This is the content template



Sun protection whilst skiing

Most people don’t realise they are at greater risk of UV damage while skiing than when on the beach. On the slopes, the skin is exposed to high levels of UV light, absorbing both the direct UV rays from the sun and the UV rays reflected off the snow.

Reasons why UV damage is greater

There are two main reasons why UV damage is greater when skiing. Firstly, the higher altitude of the alpine region means you are closer to the sun’s rays. The atmosphere is also thinner than at ground level, which means there is less pollution to filter out UV radiation.

Secondly, because the snow reflects 85% of UV rays even on cloudy days, there is risk of sun burn in unusual areas of the body, such as the underside of your chin, scalp and behind the ears.

The link between sun exposure and skin cancer

Over 100,000 new cases of skin cancer are diagnosed in the UK every year. More than 90% of all cases of skin cancer are associated with sun exposure.

Tips to prevent sunburn

If you’re heading to the slopes this winter it’s important to use sun protection. Here are some recommendations:

  • Use sunscreen with a minimum SPF of 30. A sunscreen with glycerin or lanolin will also help protect the skin from harsh cold and wind.
  • Apply sunscreen 30 minutes before hitting the slopes
  • Carry a travel sized sunscreen with you and reapply every couple of hours
  • Cover up as much as possible. Wearing a face mask, long sleeves and gloves will keep your skin warm and protected from overexposure
  • Skiing off peak, before 10am or after 4pm, will help avoid long queues and the strongest UV rays

This is the content template



Survey finds people don’t know much about skin cancer

A major survey by the British Association of Dermatologists reveals that only one person in 25 checks their skin for signs of skin cancer once a month. Checking is recommended every four weeks to spot any skin cancers as soon as possible so they can be treated promptly.

“The survey also found that most people are generally not aware of what to look out for. Few people seem confident that they would be able to spot the signs of either melanoma skin cancer (the most aggressive form) or non-melanoma skin cancer,” explains Dr Conal Perrett, Consultant Dermatologist, The Devonshire Clinic.

Over 1000 people were interviewed for the study, which was published last week during Sun Awareness Week.

Worrying lack of skin cancer awareness

  • Only 4% of people in Britain do not check their skin once a month. Around 6% of people look at their skin for signs of skin cancer once a year, but the British Association of Dermatologists warns this is not enough.
  • Over three quarters of people said they would not know how to recognise a developing melanoma skin cancer. Over 80% said they would not know a non-melanoma skin cancer if they saw one.
  • Almost 90% of those surveyed thought that skin cancer was no easier to remove than any other type of cancer.

Melanoma: what to look for

“Melanoma skin cancers often arise in a mole, so checking your moles regularly or having an expert mole check is a good idea, particularly if you have a lot of moles,” says Dr Perrett.

Signs to look for include:

  • A mole that grows, becoming bigger in just a few weeks
  • A mole that changes its colour, or develops several different colours
  • A mole that alters in shape
  • Any large moles – those over 7mm in diameter need to be checked by an expert
  • Any moles that bleed or become sore or that weep fluid
  • Any moles that hurt or become itchy

Mole checks at The Devonshire Clinic include digital mole mapping. A detailed photograph of the skin on every part of your body is taken and stored. We use advanced computer software to compare your current mole map with previous ones so that we can detect any changes in shape or size, or any new moles that have developed.

13,000 people are diagnosed with melanoma skin cancer in the UK each year. It can be highly aggressive, spreading quickly in the skin and then to the lymph nodes and other parts of the body. This type of skin cancer kills over 2000 people each year.

Non-melanoma skin cancer

This type of skin cancer is less likely to become invasive and spread through the body and is easily treated if caught early.

Signs to look for include:

  • A sore patch of skin that doesn’t heal. This usually appears in a region of skin that is often exposed to the sun, but non-melanoma skin cancers can develop anywhere.
  • A small lump in the skin. A basal cell carcinoma often looks red or pink but it can have a whitish centre, a bit like a small pearl. A squamous cell carcinoma is more likely to have a scaly or crusty surface.
  • A lump that grows slowly but then ulcerates and becomes sore.

The link between skin cancer and the sun

“It is particularly worrying that this survey found that over 70% of people had been sunburnt at least once in the previous 12 months. Despite strenuous efforts to make people aware that even mild sunburn can damage the skin, increasing the risk of skin cancer, few people seem concerned,” notes Dr Perrett.

Although skin cancer is treatable when detected early, prevention is better. Using a good sunscreen whenever you go out in the sun, avoiding the strongest sun and covering up with a hat, long-sleeves and sunglasses are all recommended.

Treating skin cancer

Dr Conal Perrett is a leading expert in Mohs micrographic surgery, the gold standard technique that removes skin cancers layer by layer.

“Mohs surgery allows us to remove the cancer in its entirety. The cancer is removed layer by layer and we examine it under the microscope on the same day. It has the highest cure rate available and is associated with the lowest chance of recurrence. Furthermore, it is also tissue sparing, which means we only take the tissue we need, so it leaves less scarring than other surgical methods” he explains.

Dr Perrett stresses that all skin cancers are treatable if diagnosed early. Non-melanoma skin cancers can be removed safely and completely, with no impact on your future health. Melanomas may need more aggressive treatment but if they are removed before they have started to spread, survival rates are extremely high.

“Skin cancer is one of the most curable cancers – if we catch it early. I would encourage everyone to check their skin once a month and seek medical advice on any worrying signs. At The Devonshire Clinic we offer complete skin checks and mole screening to set your mind at rest.”


Contact us to make an appointment or to find out more…

This is the content template



One step nearer to a skin cancer vaccine?

Dr Conal Perrett, Consultant Dermatologist The Devonshire Clinic, comments on an exciting new study showing that a skin cancer vaccine can help treat patients with advanced melanoma skin cancer.

The study is published in a leading journal but the full development of a skin cancer vaccine could still be several years away.

What is a cancer vaccine?

When researchers talk about cancer vaccines, they don’t mean a childhood injection that protects you from cancer in later life. It has long been thought that if we knew more about cancer antigens – the little flag-like molecules that stick out all over the surface of a cancer cell – it might be possible to develop a vaccine against them.

The idea of a cancer vaccine is that it is tailored to each individual person with cancer. Their cancer cells are studied, the flag-like antigens are identified, and a vaccine is made to give to that person by injection. As their body responds by producing an immune response to the components of the vaccine, this enables the body to destroy the cancer cells more easily.

No cancer vaccine has yet been developed but there has been some exciting news recently that suggests we are getting close. Researchers in the USA have been busy analysing the cancer antigens on malignant melanomas, skin cancers that are extremely dangerous and aggressive.

Unlike other skin cancers, melanomas are more likely to spread within the skin and often to other parts of the body. They are more difficult to treat than other types and have the highest fatality rate.

Melanomas are aggressive because their DNA has become completely messed up. Instead of having just a few mutations in their DNA, they have hundreds or even thousands. This means that the flag-like antigens they show on the surface are different in every patient with melanoma.

Trialling a potential vaccine against melanoma skin cancer

The respected journal Science has just published a study on just three patients who were given a personalised cancer vaccine after the cancer antigens on their melanomas were studied. Each vaccine for each person was different and took 3 months to prepare. But when it was given to the patients, they all did much better. The vaccine stimulated their immune systems to attack the cancer cells within their melanoma.

  • One patient no longer shows any sign of cancer.
  • The second patient still has melanoma but the tumours are not developing or growing.
  • The third patient had a large tumour, which shrank significantly after the vaccine was given. It is now small and stable and shows no signs of re-growing.

Researchers are cautious but optimistic

This type of clinical trial is often called a proof of concept study. It demonstrates that the principle of a cancer vaccine is a valid one, even if the techniques and details need much more study.

In addition to treating melanoma skin cancers, cancer vaccines could also be developed against other types of cancer that show a huge number of genetic mutations – such as aggressive lung cancers and breast cancers that carry the BRCA1 mutation.

This type of cancer vaccine is going to take a lot more time to develop and it is hoped that the time to generate the vaccine for each patient will reduce from three months.

“This is very good news,” comments Dr Conal Perrett, Consultant Dermatologist The Devonshire Clinic and a leading UK expert in skin cancer. ‘Melanoma is the deadliest type of skin cancer and kills over 2000 people every year in the UK. It is the fifth most common cancer and accounts for one in every 100 deaths that occur due to any type of cancer.”

“This preliminary study highlights the potential of harnessing the immune response to target skin cancer. Further studies are now required to take forward this concept of personalised vaccines for skin cancer.”

Find out more

If you are interested in finding out more about the private treatments available for skin cancer, or the would like skin cancer screening, please contact us to arrange an appointment with Dr Conal Perrett or one of his team of dermatologists at The Devonshire Clinic

This is the content template



Holiday sun linked to skin cancer risk

More than 5,700 people in the UK aged 65 and over are now being diagnosed every year with malignant melanoma – the most serious form of skin cancer – compared to only 600 in the middle of the 1970s. Although all age groups are showing an increase, the rise is the most dramatic in this older age group.

Dr Conal Perrett, Consultant Dermatologist and a leading expert in skin cancer at The Devonshire Clinic, a leading private skin clinic London, says that the latest figures highlight the growing skin cancer epidemic we have seen emerging over the last 30-40 years.

“Skin cancer is linked to sun exposure and these figures are a reflection of the proliferation of cheap package holidays and air travel, as well as the desire to acquire a suntan. It is only years later that the potentially dangerous effects of the sun on our skin are seen…”

It’s well known that skin cancer is linked to sun exposure. Sunbathing without sun protection, getting sunburn and not covering up when the sun is at its hottest in the middle of the day all increase skin cancer risk.

But in the 1960s and 1970s, when cheap package holidays to resorts abroad first became affordable for the average family in the UK, people were not aware of the damage the sun could do to their skin.

Having a deep tan was considered ‘healthy’ and sunbathing on a European beach was the height of luxury, a treat for the rest of the year spent working hard. While parents took care to make sure their children didn’t burn, the young adults going on holiday back then were less worried about themselves.

Four or five decades later, the skin damage that resulted from those holidays has been linked with the current increase in skin cancer in elderly people.

All cancers are more likely the older you get, but having sunburn just once a year when on holiday seems to be enough to increase the risk of all skin cancers. This includes the most aggressive, malignant melanoma, which can spread to other parts of the body and can be fatal. Over 2000 people in the UK die from malignant melanoma each year.

Read more about skin cancer

 How to stay safe in the sun

Dr Perrett’s advice is in line with that of other leading experts and the British Association of Dermatologists:

To avoid skin damage due to ultra violet light:

  • Cover up – wear a tee-shirt in the hottest part of the day. Make sure the material is not too thin – you can get sunburn through some fabric. Wear a hat and sunglasses.
  • Use a high quality sunblock – at least factor 30 and a reputable brand. Apply every 3-4 hours and after swimming.
  • Stay in the shade – particularly in the hottest part of the day. Locals retire for a siesta for good reasons.
  • No sunbeds – never be tempted to use a sunbed to pre-tan or to maintain a holiday tan. Spray tans are extremely good these days and will give you a tanned appearance without the danger.

Sun awareness week

Every year in the UK, the British Association of Dermatologists runs an awareness campaign. This aims to let people know how to stay safe in the sun during their holidays. And during the British Summer, because getting sunburned at home also increases your risk of skin cancer.

In 2015, Sun Awareness week is 5-11 May.

You also need to think about…

Dr Perrett adds some reminders about situations in which you can get sunburnt, even if you think you are playing safe:

  • Spring sunshine – even in the UK we do have some warm sunny days early in the year – Easter this year has been very warm for most of the country. You still need sunscreen because even this ‘weak’ sunlight can cause skin damage.
  • Hazy sunshine – the sun’s ultraviolet rays can penetrate mist and haze so take care in situations such as a sea mist or a hazy but warm summer day.
  • At the seaside – the air feels cooler by the sea, particularly in UK resorts. Don’t be fooled – if the sun is shining, use sunscreen. The rays are reflected back from the water and are still dangerous.
  • Snow and sunshine – going on a skiing holiday? You can get sunburnt in January in the freezing cold without proper sunscreen. Like water, the snow is a great reflector so those ultraviolet rays are extremely intense.

This is the content template



Combining Skin Cancer Treatments – London Dermatology

Today, Dr Conal Perrett, a leading skin expert with his own private dermatology clinic London, presents his team’s findings after trialling a combined treatment for superficial basal cell carcinoma, a common form of skin cancer.

He is speaking at the American Academy of Dermatology’s Annual Meeting in San Francisco, USA. Dr Perrett will describe the study in detail to some of the world’s leading experts in treating skin diseases.

Find out more about the American Academy of Dermatology [link:]

Combining two successful treatments

Dr Perrett’s work involved testing two treatments that are usually used separately to see if they worked better when given close together.

Photodynamic therapy (PDT)

A patient with a basal cell carcinoma is given a drug that is activated only in the presence of a bright light. The drug is preferentially taken up by the cancer cells and is then activated by a high intensity light directed accurately at the site of the cancer.

Activation of the drug just in that region of the skin kills the cells and destroys the skin tumour.

Results in patients treated only with PDT are good: the skin cancer in 90% of patients disappears within three months. Less than a quarter (22%) find that the cancer comes back and requires more treatment within two years.

Imiquimod cream (Aldara®)

Imiquimod cream is applied directly to the basal cell carcinoma. Its active ingredient is described as an immunomodulator. It acts on the immune system, stimulating the body’s own defences to destroy the cancer cells.

Its easy to apply and results are excellent. Around 80% of patients report that their basal cell carcinoma disappears within three months and only 20% have a recurrence within two years.

Results from The Devonshire Clinic

Dr Perrett’s latest study performed in a small number of patients treated using both PDT and imiquimod demonstrates even better results.

PDT was given first, with two treatments one week apart. Two weeks after the second PDT session, they were given imiquimod cream (5%) to apply every day for four weeks.

By three months, the basal cell carcinoma had completely disappeared in 94% of patients, which is better than the resolution rates seen with either treatment alone.

The study is still ongoing but by 12 months after the first PDT treatment session, only one patient had experienced a recurrence of their skin cancer.

Dr Perrett says: “This pilot study shows the potential benefit of combining two established treatments for skin cancer, namely photodynamic therapy (PDT) and imiquimod (Aldara®). Our results suggest that they may be more effective when used together than individually. We now need to perform a larger study to examine this further.”

About basal cell carcinoma

This form of skin cancer is very common, affecting millions of people worldwide each year. It is caused by exposure to sun in most cases.

Although basal cell carcinomas rarely spread through the skin or to other sites of the body, it can have a devastating effect on your quality of life. Tumours on the face or other visible parts of the skin can become very obvious, particularly if they grow large or ulcerate. Because they can invade into surrounding tissues and cause significant destruction and morbidity, prompt diagnosis and treatment is important

The Devonshire Clinic offers a complete skin cancer screening service with mole check on an annual basis for private patients.

To find out more or book an appointment contact our private dermatology clinic London.

This is the content template



New skin cancer drug approved – London Dermatology

Fast-tracked through the new Early Access to Medicines Scheme

The new drug, pembrolizumab, has been developed to treat advanced skin cancers such as melanomas that have started to spread through the body. Although it has not yet been licensed in the UK, a new scheme has made it available for people already very ill with their disease.

‘The arrival of pembrolizumab represents an exciting new development in the treatment of advanced melanoma’, comments Dr Conal Perrett, Consultant Dermatologist The Devonshire Clinic. “It is encouraging to see that it has been fast tracked to patients by the Early Access to Medicines Scheme (EAMS), an initiative set up by the UK government last year,” he adds.

Available for patients with advanced melanoma

The Early Access to Medicines Scheme allows a drug that is showing great promise but that has not yet been approved and licensed to be prescribed by doctors and consultants for the patients who most need it. In this case, this includes people with advanced melanoma skin cancer who have no other treatment options other than palliative care.

What does pembrolizumab do?

Pembrolizumab is one of a new generation of anti-cancer drugs that focus on helping the body’s own immune system recognise and kill cancer cells. When melanoma, one of the most aggressive forms of skin cancer, starts to spread throughout the body, it can be fatal. The drug blocks a process within the cancer cells that they use to hide from the immune system.

With no ‘cloaking device’ the cancer cells are open to attack my cells of the immune system and this can help fight the cancer throughout the body.

The advantages of releasing the drug early

Usually, new cancer drugs that are already shown to be safe and show great promise need to be officially licensed by the Medicines  and Healthcare Regulatory Agency (MHRA) and approved by the National Institute for Clinical Care Excellence (NICE).

Under the EAMS scheme, regulators carry out a very thorough evaluation of the evidence behind the drug’s potential and then recommend that the drug is made available. It then goes through the normal, and often lengthy process of becoming licensed and then approved for use in the NHS.

The most severely ill patients can access treatment and more data from their response to the new drug can be collected during this time. It is hoped that this will avoid delays and will show which patients can benefit from it the most in the future.

What is melanoma?

Melanoma is a form of skin cancer that can spread through the body and that kills in excess of 2000 people in the UK every year. Spending long periods of time in the sun, or on sunbeds, is a major risk factor for melanoma.

The Devonshire Clinic offers a complete skin cancer screening service with mole check on an annual basis for private patients.

To find out more or book an appointment contact our private dermatology clinic London.

This is the content template



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.”

This is the content template



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.

This is the content template



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.