Skin Institute

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.

Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC)

This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore.

BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment

Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.

Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC)

This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.

A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.

All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

Malignant Melanoma

This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.

A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

Treatment

It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.

A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.

Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).

A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration.

The following different types of treatments are available for varicose veins:

EVA - Endovenous Laser Ablation

Endovenous Ablation is a technique for destroying the larger faulty veins. This procedure was developed in 1999 and worldwide, hundreds of thousands of patients have been treated with EVA. The procedure is performed under local anaesthetic thus avoiding the unnecessary risk of a general anaesthetic. It is “Walk in, Walk out” technique and you can return to work the same day if you wish.

UGS – Ultrasound Guided Sclerotherapy

Ultrasound Guided Sclerotherapy (UGS), also commonly known as injection treatment, is a non-surgical treatment for varicose veins that are not suitable for Endovenous Ablation. The treatment involves injecting a special solution into the veins, using ultrasound guidance that causes the vein wall to become irritated and collapse. The veins dissolve and disappear over three to six months as the body absorbs them. Ultrasound Guided Sclerotherapy (UGS) is particularly effective for recurrent varicose veins.  Good results have been achieved with closure rates close to 90% at one year.

Microsclerotherapy

Sclerotherapy is a non-surgical way to shrink away those unsightly spider veins, preventing them from causing you any discomfort or embarrassment. Sclerotherapy treats spider veins by injecting a special sclerosant solution into the veins, damaging, shrinking, collapsing and dissolving them, helping to ease your mind from the stress that spider veins can bring and improve the cosmetic appearance of your legs.

Skin Institute has a wide variety of appearance medicine treatments including cosmetic injectables & dermal fillers, IPL, microdermabrasion, peels including Cosmelan, LED light therapy, Skin needling, Platelet Rich Plasma Transfer and more. As everyone has different skin and different concerns, a carefully tailored treatment plan will be recommended to address individual concerns.  

Acne is a skin disorder that is characterised by pimples, blackheads, whiteheads, and, in bad cases, cysts (deeper lumps). Acne usually starts at puberty and is in response to our body’s production of hormones, called androgens. These hormones cause the sebaceous glands (oil-producing glands in the skin) to get bigger and produce more oil. The extra oil (sebum) mixes with dead skin cells and naturally occurring bacteria on the surface of the skin and blocks pores. Once a pore is blocked the bacteria multiply and cause inflammation, which produces the characteristic signs of acne.

Acne commonly occurs on the face, neck, back and chest. Acne can lead to permanent scarring.

Other causes of acne may include:

Acne Vulgaris is the most common form of acne.

Adult Acne occurs in about 30% of people at some stage in their adult life. It is thought that adult acne also has some hormonal influences.

Acne Roseaca is similar to acne vulgaris, with oily skin and spots, but also has flushing or redness of the skin in the affected area. The flush may be set off by certain spicy food or alcohol.

Treatment

Usually acne can be treated successfully, but results do not happen overnight and what can work for one person may not work for another. It may take several months to see initial results, and once it significantly clears treatment is still required to keep it from coming back.

Some medications for acne can only be prescribed by a dermatologist. When acne is treated early the results are very good and it also helps to reduce scarring.

Over-the-counter products are available to treat mild-to-moderate acne, but check with a pharmacist which product is the best for your type of acne. In moderate-to-severe acne, treatment usually requires the help of a dermatologist and often more than one type of treatment. Treatments may include:

antibiotic creamstopical (apply to your skin) retinoidsoral (take by mouth) antibiotics: these reduce the number of bacteria present on the skin which leads to a decrease in inflammationoral contraceptives: these reduce the amount of oil produced by the sebaceous glands. However, possible side effects must be taken into consideration before starting treatmentover-the-counter acne products.

Severe Acne, with deep cysts, inflammation and scarring, should be treated by a dermatologist and in most cases can be successfully treated.

Treatment may include:

surgery: the deep cysts are removed and drainedcorticosteroid injection: used to treat the inflammation, promote healing of an acne cyst and help prevent scarringisotretinoin: an oral medication prescribed by a dermatologist that effectively works on all factors that cause acne. It can also have some side effects so you will need to be continually monitored whilst on this medicationoral antibioticsoral contraceptives.

Seborrhoeic dermatitis

This is an inflammation of the upper layers of the skin, which gradually results in dry or greasy scaling of the affected area. This type dermatitis tends to be chronic and recurrent. It occurs in both infants and adults and tends to run in families. In infants, this condition is known as ‘cradle cap’ when it occurs on the scalp, but can also affect the nappy area to cause ‘nappy eczema’. In adults, the rash tends to occur around the nose, eyebrows and scalp.

Treatment

Infants: wash the scalp with mild shampoo. Oil can be applied to help comb scale out.

Adults: regular use of an anti-dandruff shampoo is often all that is needed.

Corticosteriods can also be applied, only 1% strength to the face. Ketoconazole 1% shampoo and cream are very effective.

Contact dermatitis

Contact dermatitis is inflammation of the skin caused by contact with a specific substance. This happens because of irritation or by an allergic reaction.

Substances that can trigger this inflammation can include cosmetics, soaps, detergents, rubber, nickel (in jewellery) or specific chemicals used in skin creams or from plants.

With an allergic reaction, it is not the first exposure that causes a reaction but may be the next exposure or, in some cases, it is possible to have contact with a substance for a number of years without any skin inflammation occurring. But once the skin has become sensitive, even a tiny amount of that substance can cause a reaction.

Usually contact dermatitis affects only the area that has been in contact with the trigger or irritant (item that has caused the reaction).

Symptoms can vary from a mild rash to a severe rash and blisters, with subsequent scaling and itching. The severity depends on the concentration of the irritant and how long the skin was exposed to it. Once the irritant is taken away, the redness and rash usually disappear over a few days.

Treatment

A dermatologist can perform patch testing to find out which substances are causing the allergic reaction. This is done by placing small discs (with possible allergen-causing substance on them) on the skin and removing them after 48 hours for examination. The patches are then examined again 2 days later, to check for delayed reactions. Once the trigger has been identified, it is important to avoid it as continued exposure may cause a persistent rash, which will be difficult to treat.

Treatment involves the use of steroid creams to decrease the symptoms of the reaction. With severe contact dermatitis, oral steroids or a steroid injection may be given.

Psoriasis is a common, recurring (keeps coming back) skin condition that is hard to treat. It is characterised by raised patches of skin (known as plaques) that are red, thickened and scaly that commonly occur on the elbows, knees and scalp, but can affect any parts of the body.

Psoriasis usually starts out as a small spot that is excessively flaky and that gradually enlarges, then other plaques start to appear. Sometimes the flaking can be mistaken for dandruff. These areas are not always itchy. It is unusual in children and more common in adults.

Psoriasis happens when new skin cells are produced at a faster rate than the dead skin cells are removed, thus excess skin cells form in thick scaly patches on top of the skin. The reason this happens is unknown, but it is known that: it may run in families; it may be triggered by infection, injury or stress; it is associated with the use of certain medications; and it is associated with psoriatic arthritis.

There are different types of psoriasis and a person can have more than one type at a time.

Plaque psoriasis – the most common type, which keeps recurring, or coming back, over a lifetime. It can develop at any age. Symptoms are: plaques on the elbows, knees, nails, scalp, and behind the ears. This condition can be itchy at times. When it occurs on the nails, it is associated with discolouration and pitting of the nail.

Guttate psoriasis – this type is more common in children and young adults and often follows a bacterial throat infection. It appears as many coin-shaped pink scaly plaques usually covering the back and chest. It can be itchy. Guttate psoriasis usually disappears over time and does not recur, although if someone has guttate psoriasis they are more likely to go on to get other types of psoriasis at a later stage.

Pustular psoriasis – a rare and potentially fatal condition that generally affects adults. Symptoms are: small pus-filled blisters on palms of hands and soles of feet, with areas of skin that are painful, red and inflamed. Some scaling and thickening may be seen.

Inverse psoriasis – this commonly affects the elderly. It is characterised by large moist reddened areas of skin occurring in skin folds such as the groin area, armpits and under the breasts. This type of psoriasis is easily treated, but is also recurring.

Psoriasis can be hard to diagnose as other conditions have similar symptoms. To confirm a diagnosis a skin biopsy (small sample of skin is removed for examination) can be taken.

Treatment

Treatment can begin once a diagnosis is made and usually involves both topical (applied to the skin) and generalised treatments. There is no cure for psoriasis but treatment can control symptoms.

Topical treatments:

Oral medications such as etretinate, retinoids, methotrexate or cyclosporin can be prescribed, under the guidance of a dermatologist.

A generalised treatment such as ultraviolet light therapy may be effective and can be combined with an oral medication, which makes the skin more sensitive to the effects of light. This treatment is called PUVA or UVB and is given under the direction of a dermatologist.