- We hope you find these answers helpful. Further useful information may be found within our ‘Media’ section. This features a selection of Dr Sheridan’s educational articles. The Australasian College of Dermatologists ‘A to Z of Skin’ section is another valuable resource.
- What are BCC, SCC and Melanoma?
Basal cell carcinoma (BCC), Squamous cell carcinoma (SCC) and Melanoma are different types of skin cancer.
BCC and SCC are collectively referred to as ‘non-melanoma skin cancer’ to differentiate these somewhat less worrying skin cancers from highly aggressive and dangerous Melanoma.
BCC and SCC are generally best managed surgically. This results in a high cure rate when expertly performed. In those rare cases where surgery is inappropriate (ie in the elderly or infirm), non-surgical options exist. Your specialist will carefully determine and advise upon the suitability of these.
Melanoma is a potentially fatal skin cancer if left untreated. It is considered a medical emergency. Your GP will refer you for urgent Specialist Dermatology input whenever melanoma is suspected. Treatment of melanoma almost invariably involves surgery and this ensures a high cure rate when performed early and expertly. You will also require regular follow up for full body skin checks, and may require further investigations and adjuvant treatment if yours is a severe melanoma subtype. Your specialist Dermatologist will discuss and design a care plan appropriate to your individual situation and needs.
- Are there other skin cancer types?
Hidden amongst the parade of relatively easily managed ‘common variety’ skin cancers such as BCC, SCC and melanoma, are rare and equally important skin cancers.
These must be correctly identified and managed, as each has it’s own special characteristics and health implications. For instance, sebaceous carcinoma of the eyelid is not only challenging to manage in terms of delicate eyelid surgery; it may also form part of Muir-Torre syndrome and indicate a need to screen for associated internal cancers of the bowel, liver, urinary tract, prostate and uterus.
Other rare and important skin cancers are: Merkel cell carcinoma, microcystic adnexal carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protruberans, nerve sheath tumours, cutaneous T cell lymphoma, Kaposi sarcoma, metastatic carcinomas involving the skin.
Your doctor will refer you to a specialist Dermatologist for further management when one of these tumours is suspected or diagnosed.
- What are actinic keratoses?
Actinic keratoses are pre-malignant non-cancerous skin lesions signifying significant photodamage and an increased risk of progression to skin cancer. They typically present as scaly lesions upon exposed areas such as the hands, forearms, face and ears. Your doctor will diagnose and treat these lesions with prescribed creams, cryosurgery or photodynamic therapy (PDT); and will encourage you to engage in careful sun protection measures to avoid further development of these lesions. If any such lesion resists treatment you should consult with your doctor again to ensure it has not transformed into a malignant skin cancer.
- What are dysplastic naevi?
Dysplastic naevi are atypical benign moles that mimic the appearance, but not behaviour, of melanoma. Individuals with dysplastic naevi are at heightened risk of developing actual melanoma; both within the naevi and elsewhere upon the skin. As such, careful sun protection and regular skin examinations by a specialist Dermatologist are strongly recommended.
- How should I check myself for skin cancer?
Skin cancers are often first identified by patients, their family and friends. Individuals are well attuned to their own skin, and are often best placed to notice suspicious lesions. It is therefore important to keep a close watch upon your own skin. It is recommended that you spend at least 5 minutes at the change of each season (three monthly) examining your skin closely for new, changing, asymmetric or symptomatic skin lesions.
Be sure to to check your back with the aid of 2 mirrors; or ask a family member or friend for help.
It is a good idea to take and store baseline photos of your skin (pose front, back and side-on in your underwear) for comparison with your current skin at each self examination session. You may also elect to bring relevant photos with you to your doctor’s appointment for shared reference.
It is especially important to check yourself regularly if you have had a skin cancer removed in the past, as you will be at increased risk of new or recurrent skin cancers. All treatments, no matter how advanced, have a failure rate. This even applies to Mohs Surgery. Check the post surgical scar and operative zone for new lumps and skin changes; and remain alert for unusual persisting symptoms in the area such as pain and tingling. If you have had a skin cancer removed from the head or neck region, also check yourself for enlarged lymph nodes. These are usually felt as firm grape-like lumps beneath the skin around the ears, under the jawline and chin, and the sides of the neck. Should you detect any such changes arrange an urgent review with your Dermatologist or GP.
If you have suffered with skin cancer, your relatives may also be at heightened risk. Encourage them to engage in sensible sun protection activities and regular self examination. They may also benefit from a careful assessment by a Specialist Dermatologist.
Explore the educational links below to premier academic organisations for further information and helpful galleries or explore the follwoing patient education link: www.skincancermohssurgery.org
- How often should I have my skin checked by a Dermatologist?
Your Specialist Dermatologist will carefully generate a care plan tailored to your specific skin type, risk factors and past skin history.
In general, for routine surveillance of low risk individuals, a 12 – 18 monthly full body skin check with your Specialist Dermatologist, GP or Skin Cancer Clinic GP will suffice.
For higher risk individuals and those with a past history of skin cancer, a 6 – 12 monthly skin check with a Specialist Dermatologist is recommended.
If you notice a changing or symptomatic lesion, you should contact your doctor to arrange an urgent review.
- Do I need to wear sunscreen every day?
Yes. Like all preventative health measures (think brushing your teeth), sunscreen application must be performed daily. Nothing beats the combination of a broad-spectrum SPF 50+ UVA/UVB sunscreen, a wide-brimmed hat (Dr Sheridan favours an old school Panama!), sunglasses and sun smart behaviours. It is important to note evidence pointing to wavelengths of visible light and infrared as also contributing to skin damage, ageing and cancer. This evidence further indicates the need for year round sunscreen.
- Is an SPF containing moisturiser sufficient protection from the sun’s harmful rays?
No. While helpful, on its own this is insufficient protection from the sun’s cancer-causing and ageing UV rays. Nothing beats the combination of a broad-spectrum SPF 50+ UVA/UVB sunscreen, a wide-brimmed hat (Dr Sheridan favours an old school Panama!) and sunglasses.
- Is there a safe way to tan?
There are several grave myths around tanning and darkness of skin:
1. A sun tan protects your skin from sun damage and skin cancer.
This is a myth of the worst kind, in that it encourages an activity proven to cause premature ageing of the skin and eyes, immunosuppression and fatal skin cancer. There is a terrible misconception that a suntan somehow toughens and prepares the skin to withstand further sun damage. Nothing could be further from the truth. In fact, a natural tan signifies that the sun has already done it’s worst to exert sufficient damage, including to DNA, and to put the skin’s natural defences into overdrive to produce more melalin (melanogenesis); to create a lasting imprint of oxidised melalin – the brown ‘stain’ that is a suntan.
2. A fake tan protects your skin from sun damage and skin cancer.
As we all know, a fake tan is a good compromise for those clients who feel tanned skin looks good and who are sensible enough to avoid the achievement of this through damaging sun exposure, melanoma causing sunbeds, and questionable products obtained over the internet to stimulate melanocytes. However, the illusion that must shattered is that the applied colour dye possesses protective qualities. Fake tans are not SPF rated and confer no additional protection over the client’s baseline skin colour. Once a red head or blonde, always a red head or blonde!
3. Dark skin means you don’t have to worry about sun damage.
This is another dangerous myth. While it is true that darker skin types may prove more resilient in the sun, significant damage still occurs. Skin ageing accelerates, and the bane of all darker skin types – pigmented blemishes – increase in number. Fatal skin cancers may also arise. Dermatologists never tire of recounting the cautionary tale of Bob Marley who died of melanoma of the toe. It is also important to remember that as the world becomes ever more interconnected, mixed race backgrounds are on the rise. It is therefore not uncommon for an individual with dark appearing skin to share the genetic susceptibilities of their paler forefathers and mothers.
- How do I balance being sun smart with maintaining my Vitamin D level?
This is frequent question, and a challenging balancing act in Australia.
The sun’s radiation is both the major cause of skin cancer and the best natural source of vitamin D. In Australia we need to balance the risk of skin cancer with maintaining healthy vitamin D levels, to maintain good health.
The amount of sunlight you require to produce healthy vitamin D levels relates to a combination of factors including the prevailing UV level, your skin type, and your lifestyle. UV levels vary across Australia and throughout the year. Therefore, the amount of time you need to be in the sun to produce adequate vitamin D will vary according to your location, the season and the time of day.
Sun exposure exceeding base requirements does not result in an increased vitamin D ‘store’, but does increase your risk of skin cancer.
Brief sun exposure ‘snacks’, such as walking yo work, then at lunchtime or to the shops, are a good way to safely acquire vitamin D. It is also a good idea to vary the area of the body you expose to sunlight.
The amount of vitamin D produced also relates to the area of your skin exposed to the sun – the more exposed, the more produced. During summer in southern Australia (Sydney, Melbourne, Adelaide, Hobart and Perth), and all year round in the north (Brisbane and Darwin), a few minutes a day of sun exposure to an area of skin equivalent to your face, arms and hands is sufficient.
Daily exercise will also assist your body with the production of vitamin D.
Regular use of sunscreen day to day has not been shown to block vitamin D production.
Refer to the SunSmart UV Alert for the sun protection times at your location: http://www.sunsmart.com.au/uv-sun-protection/uv
- What dietary elements are essential for skin health?
Dr Sheridan and the Specialists at SDSL recommend: Vitamins A, B3, C, E, Zinc, Omega 3, Resveratrol and Probiotics. These should be included in the context of a balanced healthy diet and lifestyle to support inner and outward health. Read our article on ‘Skin Superfoods’ in the News section for more detailed information.
- Can vitamin supplements such as nicotinamide (vit B3) prevent skin cancer?
There is a growing body of evidence that supports the notion that certain prescribed supplements such as nicotinamide (a form of Vit B3) and retinoids (forms of Vit A) can slow skin ageing and prevent skin cancer. Such supplements must be taken in high doses to achieve a clinical effect. It is important to note that no such treatment is completely without side effects. It is best that you discuss the appropriateness of such treatments with your doctor.
- Should I apply my prescribed cream before or after moisturising?
This depends on the purpose and nature of the cream prescribed by your Dermatologist:
1. When the aim is to deliver maximum impact, the prescription cream should be applied after cleansing and before moisturising. Examples are spot treatments for acne, and creams for photodamage such as Retinol, Tretinoin, Efudix, Picato, or Aldara.
2. When the skin is in an angry state or when the prescribed cream is being gently introduced to the skin, it will generally be applied after moisturising. This ‘dilutes’ the medication and prepares the inflamed skin to receive it.
- How often should I exfoliate?
The exact frequency relates to your skin type and age. In many cases modern skin care products actually eliminate the need for active exfoliation with scrubs, peels and dermabrasion.
If exfoliation is of benefit for you, we generally suggest performing this weekly at most. More frequent exfoliation encourages abnormal skin turnover, oil production, acne and pigment.
A simple guide is if your skin is red and reactive following exfoliation, reduce the frequency. If it remains dull and scaly, exfoliate more frequently.
- What is photodynamic therapy (PDT)?
PDT is the application of a light sensitive chemical to the skin; followed some time later by illumination with a specialised light which activates the absorbed cream. PDT is an elegant method of selectively destroying pre-cancerous and frankly malignant cells, as these actively absorb the light
sensitive chemical to a greater extent than normal healthy cells.
- Is IPL the same as laser? Which is better?
IPL and laser are different. Each modality has specific advantages and disadvantages. Your Specialist Dermatologist and RN will help guide you in selecting the best treatment option for your particular condition and skin type. In many cases a combination of the two modalities is desirable to ensure the ‘best of both worlds’.
IPL contains many wavelengths of light energy; and consequently targets many abnormal elements in the skin with each ‘shot’. Laser is very specific and has only one wavelength; it therefore delivers all it’s energy to a single specific target with each ‘shot’.
As with all medical technology, the qualities of each IPL and laser machine vary significantly; as do the qualifications and experience of the person operating it. It behoves the patient to carefully research these important variables before accepting treatment; especially for delicate areas such as the face and on darker skin types.
- What is micro-focussed ultrasound?
Deep tissue micro-focussed ultrasound (aka DTUS /Ultherapy™) is a non-surgical medical procedure used to tighten lax skin about the face, neck, chest, arms, knees, thighs, abdomen and buttocks. Ultrasound energy is used to stimulate the production of new collagen and strengthen the deep structural support layers of the skin; including those typically addressed in surgical face and neck lifts. Hence DTUS is referred to as the ‘non-surgical lift’ by Dermatologists and surgeons.
- Is Roaccutane (Isotretinoin) a dangerous drug?
Roaccutane is a well known brand name for 13-cis retinoic acid, a retinoid (a form of vitamin A). It is the most effective treatment currently available for severe and scarring cystic acne. Taken correctly, it achieves a cure rate exceeding 95 percent within six to eight months at our practice. In addition to clearing severe acne, it acts to prevent permanent scarring and associated problems such as poor self-esteem and confidence.
Isotretinoin is, however, not to be trifled with. It must be prescribed by a properly credentialed Dermatologist.
Potential significant side effects include birth defects, liver toxicity (especially when taken with alcohol and other drugs), photo-sensitivity, dry skin eyes and lips, and musculoskeletal issues. Controversy exists regarding a link to severe conditions such as inflammatory bowel disease and depression; with which it has been associated. A definite causal link has not been established in large long term multi-centre studies.
Individuals suffering with severe unresponsive acne, at risk of scarring, should be made aware of this treatment option and have the opportunity to engage in a balanced and careful discussion regarding it and other available treatment options.
- I have Asian skin. Is there anything special I should be doing?
Each skin type is blessed with unique benefits and challenges. Asian skin tends to age very well. Wrinkles and volume loss are slow to appear. However pigment disorders are quick to declare. The key is to focus upon gentle reparative skin care and meticulous sun and visible light protection. Avoid harsh scrubs and exfoliants designed for Western skin, as these may irritate and risk post-inflammatory pigmentation. Likewise be very wary of laser treatments as most are designed for paler skin types.
- Why should I see a Specialist Dermatologist like Dr Sheridan?
Dermatologists are the experts in management and prevention of all aspects of skin, hair and nail disease; including skin cancer. Your GP will refer you for specialist care when this is required.
A Dermatologist has obtained a medical degree and has also undergone at least four years of specialist training. The Australasian College of Dermatologists is the only government accredited provider of specialist training in Dermatology. For more information visit www.dermcoll.edu.au and www.amc.org.au.
Some Dermatologists, like Dr. Sheridan, undertake further advanced Fellowship training in subspecialty fields such as Mohs Micrographic Surgery, Pathology, Reconstruction and Laser.
Dermatologists initially train as medical doctors, undertaking six or more years of university study to attain their medical degree. This is followed by several years of full-time training as a resident medical officer in an accredited teaching hospital. Only then can application be made to enter the four to five year national Dermatology training program. Regular assessment of trainees is conducted by the Australasian College of Dermatologists to ensure the high standards of specialists produced.
Certified Dermatologists are required to undergo continuing medical education activities to maintain and improve their clinical skills over time.
Dr Sheridan contributes to the training and examination of specialist Dermatologists through all levels of their training. He also sits on national committees overseeing their ongoing professional development.
- Is Dr Sheridan the best and only doctor I need to see?
Dr Sheridan is at the top of his field.
That said, at SDSL we are strong believers in a multidisciplinary approach to ensure the best outcomes for our patients. There are therefore instances where Dr Sheridan and our team will call upon a carefully selected network of skilled and ethical Plastic Surgeons, Oculoplastic Surgeons, Ophthalmologists, Endocrinologists, Allergists, Skin Cancer Clinic GPs, Radiation Oncologists, Cosmetic Surgeons and others to aid in the delivery of your care. In certain circumstances we will also involve the input of your local public teaching hospital department.
- What is Dr Sheridan’s philosophy?
Dr Sheridan and the staff at SDSL take pride in the delivery of peerless specialist medical care. We are deeply committed to quality, through personalised care and professionalism. We enjoy caring for all members of the community; and all skin types, from white to coloured. We work in close partnership with a network of excellent GPs, Specialists, Pathologists and Allied Health professionals. We value our close relationships with premier hospitals and academic units throughout the country.
We invest heavily in our skills, people, equipment and facilities.
Dr Sheridan has devoted himself to the highest level of Specialist training, travelling the breadth of Australia and internationally to attain his knowledge and skills. These are honed through ongoing medical education activities and interaction with respected institutions in Australasia and the rest of the world. Dr Sheridan makes academic contributions through teaching of Specialists, GPs, Nurses and Medical Students. He enjoys learning as much as he teaches through this interplay with other curious minds.
Our friendly staff look forward to welcoming you to our bright modern practice, to bring the benefits to bear upon your health and well being.
- Do I need a referral to see Dr Sheridan?
Dr Sheridan is a specialist Dermatologist. You will require a valid referral from your referring doctor to make an appointment; and to ensure that you receive the Medicare support that you are entitled to for medical conditions.
Some patients elect to ‘self refer’ and attend without a referral; and accept that they will not be able to claim Medicare support for their non-referred attendance.
Consultations regarding non medical cosmetic issues may also be initiated without a referral, as these issues do not attract any support from Medicare, regardless of referral status.
Overseas patients may also attend without a GP referral, as long as they understand and accept that they or their insurer will need to cover the entire cost of the consultation and any subsequent treatment.
- Is there a long wait to see Dr Sheridan?
Dr Sheridan is a well trusted, respected and popular Dermatologist. As such, there is usually a waiting list for a consultation. We shall open the books in December 2017 to accept new patients for 2018. If your referral is urgent, and your referring doctor indicates the time critical nature of your condition, this will be taken into account and every effort shall be made to facilitate your appointment and care. You may request placement upon our cancellation list; as appointments may become available at short notice.
- Do you give medical advice over the telephone, and via email and texts?
This practice can only offer medical advice in the context of a direct face to face consultation. There are several reasons for this, foremost of which is the imperative to maximise patient safety through full and proper clinical assessment. This involves a medical consultation, physical examination, subsequent investigation and follow-up. So as not to cause inadvertent offence to any particular individual, this is a strict blanket policy applying to all patients seeking care at our clinic. We appreciate that this policy may seem inconvenient at times in today’s busy world; however we must place health before convenience.
- Does Dr Sheridan recommend a particular skin care range?
There are many excellent skin care products available to you on the market. Unfortunately there is no ‘one size fits all’ product. Every patient and their concerns are unique. Dr Sheridan and the nurses at SDSL will help guide you in the tailored selection of the best skin care regime for your particular skin and specific concerns.
- Does Dr Sheridan perform cosmetic procedures?
Dr Sheridan has extensive and deep experience in all aspects of Dermatology, Surgery, Laser and Injectables. He is Chief Medical Officer at Phoenix Dermatology and can make arrangements for treatment of cosmetic concerns.
Visit www.phoenixdermatology.com.au or click on the Phoenix icon below for more information.
To make a cosmetic appointment and to contact our friendly and informative staff for more information: firstname.lastname@example.org.
- Does Dr Sheridan appear in the media and endorse particular products?
Dr Sheridan is willing to engage in educational activities and offer his expert opinion upon the issues of the day; where this contributes to the ongoing education of doctors, nurses, allied health professionals and the interested public. However, in keeping with our strict ethics and code of conduct, Dr Sheridan cannot and will not endorse any commercial products or events. To avoid offence to any particular individual or organisation, this is a blanket policy. We trust that you will understand and respect the position we have taken on this.
- For further information please call our helpful and friendly staff.