SERVICES | smdc -Covid

Services We Offer:

Offering a wide range of patient services:

Detailed Information:

Full skin examination with Dermoscopy

Dermoscopy uses a hand-held magnifying device combined with either the application of a liquid between the transparent plate of the device and the skin, or the use of cross- polarised light. It allows the visualisation of diagnostic features of skin lesions that are not seen with the naked eye.

Dermoscopy increases diagnostic accuracy and confidence in diagnosis, and reduces unnecessary excision of benign lesions. In expert hands it has been shown to improve the diagnosis of nearly all coloured lesions, including moles and melanoma. Training and utilisation of dermoscopy is recommended for clinicians routinely examining pigmented skin lesions.

We have researched this technique for over two decades, and published many books, book chapters and journal articles on the subject.

Skin surveillance is recommended for patients identified to be at high risk of melanoma and non-melanoma skin cancers (NMSC), including patients with a previous diagnosis of melanoma. Who is at risk? :

Causes of melanoma and other skin cancers:
- Unprotected exposure to UV radiation remains the single most important lifestyle risk factor for melanoma and other skin cancers.
- UVA and UVB radiation contribute to skin damage, premature ageing of the skin and skin cancer.
- Melanoma and Basal cell carcinoma (BCC) are associated with the amount and pattern of sun exposure, with an intermittent pattern carrying the highest risk. UV exposure in adulthood as well as in childhood contributes to BCC and melanoma risk.
- Premalignant actinic keratoses and Squamous cell carcinoma (SCC) are associated with the total amount of sun exposure accumulated over a lifetime.
- Other risk factors for NMSC can include exposure to some chemicals (e.g. arsenic); radiation therapy and psoralen (PUVA) treatment for psoriasis; immunosuppressive therapy; and some rare genetic conditions predisposing people to skin cancer.

Risk factors for melanoma:
- Multiple naevi (moles)
- Multiple dysplastic naevi
- Personal or family history of melanoma
- Increasing age
- High levels of intermittent sun exposure (e.g. during outdoor recreation or holidays spent outdoors)
- Personal history of NMSC
- Fair skin that burns easily, freckles and does not tan
- Having fair or red hair and blue or green eyes
- Immunosuppression and/or transplant recipients

Digital Dermoscopy Monitoring

Atypical lesions. The doctor may select one or a few lesions of concern for dermoscopic monitoring

Sequential digital dermoscopy imaging (SDDI) involves the assessment of successive dermoscopic images to allow the detection of suspicious dermoscopic change in melanomas that lack dermoscopic evidence of melanoma at a particular time. We perform 3 months short-term digital monitoring and 6 months long-term monitoring.
Short term computerized (digital) monitoring over a 3-month period has sensitivity of 94% and specificity of 83% for the diagnosis of melanoma.
99.2% of lesions that are not changing in 3 months are benign. 96% of melanoma are changing after 3 months.
Long term computerized monitoring over a 6-month period has a sensitivity of 97% for the diagnosis of melanoma.

Total body photography (TBP)

Total body photography allows the detection of suspicious change and is useful in high-risk patients or patients with dysplastic naevus syndrome.
This technique allows detection of early melanomas that present no features for melanoma yet, but the changes in the TBP give the clinician additional information. It also decreases unnecessary excisions of atypical lesions if they are longstanding and not changing in TBP.
TBP will give the patient a complete digital photography record of their entire skin on USB. This enables the patient to check his or her own skin at home or at any doctor’s surgery. Base line images are taken at your first visit and then repeated every 12 months for an automatic comparison of your skin lesions. This will aid in the earlier detection of melanoma and non-melanoma skin cancers

DermoScan X2: Standardized, automated full-body documentation

How does it work?

Baseline images at first visit
Yearly photos for automatic comparison of skin lesions: Analyzes and highlights differences within seconds
Your doctor will analyze the changes
Benefits:
- Time-saving procedure
- Detection of early featureless melanomas
- Avoid unnecessary excisions

For whom?

Everybody can benefit but in particularly people with multiple lesions
Talk to your doctor if you are interested

In vivo Confocal Microscopy

In vivo confocal microscopy allows non-invasive “optical biopsy” with the visualisation of the morphology and organisation of the cells inside the skin. It is useful for doubtful lesions on dermoscopy and to assess the margins of some lesions (i.e. amelanotic melanoma, lentigo maligna).
Lentigo maligna (LM) is a slow growing form of melanoma in situ that can be difficult to recognise. LM can resemble a freckle and develops in heavily sun-damaged older skin, especially on the head and neck.
- Confocal microscopy allows differentiating LM from benign freckles or solar lentigines, avoiding biopsies in cosmetically sensitive areas.
- It is also useful when there is a suspicious lesion prior to cosmetic procedures to reassure facial pigmented macules are benign.
- Margin determination of LM can be challenging because of it’s frequent amelanotic component (non pigmented area with melanoma cells that extend beyond the pigmentation we see on the skin), therefore there is more frequent local recurrence than other types of melanoma.
- Confocal microscopy can help delineate the margins before the surgery or to decide the better treatment approach depending on the extent of the lesion.

High Risk Clinic

This clinic was funded at SMDC with a grant for 10 years from the NSW cancer institute and has now rolled out in various locations due to its success. It has demonstrated its utility in diagnosing melanomas at an early stage and decreasing unnecessary excisions with the use of total body photography and digital monitoring. We have also proven that it is very cost effective and we are now lobbying the government to obtain medicare reemboursement of the TBP and monitoring with regular dermatology review for high risk patients.
It is intended for patients with multiple melanomas or dysplastic naevus syndrome and a personal melanoma or 4 family members with melanoma.

Lesion of concern Clinic

The purpose of this clinic is to give fast access to an expert who will immediately assess a specific lesion of concern for the patient.
The doctor will tell the patient the diagnosis, giving peace of mind in cases of benign lesions, or organizing a quick excision in cases suspicious for malignancy.

When to suspect melanoma?
- The ABCDE acronym can help distinguish a melanoma from a normal mole:
  - A. Asymmetry: the lesion is irregular in shape or pattern.
  - B. Border: the border or outline of a melanoma is usually irregular.
  - C. Colour: there is variation in colour within the lesion.
  - D. Diameter: the lesion is usually greater than 6 mm across. However, suspect lesions of smaller diameter should also be investigated.
  - E. Evolving: the lesion changes over time (size, shape, surface, colour, symptoms e.g. itch).

When to suspect a non-melanoma skin cancer?
- The EFG acronym can be of help:
  - E. Elevated: the lesion can appear as a small, round and raised lump on the skin. Colour may be uniform throughout the lesion and may be black, brown, pink or red.
  - F. Firm: the lesion feels firm to the touch.
  - G. Grows: a nodule that has been growing progressively for more than a month should be assessed as a matter of urgency.

Any lesion that displays the ABCDE or EFG features over a period of more than one month should be investigated. If nodular or thick melanoma is suspected, diagnosis should not be delayed, and urgent referral to an expert or immediate excision is recommended.

Procedures

Cryotherapy (liquid nitrogen therapy) for precancerous lesions such as actinic keratoses, as well as for superficial basal cell carcinomas
Curettage (deep scrapping of the lesion, suitable for superficial non melanoma skin cancers)
Diathermy/electrodessication (cauterisation to remove superficial non melanoma skin cancers and also to contain the bleeding)
Biopsies for suspicious lesions
Excisions in a day procedure clinic with local anaesthetics