Another life saved…
As a private dermatologist I am lucky to see a wide range of different skin conditions. Following on from my last blog about a lady with melanoma (a dangerous cancerous mole), I’m going to discuss a few other patients who attended my clinic recently.
A delightful 89 year old man came to me with a very itchy, widespread rash which looked like large red blotches covering his whole body. It was an obvious dermatitis, literally meaning inflammation of the skin. This is easy to fix – a very strong steroid ointment generously applied along with a greasy moisturiser to be used regularly. Soap can make it worse so the moisturiser is used as a substitute for soap when washing.
BUT -right in the middle of his abdomen there was a very large brown and black mole which looked cancerous – melanoma! Examination using a dermoscope, a special piece of equipment that allows us to look into the superficial layer of skin, revealed far more detail than can be seen by the naked eye and confirmed my initial clinical suspicion of melanoma ( or at least until proven otherwise by a biopsy).
He, however, was very relaxed about it! A gentle inquiry revealed that he had this mole for 20 years and that it had not changed over the course of time and that he had no intention to part with it! Furthermore he could not afford to have it removed privately. From my point of view, fixing the itchy rash is easy but the most important thing is to remove the melanoma which could strike at any moment and potentially kill him. It took another 10 minutes to gently explain the significance of this mole and the importance of having it removed. It is unlikely the mole hadn’t changed for 20 years and you can’t always trust an 89 year old’s eyesight so it was very important to take the time to explain to him. Finally I wrote a hand written note to his GP to refer him urgently to the NHS for removal of this melanoma (my typed letter will follow but it would take a few days to reach his GP). He left with a prescription for ointments and a promise to pass my note to his GP on Monday morning. I feel happy – another life saved.
Later, a 60 year old gardener came to see me for a follow up appointment. He came to see me the first time almost a year ago with a very large cancerous nodule on his temple – I took it out there and then and later examination under the microscope confirmed that this was indeed a high grade type of skin cancer called squamous cell cancer. Fortunately it was removed before it spread. Since that time I have been monitoring him every 3 months to keep an eye on the scar and checking his lymph glands (after the skin cancer was removed there is still a very small chance of it’s coming back) and indeed will continue to do so for 5 years.
Since I removed the skin cancer I started to treat his extensively sun damaged skin – a likely precursor of his skin cancer. He is a keen gardener and thus he has had a lots of sun in the past, but now he is more proactive about sun protection. I have been improving his skin and clearing sun damaged skin bit by bit. He did really well with a new natural gel – Picato gel which is based on natural chemical extracted from a plant called milkweed. (www.dailymail.co.uk/health/article-2345515/Garden-weed-help-fight-skin-cancer-Picato-fast-acting-treatment-condition-causes-form-disease.html). It has been licensed recently and it only takes 2 days to clear skin. Traditional creams take between 1 and 3 months or longer to do the same. His skin now looks much younger without dry red patches and blemishes.
On this routine check all was well and I could hardly see the scar from his operation – I blended it well into his skin lines. We were chatting about his garden (30 fruit trees not counting other plants!) and I treated a few thicker solar keratosis (a benign type of sun damage) with cryotherapy – a special, very cold spray. But there was one thicker scaly plaque on his neck (too thick for my liking) that could have been an early squamous cell cancer. We agreed that I would take it out as a day case in 4 days time once he gets authorisation from his insurance company.
Another man was booked into my clinic at the last moment. His GP tried to treat his cellulitis ( a type of skin infection) for a month but his leg was getting worse – redder and more swollen. At first it looked like a typical abscess but I wasn’t quite convinced as it was not giving him pain and he was well in himself. This prompted my inquiry into his recent travel and sure enough 2 month previously, and 1 month before his skin became inflamed, he had holidayed in Egypt. Despite this being a Friday night we arranged an urgent procedure that same evening – opened the abscess under local anaesthetic. And of course there was no pus inside! This meant that he did not have cellulitis or abscess – a straight forward infection of skin , oh no – he might have Leishmaniasis, an infection with leishmania parasites which he picked up during his foreign holiday! He then remembered the sandfly bite he got during his holiday but had forgotten about soon after returning.
I took a biopsy and sent it off urgently to examine specifically for leishmania (a doctor has to instruct to look specifically for these parasites otherwise the pathologist can easily miss it) and changed his antibiotics. I also got in touch with my colleagues in the London School of Hygiene & Tropical Medicine and arranged for him to be reviewed there the same week. A week later the biopsy report came back confirming that he indeed was infected with Leishmania! Not a common diagnosis at all and one which could easily have been missed. Fortunately, he responded very well to treatment and the lesion has now healed.
Thank you for reading my blog. If you have any questions, please see my website www.alexandroff.org.uk
Dr Anton Alexandroff CCT(Derm) FRCP PhD FRSM FAAD
Consultant Dermatologist and Senior Lecturer
Member of the British Association of Dermatologists
The British Skin Foundation Spokesperson
The British Association of Dermatologists Spokesperson for Media
Dr Alexandroff is an expert Consultant Dermatologist with a special interest in skin cancer, acne, dermatitis, psoriasis and hair loss. He sees private patients in Leicester Spire, Leicester Nuffield Health, Cambridge Nuffield Health and Bedford BMI hospitals.
The information in this article is intended as a guide and is not a replacement for medical advice. If you have any doubt you should always speak with your own doctor.