrated in numerous medical studies. In the early days, silicon sheets were laid over scars. Today, a film-forming, gas-permeable silicon gel performs the same function with the benefit of much better convenience, cosmetic appearance, and the ability to apply sunscreen and make-up over the top. These products are ideal for use after surgery and laser procedures in cosmetically sensitive areas. We stock silicon products by Stratpharma, a Swiss pharmaceutical company focused on products for skin scarring. We stock their products after trying the range of locally available alternatives. Stratamed® is the only product registered for use on broken skin and is used after ablative laser or shave/curettage procedures, and Strataderm® is used for older scars or new scars immediately after the surface skin has healed. Only a very thin layer is needed, and the tubes should last a long time. 3-4 months application is usually recommended.
For more information, visit the Stratpharma website
These products are safe and effective and you can purchase these products directly from our Remuera reception (or Botany by prior arrangement) without a consultation. Feel free to drop in, or contact us.
There are numerous ways that the existing pre-cancerous changes your skin may have, can be treated to help prevent the progression to skin cancer, despite years of preceding damage.
Our Dermatologists are experts at advising on the available strategies. This involves scientifically-based advice on skin care and sun-protection, a number of medical procedures, prescription creams, and oral medications.
Maintenance of your skin, and disease prevention is our priority.