SURGICAL DERMATOLOGY


Skin surgery is the most common surgical procedure performed in Australia. Many doctors perform skin surgery including dermatologists, plastic surgeons, general surgeons and general practitioners. Many factors affect the outcome of skin surgery. The main factors are discussed below:

  1. Patient factors: include general health, medications and the ability for post-operative wound care. These factors are assessed in our clinic prior to surgery to minimize post-operative complications.
  2. Surgical facility: surgery at our clinic is performed in a specifically designed Operating Theatre equiped with very high standards of instrumentation including German-made surgical instruments and theatre-grade Steris LED surgical light.
  3. Experience of the surgeon: critically important in the more complex surgery involving flap and graft repairs. Dr Roland Nguyen regularly performs flap and graft repairs for skin cancer surgery, particularly those located on the face. He supervises the surgical training of trainee dermatologists at Liverpool Hospital and has regular sessions at the Pittwater Day Surgery.
  4. Post-operative care and early treatment of complications: patients are routinely followed up carefully during the post-operative period at our clinic. We are also experts at scar treatment and can offer early treatment (including lasers) should patients develop sub-optimal scarring.

 

 

SKIN CANCERS

Skin cancers are the most common cancers in Australia because of our predominantly Caucasian population living in a subtropical climate and our love for the outdoors. Early detection and treatment are the most important factors in minimizing complications and deaths due to skin cancers. Regular skin checks are critically important for individuals at increased risk of skin cancers such as those with significant occupational or recreational sun exposure, previous use of tanning beds and solarium, family history of melanomas or those with previous skin cancers.

It is essential that you seek medical attention if you develop persistent symptoms (itching, irritation, bleeding or pain) in your skin spots or if your skin spot undergoes significant change. Self-diagnosis is not recommended since it requires prolonged training and experience to detect these cancers. Dermatologists are trained to be experts at diagnosis and treatment of skin cancers.

The great majority of skin cancers including melanomas are cured if detected early and appropriately treated. Definitive treatment of skin cancers usually requires surgery. However, non-surgical treatments such as creams, photodynamic therapy and cryotherapy can be used in some types of early and less aggressive skin cancers. Radiotherapy may be used in elderly patients who are otherwise unable to tolerate surgery.

SCAR TREATMENT

Common causes of scars include trauma, surgery and acne. Treatment is usually sought for scars that are unsightly, symptomatic (itching, pain) or causing distortion of the surrounding structures. Some individuals are more prone to lumpy keloid scars which commonly occur on the chest, shoulders, back, ears and in women having had Caesarean section. Atrophic (depressed) scars are common following acne or trauma.

Scar revision and treatment involve many techniques such as subcision, surgical revision, lasers (vascular, fractional and ablative) and cortisone injections. The choice of the most appropriate treatment technique depends on the type and position of the scar. Dermatologists at our clinic have been trained and have access to all of these techniques. They are also experts at assessing your scars and can advise you of the most effective treatment(s). Importantly, early treatment generally results in significantly better outcomes, particularly for traumatic or surgical scars.

SURGICAL REPAIRS WITH SKIN FLAP OR GRAFT

A skin flap involves the rearrangement of local skin tissue to repair a surgical defect left after the removal of a skin cancer. It is often required for skin cancers on the face, particularly on the nose and lips. Properly performed flap repair achieves the best aesthetic outcome as it provides the best match of skin texture and hides the scars in natural skin folds and lines. Most flap repairs are complex requiring advanced surgical skills and experience.

A skin graft is usually required for larger defects that are not amendable to flap repair. A major disadvantage of a skin graft is the poor match of skin texture and colour of the graft compared to the surrounding skin. However, there are post-operative procedures including laser treatment that can improve the appearance of the graft.

Dr Roland Nguyen regularly performs complex flap and graft repairs in our clinic’s Operating Theatre and at the Pittwater Day Surgery. He is also a consultant dermatologist at Liverpool Hospital where he teaches trainee dermatologists these advanced skin surgery procedures.