NZDSI Blog

Skin Cancer and Mohs Surgery

26 Oct, 2019

After our last blog you may have had a skin check! Although it is a chilly day for late October the NIWA alert for today recommends sun protection from 9.30 am to 4.30 pm. A cold day does not necessarily mean that no sun protection is needed!

Basal cell skin cancer is the most common form of skin cancer in New Zealand. These skin cancers are fully curable once they are completely removed. They are different from melanomas.

There are lots of ways to treat a basal cell skin cancer. It is important that the correct type of treatment is applied to the basal cell cancer depending on where it is on the body. The highest cure rate is getting it cut out with surgery. The other ways to treat them include freezing with liquid nitrogen, using a cream called imiquimod and a technique called curettage and cautery which involves scraping away the skin cancer with a special spoon shaped instrument and then cauterising the base.

Not all basal cell skin cancers are exactly the same when they are examined under the microscope. Some are more invasive than others which means they can spread further within the skin than can be seen with the naked eye. This can be a problem for surgery especially on the face, for example around the eyes and nose, as it may be impossible to know where they stop and start. 

A choice of treatment your dermatologist may recommend for some difficult basal cell skin cancers is called Mohs surgery. Skin cancers grow in a higgledy-piggledly way. Some of the “roots” may be longer than others and growing in lots of different directions. Frederic Mohs was an American surgeon who invented this technique. The technique involves carefully following the “roots” of the skin cancer until it is fully removed by examining the cut out skin cancer under a microscope during the operation and then returning to the exact location where the cancer remains if more needs to be removed. Mohs is usually done with a local anaesthetic and not general anaesthetic. For some this may mean re-entering the operating theatre several times during the day until the dermatologist is certain it has all gone. Once the skin cancer has been completely removed the hole that has been made by the surgery will be repaired.

Mohs surgery has an advantage that it only removes the exact amount of skin that is needed to get rid of the skin cancer and no more. Mohs surgery keeps the hole as small as possible and therefore the smallest scar so that the best possible cosmetic outcome can be obtained. Mohs has a high cure rate for difficult basal cell skin cancers. Five years after a Mohs operation for difficult basal cell skin cancers that have never had previous treatment, there is an approximate 98-99% cure rate and for those difficult basal cell skin cancers that have come back after a standard surgery, there is an approximate 95% cure rate.

The NZDSI has recently formed the New Zealand Society of Mohs Surgeons to promote the highest standard of Mohs surgery. The New Zealand standards adopted are intentionally equivalent to those of The Australasian College of Dermatologists which represents all Australian dermatologists. NZDSI approved Mohs surgeons have to complete additional mandatory continuous professional education to maintain their Mohs skills as this is a specialised technique not performed by all dermatologists. You can find more details about Mohs surgery and a list of NZDSI approved Mohs surgeons in this website.



Time to check your skin-its Spring!

21 Sep, 2019

September is here and Spring has sprung!  Longer daylight hours, bright blossoms and colourful flowers with the promise of warmer weather and sunshine.

New Zealand Dermatologists recommend this is a good time to check over your skin.

Normal moles are symmetrical in shape and colour, have a smooth outline and do not change in size in adults.  Most people have moles that look similar over their body. 

If a mole changes get it checked.

The ABCDE rule is useful to remember if your mole is changing.

  • Asymmetrical (draw a line through it and the two halves look different).
  • Irregular Border (uneven edges of the mole).
  • Varied Colours (these can include shades of black and brown, red, pink, pale and some have no colour).
  • Diameter bigger than 6 mm (bigger than the end of a big pencil).
  • Evolving (changing colour, shape, itchy or getting crusty).

These can be signs of a melanoma skin cancer so arrange to have it checked urgently. The earlier a melanoma is treated the better the outcome. Melanoma is curable if caught early.


NZDSI Wellington meeting 2019

27 Aug, 2019

What a week!

The NZDSI scientific meeting in Wellington ended on Saturday morning. Too many highlights to fit in to one blog! There was a lot of discussion about medical and surgical dermatology which was really interesting. We managed to keep warm despite the cold and it was really great to catch up with colleagues from around the country.

Some of the great talks were on surgical dermatology and particularly about the use of Mohs surgery for very early melanomas. If you are not sure what Mohs surgery is, take a look at the web site for more information. Melanoma in situ is an early melanoma just within the upper layer of the skin called the epidermis. These early melanomas are fully curable when they have been removed. Mohs is an excellent way to remove it all, especially on difficult areas like the face. Expertise and skill is needed to know where the edge of the melanoma stops and the normal skin starts. 

There is a new treatment for atopic eczema in adults called dupilumab. Atopic eczema is a distressing and itchy condition. A lot of New Zealand children have it and it often gets better with age, yet some carry it through to adulthood. This new treatment is a medicine that blocks a key molecule causing inflammation of the skin. Unfortunately, we do not have it in New Zealand yet but hopefully it will come soon. Our distinguished overseas visitors discussed the use of this medicine in the United Kingdom, it works well and has made such a difference to those suffering with this disease.

So despite the cold weather, this was an excellent conference. Well worth battling wild windy Welly! 

 

A new web site for the New Zealand Dermatological Society Incorporated (NZDSI)

19 Aug, 2019

Welcome to the New Zealand Dermatological Society Incorporated (NZDSI) news blog. NZDSI is the national organisation representing New Zealand dermatologists (Skin Specialists).

We hope you find it interesting and informative. On this website you can find a list of all NZDSI dermatologists in New Zealand, information on dermatology, updates from the society and more! Follow us on Twitter to find out what’s happening in the world of the NZDSI!

This blog will be the leading source of information for dermatology in New Zealand. We will bring you accurate, interesting, local and international dermatology news.

Did you know that in New Zealand it takes at least 13 long and rigorous years to train as a dermatologist from the time of entering medical school? Make sure your skin specialist is a dermatologist! Only NZDSI dermatologists are allowed to use the NZDSI logo so you can check if your skin specialist is a dermatologist by looking right here at the NZDSI site or the Medical Council of New Zealand site.

This week the NZDSI meets for its annual scientific meeting at Te Papa, Wellington. The meeting will explore the new scientific advances in dermatology. Distinguished international speakers will talk about the latest advances in psoriasis and skin cancer surgery. Expert New Zealand dermatologists will talk about specific areas of interest in dermatology.