Skin Specialists and Skin Cancer
Almost every high street boasts a ‘skin clinic’. These frequently offer anything from skin peels and acne treatments, to Botox and laser therapy. More often than not their Staff do not include Dermatologists.
Only Dermatologists have the in-depth training and experience to be true ‘skin specialists’. All UK Dermatologists are qualified Medical Doctors and have trained in general medicine before passing the Royal College of Physicians membership examinations. Thereafter at least 4 years are spent as a trainee Dermatologist, progressing through the years to Consultant level. Upon completion of this high quality, regularly appraised training, a Certificate of Specialist Training is awarded and entry is gained onto the GMC Specialist Register. Thus only fully accredited Dermatologists are listed on the Specialist Register.
Commercial mole check clinics are becoming increasingly popular, particularly in urban centres. Their growth has been dependent upon the development of software systems that interpret the images from dermatoscopes – precision hand-held magnifying tools, which enable the patterns of pigmentation and blood vessels within lesions to be assessed. Whilst some patients can benefit from such checks, software systems can never reproduce the intuition and art of medical practice. Dermatologists have carefully honed visual diagnostic skills and are able to interpret findings based on a global cutaneous assessment rather than just looking at one ‘spot’. All Dermatologists have seen melanomas that would not have been picked up using standard algorithms. Moreover, recent research has shown that 80% of melanomas detected by Dermatologists are incidental findings, that is, they were not noticed to be a concern by the patient or other healthcare professionals.
Melanoma is the most serious type of skin cancer. Melanoma rates in the UK have increased by 370% since the late 1970’s, largely attributable to more accessible sunny holidays and the use of sunbeds. Until the desirability of a ‘natural’ tan wanes, this climb in incidence is unlikely to change.
Non-melanoma skin cancers are also on the increase. These are related to excess sun exposure, usually over many years. Basal cell carcinomas are the most common skin cancer. These are slow growing and with the exception of very large, usually neglected lesions (>10cms in size), they do not spread to other parts of the body. Squamous cell carcinomas are the second most common skin cancers. These have the potential to spread, usually via the local lymph nodes. At Kingston Hospital we have seen the diagnosis of Melanoma and Non-Melanoma skin cancer more than triple in the last 5 years.
Further information regarding skin cancers can be found at www.cancerresearchuk.org/about-cancer/skin-cancer.
It is important to practice safe sun measures, whatever your age and skin type. Contrary to popular belief, people with pigmented skin can also burn. Babies and very young children should be kept out of direct sunlight. All other ages should avoid direct sun exposure between 11am and 3pm, where possible. Loose clothing, made from natural fibres, helps to keep the body cool and limits the amount of skin that requires sun screen application. Manufactured UV protective clothing is very helpful for children, especially when swimming or playing in the sun. Whenever possible a hat with a wide brim should also be worn. A high factor (SPF 30 or above) sunscreen with high UVA coverage (4 or 5 star rating) should be applied ideally 30mins before sun exposure and reapplied generously every few hours, especially if exercising or swimming.
For further information regarding sunscreen use, please see the British Association of Dermatologists Sunscreen and Sun Safety Factsheet in the Resources section.