Conditions

Basal Cell Carcinoma is the commonest type of skin cancer, diagnosed on a daily basis by dermatologists in Australia. It predominantly affects fair skin people and is related to exposure of sunlight. Whilst this is most commonly found on exposed sites, many BCCs can also occur at covered areas such as the back.

To many untrained eyes, they can be easily missed as these tumours do not tend to be painful. They can look slightly pinkish, pigmented or skin-coloured. They can ulcerate and bleed.

They are generally slow growing skin tumours (usually grow over months or years), and almost never spread beyond the skin. Even though they are regarded as “harmless”, these need to be treated early before they grow bigger or cause other problems such as bleeding or invasion into surrounding structures.

A number of forms of BCCs exist. Excision remains the gold standard, but certain forms (such as superficial subtype) may be treated with non-surgical method (such as cream, photodynamic light treatment or gentle scraping/curretage). Sometimes radiotherapy is recommended, especially for the elderly. Dermatologists are best suited and skilled in a range of treatment options and will tailor the best option according to location, your age, subtype, and your personal medical circumstances.

At Melbourne Eastside Dermatology, we work closely with a team of specialists including plastic surgeons, radiation oncologists and pathologists to provide a comprehensive and suitable treatment that best suit the individual case.

Squamous Cell Carcinoma is the 2^nd most common type of skin cancer, again related to sun exposure. This cancer grows faster (over weeks or months) and is more aggressive than BCCs. They tend to look and feel like a hard crusty lump. They are also likely to be sore to touch. Commonest sites include hands, forearms, face, scalp, lips and ears.

Even though they have the potential to spread, in a healthy individual, the chances of spread are actually low. In patients with immunodeficiency or who take immunosuppressants (e.g. for transplant organs), the risk of spread and recurrence are higher. SCCs of the skin are not to be confused with SCCs of the oral cavity or other internal organs. These SCCs outside the skin are a group of much more aggressive tumours.

Excision (and in some cases, radiotherapy) is generally recommended for SCCs. The very minor superficial types can be treated with gentle scraping/curettage or cyrotherapy, but these will need to be monitored very closely for recurrence.

Melanoma is rarer than BCCs and SCCs, but Australia has the highest incidence of melanoma in the world. On average, 30 Australians are diagnosed with melanoma every day.

Usually, melanoma are pigmented. For patients, the best way is to look out for the standout mole (“ugly duckling”), moles that are changing in appearance, for any new moles growing, or to look out for irregularity using the ABCDE rule – asymmetry, irregular border, irregular colour, large diameter, and elevation (growing vertically).

Unfortunately, some melanomas are not pigmented and can look like anything ranging from scaly red patch to blue grey round lump. They can also occur anywhere on the body from sun-exposed sites, to unusual sites such as palms and soles.

This skin cancer raises the highest concern as it has the highest potential to spread. More than 1200 Australians die from this each year. Generally speaking, the prognosis of melanoma is hugely dependent on the depth of the melanoma seen under the microscope. If it is level 1 (non-invasive), it is considered cured after treatment. The danger of spread increases hugely with the cancer being seen deeper in the skin. Therefore early detection of melanoma is crucial.

Excision with a wide margin (wide local excision) is mandatory for all cases of melanoma. There is a procedure named sentinel lymph node biopsy, which is indicated in certain cases of melanoma to provide a better prognostic indicator. Advanced cases generally will be managed in the hospital for other treatments such as radiotherapy, chemotherapy or the latest molecular drug therapy. Dermatologists will diagnose and discuss the need for further treatment with you.

Once diagnosed with melanoma, patients will require a regular skin check surveillance program. Part of this is to ensure the melanoma has not recurred or spread, and part of this is also for early detection of a second new melanoma. For someone diagnosed with melanoma, statistics in Victoria indicated the average risk of developing another new melanoma is around 1% per year (roughly 20% in the life time)

It is best you speak to dermatologists about your concern of unusual moles, or for treatment and surveillance program of a diagnosed melanoma.

These are pre-cancerous lesions and are very commonly seen on sun-exposed sites as red scaly ‘sunspots’. The risks of these lesions turning into skin cancer are variable, and range from 0.1% to 12%.

Many treatments (e.g. creams, photodynamic therapy, freezing / cryotherapy) exist and will need to be tailored to each individual cases. More importantly, regular sun protection, self skin check and skin surveillance are crucial as the presence of sunspots does indicate a higher risk of skin cancer development.

Many lesions that exist (especially those that grow with age) are benign, and include seborrhoeic keratosis, angiomas (Campbell de Morgan spots), and dermatofibroma. These do not require treatment except for cosmetic reasons or irritation.

There are a myriad of rarer malignant tumours. Examples include atypical fibroxanthoma, dermatofibrosarcoma protuberans, microcystic adnexal tumours, sebaceous carcinoma etc. Dermatologists are well trained in detecting and managing all types of skin tumours like these.

Molluscum contagiosums are benign pox virus infection very commonly seen in young children. They are seen less frequently in adults as immunity towards these virus has developed over time. Many of minor cases will resolve on its own accord and require minimum treatment.

A highly effective painless therapy utilizing Cantharidin drops is available at Melbourne Eastside Dermatology. A variety of other therapies (generally cream therapy) can also be effective.

This is a common and frustrating condition. Many patients will start with over the counter wart therapy. Liquid nitrogen cryotherapy is one of the most commonly used physical treatment.

Your dermatologist can discuss with you about a variety of possible therapy including immno-contact therapy, strong keratolytic cream, irritant drops, oral tablets and rarely local chemotherapy injection for difficult and resistant cases.

Acne is a potentially permanently scarring condition. Most of the cases occur during puberty, correlating with the hormonal changes. Some cases of acne are related to other medical conditions (such as polycystic ovary syndrome) or induced by medications (such as testosterone and steroid supplements).

Treating acne is not just about preventing future scarring. One of the greatest rewards for treating acne successfully is regaining the self confidence when skin becomes clear after acne therapy.

Mild to moderate acne are often managed using over the counter products or prescription topical medications. Oral medications include antibiotics, hormonal therapy and oral Isotretinoin. Oral Isotretinoin is the most effective way to produce permanent treatment. There are a number of side effects associated with treatment with oral Isotretinoin. Fortunately, the majority of patients suffer only from temporary side effects such as dryness, sunburn and minor initial flare up of acne.

In Australia, specialist dermatologists are authorized to provide Isotretinoin therapy.

Dermatologists in Melbourne Eastside Dermatology will discuss the most suitable therapy for you, and tailor your acne treatment.

Eczema, or atopic dermatitis, is likely the commonest skin rash that dermatologists deal with, especially in the dry weather of Melbourne.

Eczema is a rather difficult disease to understand. It most commonly affects newborn and young children (and very common amongst Asian patients), but eczema can also occur later in the life as skin dries with aging.

On one hand, eczema occurs as the skin develops inflammation towards a lot of what human skin is normally exposed to in our environment, such as dust mites, pollen, grasses, sweat, overheating, and many other substances. This often comes in combination with asthma (chest) and hay fever (nasal cavity), which is termed “atopy”.

On the other hand, patients with eczema are frequently found to have deficient skin barrier function (dry skin). Genetic mutation on fillagrin (a skin cell protein responsible for ‘packaging’ of skin barrier) has been identified as a major contributing factor for this problem. Frequent soap use and lack of moisturizing use exacerbate this problem.

When eczema develops, the itch is often unbearable, leading to scratching, more damage to skin barrier, more inflammation, more infection and creates an itch scratch vicious cycle. Skin often thickens up as a response to this.

Eczema therapy includes not just a good prescribed combination of creams (sometimes tablets) to settle down the acute inflammation, ongoing skin care (frequent moisturizing and soap substitute use) plays a really important role in maintaining skin barrier to avoid problems. Sometimes, treatment like ultraviolet phototherapy or long term tablets to suppress immune system are required.

Even though severe eczema can look horrible at times, most cases of eczema if treated appropriately do not leave behind any permanent scarring. Do not be alarmed if eczema leaves behind brown or white patches – these are post-inflammatory hypo- or hyper- pigmentation, which will normalize with time.

Dermatologists in Melbourne Eastside Dermatology are always happy to address your concern about your child’s or your own eczema, tailor the most suitable therapy, and to act on quickly to achieve the best treatment outcome available.

Psoriasis is a skin condition that causes considerable distress amongst sufferers, mainly because of its appearance. The lack of knowledge amongst the public also makes it difficult for psoriasis patients to explain the fact that this is a non-contagious skin rash.

Many types of psoriasis exist. Some will present as widespread rash all over, many psoriasis will present only in limited fashion such as scalp rash, elbow/knee rash, palms/soles rash, or rash on buttock. It may be itchy at times.

Except for a small number of cases where psoriasis is induced by trauma, throat infection and certain medications (such as lithium, beta-blockers, plaquenil), most cases are likely genetically inherited. However, the mode of genetic inheritance is complex and it is possible that there is a complete lack of family history in psoriasis patients.

Even though there is no cure for psoriasis (all available treatments aim to control rather than cure), treatments have advanced very rapidly over the years.

Psoriasis can be treated with different types of creams, ultraviolet phototherapy, and a few different types of tablets (methotrexate, cyclosporine or acitretin). All of these tablets carry certain side effects and these will require frequent monitoring.

A few highly effective new injections therapy (termed ‘Biologic’) are now available. However, because it is an extremely costly therapy, there is strict criteria to go through before you would be eligible for PBS cover.

Speak to your dermatologist and enquire about the most suitable therapy for your psoriasis.

Skin allergy is extremely common, and is frequently under-recognized even by medical practitioners. On the other hand, there are many other rashes (such as eczema) that can look very much like skin allergy.

Generally speaking, contact allergy involves specific body site that is dependent on the type of allergens exposed to. There are hundreds (and perhaps thousands) of potential allergens, ranging from personal grooming products (e.g. hair dye, hair products, perfume, cosmetic products, body creams, nail polish) to household products (e.g. rubber/leather gloves, baby wipes) and recreational/work-related products (e.g. plants, glues, paint, sprays).

Food is often blamed by patients to be the cause of their allergies, but most of the allergies stem from direct contact to the skin instead.

Eczema in babies and young children is different from contact allergy. Only a small amount of cases are related to food hypersensitivity.

Dermatologists will assess your skin rash through skin examination and exposure history. If your rash is deemed to be due to contact allergy, appropriate testings will be arranged. The most important test is skin patch test, which tests for “type 4” allergy. This will be organized through specialized patch-test clinics either privately in Skin and Cancer Foundation, or in the public hospitals (with a long wait list).

Blood tests and skin prick testings are sometimes done to investigate “type 1” allergy (such as Latex and food allergies), examples are rashes due to food allergies in babies or toddlers.

If you have a persistent skin rash and you suspect allergy, speak to doctor to get a full assessment by a dermatologist.

Vitiligo can be divided into segmental type (involving one segment of the skin) and non-segmental type (involving multiple different sites). The non-segmental type vitiligo is caused by auto-immunity.

In vitiligo, immune cells attack the melanocytes (the cells in skin that produce pigment.) The skin then loses the pigment and skin colour becomes white. There is often no particular reason why this happens. Vitiligo sometimes happens in conjunction with other auto-immune conditions, such as thyroid diseases or pernicious anaemia.

Treatment for vitiligo has advanced significantly over the last 10-15 years. It requires patience as most treatments take months (sometimes years!) to achieve maximum improvement.

The commonest treatment include creams (both potent cortisone and non-cortisone based creams) application in combination with ultraviolet phototherapy or excimer light/laser therapy. Certain cases can be treated with cortisone injection or cortisone tablets, which are usually restricted to shorter period of use.

Surgeries are now available for vitiligo patients, who have vitiligo that are stable for more than 6 months. In conjunction with Skin and Cancer Foundation and Monash Medical Centre, non-cultured autologous skin graft surgeries are now available for both adults and children.

Dr Desmond Gan has spent time overseas (India, Belgium, France and South Korea) after his dermatology fellowship training to subspecialise in vitiligo treatment. Dr Gan is currently running specialized vitiligo clinic at the Skin and Cancer Foundation on a monthly basis. At Melbourne Eastside Dermatology, we will soon have the facility in Blackburn South to provide state of the art most up-to-date phototherapy treatment for vitiligo sufferers. 

With the resources and experience we have, we will be able to tailor the most appropriate and effective therapy for vitiligo sufferers.

Melasma is a common skin disorder, which presents with darkening of the face, usually on the cheeks, forehead and around the mouth. This condition is thought to be related to genetics, darker skin type, ultraviolet exposure and hormones (It is common to present during pregnancy or during consumption of oral contraceptive hormonal tablets).

Melasma is traditionally thought to be hugely treatment resistant, but recent advances have shed new light on more effective therapy.

First line therapy involves combination bleaching cream, together with strict avoidance of sunlight and contraceptive pills. Recently, oral tranexamic acid tablets have been found to have an instant effect on reducing pigmentation. Laser and light therapies have also been trialled in many countries with varying success. In fact, many lasers are not safe in treatment of this condition, and sometimes can leave permanent scarring or whitening of the skin.

Speak to your dermatologists about the most suitable and safest option for pigmentation on your skin.

There are a number of conditions that can cause hair loss.

General hair loss

The general hair loss or shedding may be due to multiple reasons. The 2 commonest causes are male/female pattern hair loss (hair loss under the influence of hormone) or telogen effluvium (hair shedding).

Generally speaking, patients suffering from male or female pattern hair loss (androgenetic alopecia) do not have an underlying hormone problem. It is the genetic tendency that causes hair follicle to shrink faster and earlier in life. The genetics of this is complex and does not always affect every family members. Treatment include topical solution and/or tablets that reduce hormone influence on hair follicles. Hair transplant can be considered in certain cases of male pattern hair loss.

Telogen effluvium (hair shedding) generally does not produce significant hair loss with time, even though one-third of cases what are thought to be due to this condition can progress to androgenetic alopecia (see above)

Discrete bald patches

Discrete bald patches can be divided into non-scarring type and scarring type.

There are a number of conditions that can produce the non-scarring type. One condition that is most commonly seen by dermatologists is alopecia areata. This is an autoimmune condition that is usually treated with combination of steroid creams and injection. Rapidly progressing cases can also be treated with special drops (immuo contact therapy) and oral immunosuppressive tablets.

The scarring type bald patches are important not to misdiagnose, as it can produce permanent hair loss if not treated early. Examples include discoid lupus, or lichen planopilaris, both of which are autoimmune inflammation of scalp. Diagnosis is usually made through skin biopsy. A combination of creams, injections and tablets should be considered as soon as diagnosis is made to prevent further permanent scarring.

If hair loss problem occurs, it is best to speak to your local doctor and if necessary, a referral to dermatologist who will make an accurate diagnosis and suggest the most appropriate therapy. Always discuss with your dermatologist whether the expensive advertised hair treatment is necessary for your hair condition.

Rosacea is a common problem that can affect anyone as an adult. It is due to a combination of reasons, including exposure to ultraviolet light, lack of good skin care, soap use, heat, alcohol and sometimes cortisone creams.

Symptoms of rosacea include flushing, heat, redness, and acne-like skin lumps (and hence the old misleading terminology of ‘acne rosacea’). In advanced cases, eyes can be involved and nose can develop lumpiness.

Treatment is complex and will involve tailoring a suitable set of skin care regime, medicated creams, together with long courses of oral antibiotics or Vitamin A tablet (Isotretinoin). Redness is also amenable to suitable laser therapy. Long term maintenance is crucial with avoidance of any identifiable triggers and good skin care. Certain makeup product is better suited for this condition.

Many patients are frustrated by this condition, but with a good comprehensive treatment plan, many of the symptoms will improve and can stay under good control.