We offer the following Medical Procedures

This is a very popular procedure for axillary hyperhidrosis (excessive sweating). It can also be performed for other areas if required. It is safe to perform and last for up to 9 months.

We cover the whole spectrum of clinical dermatology.

This forms an important part of our practice. We have a dedicated Doctor, Dr. Emmerentia van Schalkwyk, who uses the superb photofinder system.

MOLE SCAN AND MOLE MAPPING:

THE SUN HAS ITS DARK SIDE – PREVENTION IS THE CURE!

The sun also has its dark side…
In recent years the number of melanoma cases has increased significantly. 1 out of 100 diagnosed skin tumours is a malignant melanoma.
It can arise from existing moles or healthy skin.
Although melanoma is 100% curable if diagnosed early, many patients die from skin cancer if it is not detected in time. The most significant risk factor is excessive exposure to sunlight. Therefore avoid intense sunbathing and keep an eye on your skin.

MORE AND MORE IMPORTANT- PERIODICAL SKIN CHECKS:

Mole mapping is the most advanced method for early diagnosis of skin cancer. With a medical camera we will take microscopic photos of your at-risk moles – digital dermoscopy. Additionally we take overview images of your body to localise the moles and find them again at follow-up visits. The mole images can be measured, analysed and stored in a digital database. At follow-up examinations your mole images are taken again and compared side-by- side to detect even the slightest changes and therefore possible skin cancer at an early stage.

We can detect even the slightest change in mole structure. You can see the old comparison yourself on screen. Through image storage and mole comparison, digital dermoscopy provides the best prevention for skin cancer, especially for patients with multiple moles. Long-term observation through continuous skin checks helps to avoid unnecessary excisions of moles.

WHO BELONGS TO THE HIGH RISK GROUP?

If any of the following questions apply to you, please come in to have your moles checked:

• Do you have multiple moles – more than 50?
• Is there a history of skin cancer in your family?
• Do you have a melanoma in own medical history?
• Do you have large moles – diameter larger than 5cm /2in?
• Do you have conspicuous or recently changed moles?
• Did you suffer from severe sunburns during childhood or adolescence?
• DO you have sensitive light skin?

DON’T GIVE CANCER A CHANCE!!

THE A-B-C-D-E OF MOLES:

The ABCDE rule helps you to recognize suspicious moles.
Moles that show at least one of the characteristics below should be examined by us.

A for Asymmetry
B for irregular, blurred or jagged Borders
C for Colour variation
D for Diameter larger than 5mm – 3⁄4 in
E for Elevation especially when uneven and Evolution – changes over time

ANY ALTERATION IS AN ALARM SIGNAL!

Changes in colour – darkening, loss of colour, new colouration
Decrease or increase in size or thickness
Changes in the surrounding skin –redness, white spots or swelling
Itchiness, sores, odd sensation
Bleeding moles
Newly appeared moles – especially in patients older than 25 years

WHO BELONGS TO THE HIGH RISK GROUP?

If any of the following questions apply to you, please come in to have your moles checked:
Do you have multiple moles – more than 50?
Is there a history of skin cancer in your family?
Do you have a melanoma in own medical history?
Do you have large moles – diameter larger than 5cm /2in?
Do you have conspicuous or recently changed moles?
Did you suffer from severe sunburns during childhood or adolescence?
DO you have sensitive light skin?

DON’T GIVE CANCER A CHANCE!!

We highly recommend that you come in periodically to have your moles checked.

The management of damage to the skin resulting from overexposure to UV-radiation and skin cancer occupies a significant proportion of our time in a Dermatology Practice. An ever increasing incidence of a skin cancer and its precursor lesions, such as actinic keratoses combined with an increased awareness of the problem by the public results in a rising demand for more effective therapies. As lesions often affect the face, patients expect a practical treatment, which offers good clearance, but wish for the best possible outcome. Topical photodynamic therapy (PDT) is an effective alternative to surgery and other destructive therapies in certain non-melanoma skin cancers.

INDICATIONS:

Basalcell Carcinoma

Superficial spreading
Nodular
Basalcell Carcninoma forms 75% of non-melanoma skin cancer

Bowens Disease (squamous carcinoma in situ)

PDT is now the first therapeutic choice.

Solar keratoses

Very effective for extensive areas e.g. scalp, whole face, arms, hands and thorax anterior.

HOW DOES PDT WORK?

Photodynamic therapy is a two-step process involving the application of a topical light sensitive substance followed by activation of this substance through illumination with a proprietary light source. Commercial agents used at present are 5-Aminolevulanic Acid (ALA) and Methyl-Aminolevulinate. ALA and its esters accumulate photo active porphyrins (PAP) in neoplastic tissue. Exposure to red light in the presence of oxygen generates reactive oxygen, which damages cellular membrane, particularly in the mitochondria leading to selective cell death. Healthy surrounding tissue which has not accumulated porphyrins is left undamaged. After 2-3 weeks the lesion is replaced by new and healthy tissue. Repeat treatments are possible if required to optimise success.

THE PROCEDURE:

Firstly scales and crusts are removed and the ALA or ALA ester is applied to all lesions plus a small surrounding area and then covered by an occlusive dressing for 3-4 hours. The dressing is removed and excess cream is wiped off and the area is immediately exposed to red light of 635 nm with a total light dose of 80J/cm. Multiple lesions can be treated during the same treatment session.

PDT is quite a novel treatment for non-melanoma skin cancer. It is effective and has several benefits over conventional treatment approaches.
• It is as effective as surgery but superior to cryotherapy.
• It is selective for cancerous tissue.
• It is non-invasive and non-scarring.
• It can be used repeatedly if necessary.
• Cosmetic results are superior to all comparable treatments.

PDT PATIENT INFORMATION:

You have been prescribed PDT or Photodynamic Therapy – so how exactly will you be treated?

PDT is a non-surgical treatment of skin cancer or pre-cancerous lesions. You could either have Solar Keratosis or Basal Cell Carcinoma (BCC) or a Bowens. Solar Keratoses are usually red and scaly and occur most commonly on the face, head (in balding men) and on the forearms and hands. Initially they come and go but finally they are there all the time. If left untreated ± 10 – 20 % of these lesions turn into skin cancer over a 10 year period – which is why we treat them!

A BCC of Bowens is already skin cancer and BCC’s occur most commonly on the face and back while Bowen’s is usually on the arms and legs. Skin cancer is the most common form of cancer worldwide and in particular in our country. Almost everybody has had enough sun damage in his or her lives to develop skin cancer when we get older.

The most common treatment for solar keratoses is liquid nitrogen (freezing them) while skin cancers are usually removed surgically. This obviously leads to scarring, which can be subtle if done well, but never the less as skin cancers are almost always multiple, this can be a major cosmetic problem. This is why PDT was developed in Europe to find a treatment which is equally effective but does not leave you with scars.

HOW DOES IT WORK?

Firstly the “ALA” cream is applied, this is Levulanic Acid, a compound related to Bilirubin and Porphyrins (substances produced in your liver). All cells in the body need this compound, but abnormal cells absorb it faster than normal cells. Secondly a Tegaderm dressing is applied to allow the cream to be absorbed. After a period of 3 to 4 hours the dressing is removed and a red light is applied to the skin. This is not infra red nor is it a laser, just a strong visible red light (635nm). The energy from this light activates the cream and this produces oxygen radicals. Those radicals destroy all cells that have absorbed the cream thereby destroying abnormal cells but not your normal cells.

While those cells are being destroyed and die it is painful, usually worse during the first 8 – 16 minutes. You will need Stopayne ½ hour before the treatment. Over the following 24 hours it will feel like severe sunburn: the skin will turn red, sometimes swollen, some crusting and oozing can occur if the lesions were deep. In the first 24 hours it may be necessary to take more Stopayne. After that the area usually heals within 1-2 weeks. It is important that you keep the area well moisturised at all times (by applying Aqueous cream 3-4 times per day) and if there is crusting/oozing then you should use Bactroban 2 timesper day for 3-4 days. The skin will peel off like as in a sunburn and heal completely. Although it will be very unsightly for those 1-2 weeks the end results are always good.

One more word regarding the pain: the amount of pain depends on the amount of sun damage which is difficult to assess before the time. However it is always manageable with Stopayne. The reddening which is seen after healing, can also take up to 6 weeks or sometimes even months to disappear. Again this is an individual reaction but it is never permanent. The clearance or cure rate with this treatment is comparable to that of surgery but the cosmetic outcome is always better. If you would like to know more , don’t hesitate to ask!.

Here are some answers to common questions that you may wish to know.

Omnilux PDT – the leading light.

Q: – Is Omnilux a complicated procedure?
A: – No usually it is a single treatment.

Q: – How does Omnilux PDT work?
A: – The treatment consists of applying a special cream called 5-ALA to the skin cancer and the after 3-4 hours shining a pure red light on the area to be treated. After treatment you can go home.

Q: – Is Omnilux PDT safe?
A: – Ye the treatment is simple and doesn’t harm normal skin. There have been no noted complications during the treatment and no long term side effects.

Q: – I’ve heard lasers are dangerous?
A: – Don’t worry, the Omnilux PDT is NOT a laser and the regulation authorities have also given it a health and safety (CE) seal of approval.

Q: – How successful is Omnilux PDT
A: -The technology has already proven itself in South Africa over the past 20 years with thousand cases of skin cancer treated successfully.

Q: -What are the advantages of Omnilux PDT?
A: – The light can reach difficult areas and can be used on broken or poor healing skin. Importantly the light can be used on areas of the body where you do not want scarring, such as the face, legs and arms. Healing is rapid and the final quality of healing is usually excellent. The cosmetic result is very good.

Q: -Are there any complications?
A: -There have been no recorded complications or long term side effects noted in 20 years of clinical studies.

Q: – What will the treatment involve?
A: – In the morning you will be asked to attend Dr’s rooms where a special photosensitising cream (ALA) will be applied to the skin cancer and the area will be covered by a simple dressing. After 3-4 hours the dressing will be removed and the pure red light will be shone onto the skin cancer.

Q: – Does it hurt?
A: – There may be slight discomfort or pain during the treatment. If so the Dr may relieve this for you with a local anaesthetic to numb the area.

Q: – How many treatments are necessary?
A: – Usually one is all that is necessary, but occasionally a second is required for some cancers.

We will advise you of a date for a routine follow-up examination.

Phototherapy has been part of our practice since 1990. We use TL-01 UVB (311mm) which is very effective for psoriasis, eczema, vitiligo and various other UV responsive dermatosis.

We have a dedicated procedure room and do surgery for all forms of skin cancer (basalcell carcinoma, squamous carcinoma and melanoma). We also remove benign lesions (skin tags, benign moles, other benign growths) if so required by the patient. Conscious sedation can be used if applicable.