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Skin cancer – cutting your risk

As a Consultant Dermatologist and specialist Dermatological Surgeon, Dr Conal Perrett treats many cases of skin cancer each year. Most are the common basal cell carcinomas, which grow slowly and can be treated successfully. Other types of skin cancer can, however, be more aggressive.

Dr Perrett supports Sun Awareness Week 5-11 May 2014, an event set up by The British Association of Dermatologists, to raise awareness of the damaging effect of too much Sun on the skin.

“Last month, data published by Cancer Research UK showed that the number of people diagnosed with malignant melanoma, the most aggressive and dangerous form of skin cancer has gone up worryingly. Before it was usual for people to have holidays in the sun, in the 1960s, around 1800 cases were seen in the UK each year. Now its more than 13,000 in any one year and 2,000 people die.”

Risk factors for skin cancer

More exposure to the sun is not the only cause of the increase – it’s also connected with the use of sunbeds and the ‘tanned’ look that became popular in the 1970s and 1980s and still is sought after by many people.

“My advice would be that you should avoid sunbeds and tanning sessions. Spray tans and other cosmetic products have improved and give a natural tan and a good beautician can control the colour very accurately. Lying in the Sun until your skin gets red is also a bad idea, but that doesn’t mean that you need to hide in the dark.”

“Being out in the sunshine and fresh air is a good thing – just make sure that you dress sensibly, wearing a hat, sunglasses and clothes to cover your skin when the sun is strong. Even in the UK, midday sun in May can damage fair skin.”

“Wearing a good sunscreen is also essential, particularly for babies and young children. Choose a higher factor if your skin is pale and you are prone to freckles and babies and encourage older children to apply sun cream for themselves as soon as they can. Reapply it during the day and after swimming or splashing about in water.”

Worried about your skin?

If you have a mole that you are worried about or other mark on your skin that is sore, weeps or bleeds and that doesn’t heal for 3-4 weeks, get some medical advice.

“Your GP can help rule out something very sinister but you can also make an appointment with a dermatology clinic to have a complete mole screen and skin check for peace of mind. Spotting skin cancers at an early stage can be tricky: our dermatologists have many years of experience and can then advise on the best treatment.”

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What are cosmeceuticals?

Cosmeceuticals is a portmanteau word for products that combine the effects of both cosmetics and pharmaceuticals. These products claim a wide range of skin care benefits, such as anti-aging, anti-wrinkle and firming effects, in addition to cosmetic functions.

Cosmeceuticals are becoming more common and more widely used in the UK, but its important to be cautious when opting to use them. Dr Conal Perrett, a Consultant Dermatologist with many years experience of medical and cosmetic dermatology offers only those cosmeceutical treatments that have a good reputation and that are likely to benefit your skin.

Are cosmeceuticals regulated?

Cosmeceuticals are not regulated in the same way as mainstream drugs or medical treatments, and they do not have to undergo a programme of rigorous testing before they are approved for use. As long as the product is not marketed as a pharmaceutical, it does not need approval by the health authorities.

However, any claims made by cosmeceuticals must be backed up by strong clinical or scientific evidence. In the UK, the Advertising Standards Authority will carefully check the legitimacy of any claims before allowing advertising or marketing to go ahead. If a product makes a medical claim that cannot be substantiated, or which is not backed by a reliable, scientific study using a large enough sample, then the ASA can ask for the ad to be removed.

To avoid such action, comeceutical advertising often makes vague or unspecific claims, using language that is hard to quantify or disprove. These claims are often related to the success of a proportion of a relatively small sample. (eg “8 out of 10 women said they felt their skin looked younger” – referring to just 68 out of 85 women).

Do cosmeceuticals work?

Cosmeceuticals contain a variety of chemicals with known skin health benefits. These include:

  • Vitamin C and E – for sun protection and anti-oxidant properties
  • Coenzyme Q10 – to prevent free radical damage and rejuvenate your skin
  • Peptides – to promote collagen production and firm the skin
  • Retinoids – to rejuvenate skin and inhibit the skin ageing process
  • Retinols – to clean and maintain the skin
  • Hyaluronic acid – to boost skin volume

However, it is important to remember that many high street cosmeceuticals, especially those at the cheaper and of the scale, generally do not contain enough of these active ingredients to make any significant difference to your skin. Even the really expensive creams and lotions, with high concentrations of the active ingredients, will not match the quality or potency of products that you will obtain through treatment with one of our medical dermatologists.

Taking care with cosmeceuticals

Top of the range cosmeceuticals often cost a lot of money for a very little jar, so you should take great care when choosing these products. Always read the small print, check the evidence that the claims are based on and stick to reputable brands with a well established track record in skin care science.

Alternatively, you can just let your cosmetics be cosmetics and leave your skin care in the fully qualified and highly experienced hands of your dermatologist.

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Are nail lamps a skin cancer risk?

Hardly a week goes by without some sensational story in the media about a new cancer risk or a new carcinogen discovered in our every day environment. A typical example of this is the recent study into the skin cancer risks from UV lights used in nail salons.

UV lights are commonly found in nail salons and high street beauticians, and are used to dry and cure nail polishes, varnishes and other finishes such as acrylic nail fillers. They consist of a small box containing a ultraviolet lamp, with an opening at the front into which the hand is inserted. The concern was whether this exposure to UV rays would be harmful to the skin of the fingers and potentially be a cause of skin cancer.

What did the study show?

This was the first study to use a range of actual salon lamps for testing. Dr Lyndsay Shipp and her colleagues tested 17 different UV lights found in 16 different nail salons. The lamps had an assortment of bulbs of different wattage, emitting a range of irradiance.

Having thoroughly tested the bulbs under laboratory conditions, the researchers found that the high power bulbs did indeed produce higher levels of dangerous UV radiation, which is associated with DNA damage and subsequent skin cancers. Inevitably, this sparked scare mongering headlines in the more sensationalist media, suggesting that weekly manicures could cause skin cancer.

However, a more careful examination of the results shows that this is unlikely to be the case. In fact, the team concluded that while the level of UV-A was, in theory, potentially dangerous, the exposure time for the average nail station client was so short that even with multiple exposures to the lamps, the risk of developing skin cancer as a result remained small.

What this means for you?

With so many ill informed headlines about, it can be difficult to know what to believe, but the Health Information Officer from Cancer Research UK, Dr Indrayani Ghangrekar, made the message plain. “Studies have shown that UV nail lamps are likely to pose very little skin cancer risk,” she explained.

The organisation is far more concerned at the lack of awareness of the skin cancer dangers of excessive sun exposure, which presents a far higher risk than a few minutes under a nail lamp once a week.

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Mohs microsurgery – a brief history

Mohs micrographic surgery is a precise technique that is used to remove skin cancers such as basal cell carcinomas and squamous cell carcinomas. The surgery ensures the complete removal of the cancer cells, with minimum damage to healthy tissue around the cancer.

Mohs microsurgery is particularly useful for skin cancers on the face and hands, where preservation of as much healthy tissue as possible is paramount. The principle is to remove the lesion in thin layers, examining each piece of tissue that’s been taken away under a microscope during the surgery. The surgery is finished only when the surgeon is confident that the entire cancer has been removed. The margin of healthy tissue removed with it is minimised as the edges of the tumour are precisely detected. This means faster healing and less scarring afterwards.

The origins of Mohs microsurgery

The Mohs technique was invented, developed and refined over decades of work at the University of Wisconsin and at Wisconsin General Hospital. Dr Mohs performed the technique for the first time on 30th June 1936 while working from a single room clinic at the hospital; he went on to train doctors across the world in the technique that would eventually bear his name.

The Mohs technique was initially rejected by many surgeons because they were not keen on the idea of having to learn the new skills in histology and slide preparation that are an essential part of the procedure. However, it was embraced by dermatologists, who were already familiar with these procedures.

Dr Mohs technique originally involved using a chemical paste of zinc chloride and bloodroot to cauterise and kill the affected area ready for the surgery. However, in 1953, it is said that he performed a fresh tissue excision by accident, and was so surprised with the enhanced results that he changed his technique. Most chemosurgeons changed to the fresh tissue method soon afterwards as the new method had the benefit of allowing full excision and closing of the wound on the same day.

Improving the technique for Mohs microsurgery

The Mohs surgery technique was improved in the 1970s by Perry Robins, who introduced the idea of using a local anaesthetic and then freezing the excised tissue ready for examination. Although Mohs chemical paste is no longer part of the technique, the term chemosurgery is still sometimes used to refer to Mohs microsurgery.

While Frederic Mohs was the pioneer and lifelong advocate of his famous technique, he has enjoyed the support and inspiration of many leading scientists along the way. These include his original mentor, the zoologist Dr Michael Guyer, Bob Patnaude, his trusted technician of almost 40 years, and Dr Theodore Tromovitch, who published a revolutionary paper on fresh, unfixed tissue excision.

Frederic Mohs died in 2002 aged 92, having dramatically improved the outcome for countless skin cancer patients around the world.

Mohs microsurgery today

Today’s dermatology surgeons have advanced microscopes but the technique is essentially the same. Experience is hugely important – Dr Conal Perrett is one of the UK’s leading experts in Mohs microsurgery and he operates on many cases each month, both in private practice and in the NHS.