Martin performs your skin examination using a microscope called a dermoscope (shown below). Research shows that experts diagnose melanomas with only 60% accuracy with the naked eye. Using a dermoscope improves accuracy to over 90%. This is because the dermoscope enables the doctor to look beneath the top layer of the skin into the deep layer to reveal tell-tale signs of early melanoma and other skin cancers. Improved accuracy means less chance of missing a skin cancer and fewer benign lesions removed and sent to the lab unnecessarily, which saves money, pain, scars – and lives. Martin has completed years of dermoscopic training to interpret the special signs of early cancer.

If Martin identifies any skin lesions of concern he will advise either a skin biopsy or complete surgical removal depending on the situation. This is usually booked about a week later and takes place at the same clinic under local anaesthetic. Martin performs all biopsies and surgical removals and is very gentle so the pain is no worse than a blood test.

If you have a skin lesion that is not entirely normal and there is a low level of suspicion for melanoma, he will take a digital dermoscopic photograph of the lesion and advise you to come back three months later so he can rephotograph it and look for any changes. If there are no changes the lesion is over 99% likely to be benign. If there are changes he can surgically remove it.

Martin’s professionalism and thoroughness mean most people find skin checks to be an easy, reassuring experience.

Martin is a fully trained dermoscopist to Masters level and uses the latest 24-megapixel digital camera technology. The camera is wirelessly linked to an iPad so the images can be discussed with you straight away and a management plan decided upon before you leave the clinic. There is no waiting for reports.

Since early detection of melanoma is crucial, dermoscopic examination of the skin is essential. Martin uses digital photography to store images of your skin and highly magnified dermoscopic images of your moles. These images are used to compare your moles from year to year for early diagnosis of melanoma.

Here is an example of someone for whom digital dermoscopic melanoma screening is a good idea. This man has multiple abnormally shaped moles (atypical or dysplastic naevi) on his back. This increases his melanoma risk several times compared to the normal population. The photographs below show the incredible detail that the dermoscope can obtain. This is the gold standard for early melanoma detection.

Here is an example of a melanoma picked up using digital dermoscopy. The dermoscopic images are magnified to fill a 27- inch computer screen, which helps early melanoma detection.

If the mole is flat, it can be surgically removed. If it is small enough, it can be removed with a punch biopsy tool (a circular metal blade). If a punch biopsy tool is used only 1 or 2 small stitches are needed to close the wound and healing is usually excellent.

All surgical removals will leave you with some scarring no matter who performs the procedure. It is impossible to avoid scarring, as it is the skin’s natural healing process. However, with excellent surgical technique and good post-operative wound care, scarring can be kept to an absolute minimum.

Liquid nitrogen is -195.8C and freezes the skin cells to -50C. This forms ice within the cells, causing cell death. The liquid nitrogen is sprayed for 3-30 seconds depending on the nature of the skin lesion and can be used to treat many lesions including sun damage, warts and some early or superficial skin cancers.

The treated area becomes red and slightly swollen, and then turns purple, brown then black. Clean the area daily with soap and water and don’t cover it. A scab forms, which you shouldn’t pick, but you can apply petroleum jelly. The scab usually falls off after 1-2 weeks on the face, 2-3 weeks on the hands and 4-12 weeks on the legs. It leaves you with slightly pink skin that then fades back to normal skin colour after a few weeks.

Complications with liquid nitrogen are very rare but include blistering, hypopigmentation (a white patch) and hyperpigmentation (a dark patch, more commonly seen in dark-skinned people).

Efudix cream has been used to treat sun-damaged skin since 1963. It was originally used as a chemotherapy agent and was found that a useful side effect was that it improved patients’ skin. It comes in a 20g aluminium tube with a 5-year shelf life. It is used to treat pre-cancerous skin lesions such as actinic keratoses and is applied 1-2 times daily for 3-4 weeks. For best results, different regions of the face can be treated at the same time e.g. forehead and temples. Do not treat an area greater than 23 x 23cm (the size of a dinner plate). Wash your hands after application and do not get it in your eyes, nose or mouth.

Treatment leads to redness, scaling, burning, itching and tenderness, which settles down once treatment stops. New skin grows over the treated area after 3-4 weeks. As with all of these topical treatments, there is a degree of “no pain, no gain”. Inflammation of the skin is needed to treat the sun damage so if the area is red and inflamed it means it’s working. As a guide, the inflammation takes 1-3 weeks to form, 3-6 weeks to settle and it takes 6-16 weeks for the sun-damaged skin to clear.

Aldara Cream (Imiquimod)

Aldara cream stimulates your immune system to treat pre-cancerous and some cancerous skin lesions. It comes in sachets, which should be used on the same day, but you can roll up the foil so they last a few days. Wash the area with soap, apply a thin layer of cream, rub it in, apply to a small margin of normal skin and leave on for 6-10 hours. It can be applied to an area 5x5cm = 25cm2. Avoid sunlight and tanning beds. Wear protective clothing and hats.

For actinic keratoses is applied 3 times per week (Monday, Wednesday, Friday) for 4 weeks. The area is assessed after another 4-8 weeks and if there are still lesions, the cycle can be repeated. For biopsy-confirmed superficial basal cell carcinoma it is applied 5 days per week (Monday-Friday with a break at the weekend) for 6 weeks. The area is assessed 6-12 weeks after treatment to see if it has been successful.

If there is too much redness or irritation, reduce the dose accordingly. You can use as infrequently as
2-3  days per week. The goal is to obtain tolerable amount of irritation, which is the evidence that your body is trying to fight the disease. If a severe local reaction occurs, such as extensive crusting or blistering, stop the Aldara cream until the reaction resolves. This usually takes 3-4 days, then restart at a reduced frequency.

Picato Gel (Ingenol Mebutate)

Picato gel is an extract of a common plant called petty spurge, milkweed, radium weed or cancer weed. It was approved by the FDA in 2012 for the treatment of actinic keratoses of the face, scalp, trunk and limbs.
It is available as a colourless gel in 0.015% and 0.05% concentrations.
The advantage over other creams is that it only needs to be applied for 2-3 days.

For the face and scalp, 0.015% gel is applied daily for 3 days.
For trunk and limbs, 0.05% gel is applied daily for 2 days.
It can be applied to an area 5x5cm = 25cm2.
Avoid the eyes. Allow the gel to dry for 15 minutes, do not wash for 6 hours, avoid sweating, and then wash off with soap the next day. Store at 2-8 degrees C and discard after a single use.

Picato commonly causes skin reactions such as pain, itch, irritation and swelling.
Local skin reactions occur within 1 day and last 1-2 weeks for head and 4 weeks for non-head areas.

With a punch biopsy tool, a small 3-6mm circle of skin is removed and 1-2 stitches are put in to hold the wound together. The stitch is taken out a week or so later.

With a shave biopsy, a blade is used to shave a thin layer of skin. No stitches are needed.

A dry dressing is applied to the wound and you are asked to keep it dry for 24-48 hours. You can then have a shower with the dressing on. Remove the dressing after the shower and re-apply another dressing with some petroleum jelly to keep it moist (this speeds up healing). Both biopsies usually heal very well leaving minimal, if any scarring.

When a mole is removed from an area of skin tension (shoulders and back especially, but also trunk and limbs), deep sutures are placed to hold the wound together. These take 3-6 months to absorb depending on the type of suture material used. Sometimes surface sutures are also used. These need to be removed by a nurse 5-14 days after the procedure depending on the location of the surgery. Wound care is similar to skin biopsy. Keep it dry for 24-48 hours, and then you can run water over the wound. Don’t rub the wound with soap. Be gentle with it. Dab it dry and re-apply a dry dressing. Pain after the procedure is usually mild. Simple painkillers such as paracetamol are all that are usually needed. If there is any sign of redness, oozing or pus discharging from the wound, please contact me straight away as there could be a wound infection and a course of antibiotics might be needed. Martin’s risk of wound infection is very low at less than 1% of surgical cases.

Follow-up after skin surgery is essential so that the wound can be reviewed and the result of the histology (tissue examination) discussed. Histology not only confirms the diagnosis but also if the tumour has been completely removed. 97% of Martin’s malignant tumours are completely removed at the initial procedure.

If the mole removed is a melanoma, you will need to have a second procedure to take another margin of skin. This margin depends on the thickness of the melanoma and is usually 5-20mm. Patients often wonder why a doctor had ‘two attempts at it’ but this is standard practice because we need to make sure there is not a single melanoma cell left in your body. Re-excision is done at both clinics. In complex cases, Martin will refer patients to a Plastic Surgeon specializing in melanoma management.

Skin surgery will always leave a scar, no matter who performs the procedure. Scarring can be minimized with good surgical technique and post-operative wound care. Some people scar more than others and some areas of the body are more likely to scar e.g. upper anterior chest wall, shoulders and back. Most skin cancers are found on the head and neck and fortunately, the head and neck heals very well due to its excellent blood supply.

Martin regularly provides workplace dermoscopic skin cancer screening for companies. Your staff fill out a skin questionnaire and attend a 15-minute thorough head-to-toe skin examination. He takes the opportunity during the consultation to educate about the symptoms and signs of skin cancer, skin self-examination, sun avoidance and the use of sunscreens

Skin cancer seminars

He also provides 30-40 minute interactive seminars on skin cancer aimed at teaching people about their risk profile, what to look for and how to reduce skin cancer risk. He has lots of interesting photographs and plenty of stories!