skin cancer

As May marks Skin Cancer Awareness Month, now is a great time to learn more about this. While if caught early, the majority of patients make a full recovery from skin cancer, battling any form of cancer is a frightening and stressful experience.

Here, we will look at the different types of skin cancer and how they are treated.

What are the different types of skin cancer?

There are three main forms of skin cancer, known as squamous cell carcinoma, basal cell carcinoma, and Melanoma. You find basal, squamous, and melanocyte cells within the epidermis. So, the types of cancer relate to where they are found in the skin.

Both squamous cell and basal cell carcinomas are non-melanoma cancers. These tend to be the most common types of skin cancer diagnosed. Basal cell carcinomas grow slowly, and they very rarely spread to other areas of the body. There are a lot of different types of this cancer, but it mostly presents as smooth and shiny spots which form an ulcer over time.

With squamous cell carcinomas, they tend to present as small lumps with a crusty surface. They can develop on areas of the skin exposed to the sun, as well as in non-exposed areas. These types of cancers tend to grow quickly, and they can spread to other parts of the body.

Melanoma is the most serious form of skin cancer. Developing on the lower layer of the epidermis, if not treated early it will spread to other areas of the body. It is important to notice any changes in the skin as early as possible.

These are the main types of skin cancers to be aware of. While melanoma is the most dangerous skin cancer, treating any type of cancer quickly is important. Therefore, understanding the differences between them is crucial.

Understanding the different stages of investigation

If you do notice any unusual changes in the skin, there are four main stages of investigation you’ll undergo. These include:

  • Appointment
  • Full skin check
  • Dermoscopy
  • Biopsy

If you are worried about a lesion, consult your GP or book an appointment with Consultant Dermatologist Dr Kara Heelan to carry out a full skin check, providing an in-depth examination.

Specific lesions will be evaluated through dermoscopy, using a dermatoscope or a handheld magnifying lens. If it is deemed necessary, a biopsy will be taken to analyse the skin under a microscope.

The diagnosis is fast and painless. If any issues are detected, a thorough treatment plan can then be created with a specialist.

With all skin cancers, prevention is the best cure. Looking after the skin will help to keep your risk to a minimum. Always use a good sunscreen with minimum SPF 30 and both UVA and UVB protection to protect against the sun’s harmful UV rays.

For more advice, book a consultation with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 020 3494 4024.

moles checked

The 3rd to 9th May marks Sun Awareness Week. While everything feels much better when the sun is out, it is important to protect the skin from its harmful UV rays.

Melanoma is a common cancer that is increasing in incidence, and a real concern for those who frequently expose their skin to the sun.

One of the best ways to protect yourself is to look out for any changes in the skin. Changes in your moles can be an indicator that something is wrong. Doing a self-skin check is really important. If after doing this you are concerned about anything, getting your moles checked by an expert is a sensible idea.

What happens when you have moles checked?

If you do decide to have a mole check, you may be wondering what to expect. Typically, a full skin check is carried out and this takes a few minutes to complete. You will need to remove your clothing so that the dermatologist can clearly see all of the moles present.

You may need to remove makeup, and it is important to also remove any nail varnish you have on. Fake tan should also be avoided as this could obviously make it difficult to spot the moles.

Mole checks are a simple and pain-free procedure which allows you to get a comprehensive look at the moles on your body. Sometimes photographs of specific moles will be taken for monitoring. Monitoring them over time will help you to identify any changes quickly.

Keeping the skin protected

Getting your moles checked by a professional is important and can potentially help to catch skin cancer early.

However, don’t forget there are things you can do to keep the skin protected. Wear protective clothing, protect your eyes, seek shade and wear adequate sunscreen reapplying regularly. SPF with a minimum SPF 30 with both UVA and UVB protection provides the best line of defence for the skin against the sun when used alongside other protective measures. For those with acne prone skin conditions, look for sunscreens with oil-free SPF formulations that contain additional antioxidants and DNA repair enzymes.

Book a mole check consultation today with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 020 3494 4024.

treat rosacea

As April marks Rosacea Awareness month, here we will look at what the condition is and how you can treat it.

What is Rosacea?

Rosacea is a very common skin condition which typically develops on the face. More common in those with fair skin, it largely affects those aged 40-60 years.

It is known to be a chronic condition, which means patients suffer with it for a long time. It causes persistent redness of the cheeks, chin, nose, and forehead, though its severity can vary.

Causes and symptoms of Rosacea

The condition occurs when blood vessels have dilated under the skin. However, the exact cause isn’t known. It is thought that environmental factors, immune system factors and genetics could play a role.

The symptoms of Rosacea include redness on the face, eye problems and frequent blushing. Certain things can exacerbate the condition too, such as alcohol, high and low temperatures, spicy foods, exercise, and stress.

What are your treatment options?

Although there is no cure for Rosacea, there are some effective treatments available. Rosacea skin tends to be very sensitive skin so a gentle skin regime is very important. To cleanse use a soap free cleanser and avoid exfoliating agents. Maintaining a good skin barrier is key.

Those who do suffer with Rosacea should moisturise regularly and keep the skin protected with sunscreen. Sunscreen is of utmost importance in patients with rosacea. This will help to control and minimise symptoms. A broad spectrum SPF with UVA and UVB protection of at least SPF 30 needs to be used every day.

Sunscreen containing physical filters (titanium dioxide or zinc oxide) can be very helpful for sensitive skin. An ultra-light UV protection designed for sensitive skin with added Vitamins C and E can help to maintain cell growth is an option.

If you suspect that you are suffering from Rosacea, you can book a consultation with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 020 3494 4024. Dr Heelan will be able to answer your questions about the condition and you can discuss the best form of treatment to suit you.

bowel cancer treatment

April is Bowel Cancer Awareness Month, helping to raise awareness of the cancer and its symptoms. Did you know that bowel cancer is the fourth most common cancer in the UK? It is also the second biggest cancer killer, with more than 42,000 people diagnosed with the condition each year.

If diagnosed early, most patients will survive thanks to advanced treatment options. Going through bowel cancer treatment can cause a lot of unpleasant side effects including skin side effects. However, there are some treatment options available that can help.

Here, you’ll discover how you can look after your skin whilst having bowel cancer treatment.

What type of skin issues can cancer treatment cause?

Approximately half of people treated for cancer will develop a dermatologic issue during treatment affecting hair, skin or nails. Skin side effects of treatment can make an already very difficult time in a patient’s life even more difficult. Chemotherapy, radiotherapy or targeted treatments work by killing cancer cells, while immunotherapy treatments work by boosting the body’s own immune system. These effects can have repercussions not just on the target organ but also on other organ systems including the skin.

The side effects which we commonly see include:

  • Itchy, more sensitive, dry skin
  • Skin that can develop infections much more easily
  • Nail changes
  • Hair loss
  • Sun sensitive or photosensitive skin
  • Pigmentation issues either darker or lighter skin
  • Hand-foot syndrome
  • Blisters

Less commonly we see:

  • Allergic or toxicity reactions
  • Non-melanoma skin cancers

Skin changes are often based on the type of treatment you are receiving. Some very specific types of rashes occur with specific drugs for example acneiform rashes occur commonly with EGFR inhibitors. These specific types of reactions are often the typical ones seen in patients on targeted therapy in the treatment of bowel cancer.

How can you protect your skin?

When you are going through cancer treatment of any kind, it is important to keep the skin protected. The products you choose should be designed with sensitive skin in mind.

The skin barrier is our protective layer on the outside of our skin. This protects from moisture loss, effects of allergens and irritants and infections. To enhance this rather than waiting for skin problems to develop before commencing cancer treatment take steps to enhance this barrier by taking action to minimize skin effects a few weeks prior to starting cancer treatments.

You can adapt your skincare regime by considering the following by exchanging soaps for mild gentle fragrance-free soap substitutes or washes. Prior to starting treatment, you will want to keep the skin well moisturised. It is important to use a lightweight, hydrating product that aims to keep the skin balanced.

During your treatment, your skin will also be more sensitive to sunlight. This makes using sunscreen important. Again, choosing a lightweight lotion is ideal, and it should have a high SPF with both UVA and UVB protection. For those with acne prone skin conditions, oil-free SPF formulations are helpful. Look out for ones that contain additional antioxidants and DNA repair enzymes.

Try to maintain a skincare routine that focuses on products for sensitive skin, avoiding any harsh exfoliants or acids.

Dr Kara Heelan is a specialist in oncodermatology, which is the area of dermatology that supports oncology patients with their skincare. For more advice on how best to care for your skin while undergoing cancer treatment, call us on 020 8661 3372 to arrange a consultation with Dr Heelan.

melanoma patients

Dr. Edwards has recently completed a retrospective review of our melanoma patients at The Royal Marsden developing cutaneous toxicity while receiving checkpoint inhibitor therapy. ‘Cutaneous toxicities in patients with melanoma receiving checkpoint inhibitor therapy: a retrospective review. The experience of a single large specialist institution.’

Checkpoint inhibitors have significantly improved the overall survival for several cancers and have also gained recent approval for adjuvant use in melanoma patients.

Modulating the immune system however is associated with potential side effects the most common of these being cutaneous side effects. We conducted a retrospective review of our adult patients with melanoma who between 2006 and 2018 received nivolumab, pembrolizumab or ipilimumab. This study which covers 12 years is the largest study of cutaneous side effects of checkpoint inhibitors in melanoma patients. Our results show that cutaneous toxicity occurs in at least 24% of patients, some developing more than 1 episode of toxicity. Grade 3 and 4 severity skin toxicities occurred in over 13% of patients with less than 5% of patients requiring treatment discontinuation.

Our study confirms that overall most cases are mild but severe reactions do occur. Prompt recognition and treatment can control the impact on quality of life and potentially allow urgent treatment to be administered when needed. It is important that these patients are managed both by an oncologist and dermatologist.

Read more here – https://doi.org/10.1111/ced.14469

To arrange an appointment with Dermatologist Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 0203 494 4024.

lockdown skin

The COVID-19 pandemic has led to unprecedented lockdowns across the world. For almost a year, UK residents have been living under some form of lockdown, restricted mostly to their homes. Not only is this having a significant impact on our mental health, but it’s also contributing to a number of skin issues too.

Here, we’ll look at how lockdown could be stressing out our skin and more importantly, what you can do about it.

How is lockdown impacting the skin?

During lockdown, the two most common skin conditions being reported are dry skin and ‘Maskne’.
Occlusive masks have contributed to acneiform eruptions. The term ‘Maskne’ has been coined for this during the pandemic. It is an acne variant associated with an occlusive environment exacerbated by heat and moisture. As we have also been limited to spending a lot of our time indoors at home dry skin is also an issue.

The lockdown has caused many of us to relax our skin care routines. With nowhere to go, spending time cleansing and moisturising the skin can feel pointless. However, it is just as important to look after the skin now as it was before the lockdown.

Another reason many people may be experiencing issues with their skin is because of a lack of sleep. The stress caused by the lockdowns and pandemic has had a negative impact on many people’s sleep routine. When you don’t get enough sleep, it will really start to show on the skin.

These are some of the common reasons thought to be behind an increase in skin issues during lockdown. However, it isn’t all bad news.

The lockdown has also helped the skin in other ways. Air pollution has been significantly reduced due to fewer people travelling. Some people have also ironically spent more time outdoors than they usually do as outdoor exercise has become more popular with the closure of gyms.

How to improve your skin during lockdown

If you are experiencing skin related troubles during lockdown, there are some things you can try. Ensuring you get plenty of sleep, maintain a healthy diet and keep on top of your skincare routine, are some of the most effective tips you can follow.

Eating a healthy diet will provide the skin with the nutrients it needs to repair itself. Meanwhile, skin care products such as a gentle cleaner and a lightweight moisturiser can also help.

For those with oily or breakout-prone skin there are cleansing products available with extra calming properties. And if you are spending more time outside, remember to wear a sunscreen with a high SPF to protect your skin from harmful UV rays.

While lockdown has presented many challenges for the skin, the above are some of the best ways to keep it healthy. With a date for the end of lockdown announced, now is the time to start focusing on getting the skin back to its best.

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 020 3494 4024.

Systemic treatment

Well done to Dr Ferguson and Dr Ho. Our case ‘Extensive mucocutaneous, oesophageal and otic lichen planus secondary to Nivolumab therapy’ has recently been published in Skin Health and Disease.

Anti-PD-1 therapy is a type of immunotherapy and an area in increasing development for its efficacy and advantages in the treatment of advanced metastatic melanoma.

Lichenoid reactions are well recognised within the context of anti-PD-1 therapy. We report a rare case of lichen planus occurring in the mucous membranes, oesophagus and otic canal. This case highlights the importance of considering systemic involvement in these patients. These cases can be difficult to treat especially within the context of malignancy.

Read more here – https://doi.org/10.1002/ski2.8

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 0203 494 4024.

skin in the sun

If you are being treated for cancer, whether this is with chemotherapy, immunotherapy, targeted therapy or radiation keeping your skin protected all year around is essential. Cancer treatments can make your skin more susceptible to sun damage. Even on overcast days, UV rays can still penetrate the skin. Under the right conditions, patients can still burn in the sun on a winter’s day. This makes it essential for patients to keep themselves protected.

Here, we will look at the dangers of sun for cancer patients, alongside what you can do to minimise the risks.

How can the sun damage our skin?

Sun damage is caused by UVB and UVA radiation. While UVB radiation is most harmful in the summer, it can still be present in winter. UVA radiation is associated with skin damage, ageing and specifically in patients being treated for cancer with drug photosensitivity.

UVA radiation tends to stay consistent all year round and can even penetrate through glass. It means that even if you are spending time indoors, you can still suffer skin damage from the sun.

The rays of the sun are strong enough to penetrate through clouds and fog. So, whether it is an overcast day or a bright sunny day; you remain at risk from sun damage if you don’t protect the skin.

When you are undergoing cancer treatment, sun damage can be severe. Depending on what drug you are on, this can happen very quickly, making it crucial to take preventative measures.

How can you protect skin from the sun?

Now that you know how damaging the sun can be, the question is how can you protect yourself?

Protective clothing including hats, sunglasses, and long sleeves are really important for sun protection. Wearing a hat is a good way to protect your scalp, especially for those with thinning hair. Sunglasses with wide frames are also a good idea to protect your eyes and sensitive skin around them. Regular sunscreen is a crucial way to protect the skin throughout the seasons. Ideally, you will want to choose a product which contains a minimum SPF 30 with both UVA and UVB protection.

For those with acne prone skin conditions oil-free SPF formulations are helpful. Look out for ones that contain additional antioxidants and DNA repair enzymes.
A good choice for men is a fragrance-free sunscreen that dries completely clear.

Alongside ensuring you have the right products; you should also avoid being out in the sun for long periods of time.

Cancer patients do need to be extra careful when it comes to keeping the skin safe from winter sun. The above are some of the best ways to keep yourself protected.

For more advice on how best to care for your skin while undergoing cancer treatment, call us on 0208 661 3372 to arrange a consultation with Dr Heelan.

HER2-Positive Breast Cancer

Congratulations to Dr Chawla who has recently written a case report entitled ‘Annular atrophic lichen planus induced by anti-HER2 antibodies’. This has been published in the Australasian Journal of Dermatology.

Monoclonal inhibitors Pertuzumab and Trastuzumab inhibit human epidermal growth factors receptor 2 (HER-2). These are used to treat HER-2 positive breast cancer. Our case highlights a rare variant of a lichenoid drug eruption in a 35 year old female. Recognising rare potential side effects can ensure patients do not require treatment interruption.

Read the article by visiting here.

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 02034944024.

oncodermatology

Dermatologist Dr Kara Heelan recently shared her expert advice with Vogue on how to care for your skin while undergoing treatment for cancer.

Dr Heelan is a specialist in oncodermatology and explained that “approximately half of people treated for cancer will develop a dermatologic issue during treatment affecting hair, skin or nails. Chemotherapy, radiotherapy or targeted treatments work by killing cancer cells, while immunotherapy treatments boost the body’s own immune system,” she says. “These effects can have repercussions, not just on the target organ, but also on other organ systems including the skin.”

Your skin can be affected in different ways, depending on the treatment you receive:

  • itchy, dry skin
  • extra sensitivity
  • increased sun sensitivity
  • pigment changes
  • skin can be more susceptible to infection

The first step is to look at your current skincare routine and eradicate any products that will irritate the skin. Dr Heelan recommends avoiding “harsh toners, and any facial treatments that contain alcohol, BHAs (beta-hydroxy acids), irritant anti-acne products such as salicylic acid or benzoyl peroxide and scrubs, harsh exfoliants or bead containing products.

“Patients often ask me about continuing their ‘active’ topical skin treatments, like vitamin C or tretinoins. However, this often needs to be dealt with on a case-by-case basis, depending on the individual’s cancer treatment and the specific topical product constitution.”

Dr Heelan also advised which products you should be using. “Exchange soaps for mild, gentle fragrance-free soap substitutes or washes, and take short, warm – not hot – showers and baths,” suggests Dr Heelan. When it comes to the skin on your face, Dr Heelan advised gently patting or dabbing your skin dry after washing and applying moisturisers or other products at this stage. “When the skin is damp, there is increased absorption of topical agents.”

Moisturising is also extremely important for treating dry skin and even before you start your cancer treatment, start building up your skin barrier. “Creams and ointments are usually better at hydrating the skin than lotions or gels, and ceramides can also be quite soothing.”

And, most importantly of all, do not neglect sun protection. “Sun-sensitivity can be particularly severe depending on the drug you are on, and can occur quite quickly. Protect your skin with clothing and SPF and use lip balms with a high SPF, as lips can be particularly sensitive. You don’t have to avoid sunshine holidays, but be very careful and wear protective clothing, and regularly apply sun cream with a high SPF of at least 30. Look for mineral or physical sunscreens, which can be less irritating on very sensitive skin, particularly for acne type skins.”

For more advice on how best to care for your skin while undergoing cancer treatment, Dr Kara Heelan recommends that patients should consider consulting a dermatologist with a special interest in oncodermatolgy. Call us on 020 8661 3372 to arrange a consultation with Dr Heelan.