The dermatoscope is a hand held magnifying lamp that magnifies the lesion by ten and gives us a bird's eye view of the skin from top to bottom. Lesions have a very specific pattern which enables us to decide pretty much there and then what it is. An image can be taken for future reference or for a second opinion. The dermatoscope is a very handy device that can give you an instant diagnosis and minimise the need for a skin biopsy. It will give us the confidence to remove non-malignant lesions if you feel they are unattractive. The lesion will be sent to histology to confirm the diagnosis.
Dr Elisabeth Dancey has completed her minor skin surgery course with the PCDS and will remove any simple lesions. More complicated or suspicious lesions will be referred back to your GP.
Minor surgery is not always available on the NHS as they concentrate on malignant lesions. Some trusts have a policy of not removing benign lesions at all. Understandable in these straightened times but some lesions are simply not attractive. As we get older more lesions tend to develop. Whilst women ask for them to be removed themselves, it is often the wives that remark upon the lesions on their men folk.
Most lesions can be shaved off using a scalpel. The area to be removed is first numbed with local anaesthetic, then the lesion removed. Any bleeding that ensues is immediately stopped with the cautery device which also tends to make the skin shrink, reducing the size of the scar. A dressing is applied which needs to remain for a week. The area heals gradually over the next few weeks and will leave a small scar. It can be a bit painful for a while once the anaesthetic wears off. The area will need to be kept clean and dry for a week. We apply water proof-plasters.
This is the medical term for the dry scaly spots that appear on sun exposed areas of the face. The sooner they are treated the better as a very small percentage may turn into something nasty. Cryotherapy is recommended for AKs once diagnosed with the dermatoscope.
These, too, may be caused by the sun and develop on the face and body after about the age of 50. They are brown and scaly and can look alarming. A quick check with the dermatoscope reveals their characteristic harmless features. Small ones can be removed with cryotherapy; larger ones need to be shaved off as a shave excision.
These can appear in areas of constant trauma (under the bra strap, the neckline and armpits), but frequently for no apparent reason. They are not nasty but unattractive and many people feel happier without them. They can be easily removed with the Radiolase device or shave excision, depending on their size.
Warts and Verrucae
These are viral infections of the skin. Eventually the body develops immunity to them and finally fights them off, but this can take many years. Warts can be removed with minor surgery, the laser or cryotherapy, depending on their size and position. First of all the hard skin is removed, then they are zapped by whichever energy device we feel is the best.
Verrucae are warts on the sole of the foot but are pressed into the skin by constant pressure. There, too, can be treated by removing the excess hard skin then zapping them with the laser.
This is an age-old technique that freezes the lesion causing it to die and drop off. We use the Cryopen because it has a small jet of liquid nitrogen and can treat small areas with little damage to the surrounding skin. Many people are familiar with the bubbling canister of dry ice lurking in the corner, but the cryopen uses small canisters of nitrogen to achieve results. It is clean, quick and pain free. The areas treated become quite brown then drop off about ten days later.
Cryotherapy is used for brown spots on the face and hands, warts and actinic keratosis.