From many years in General Practice to training with the Skin Cancer College of Australasia, Association of Cosmetic Medicine and the University of Queensland, Dr Julian Fox has gained the knowledge to be able to assess, diagnose and treat many skin conditions and cosmetic concerns. He is joined now by a number of other doctors with similar training or under his supervision
About Your Skin
- As the largest organ in your body (you may not have thought of it like that before) it is unique in being completely exposed to the environment- whilst completely linked to you! As such the skin is a unique interface. Its health can be an indicator of your own health and many internal diseases manifest external features in the skin. A doctor treating your skin should have a wide understanding of medical and psychological conditions.
- Skin cancer is one of our key concerns. We think wider than just moles and marks – assessing the overall damage your skin may have suffered, in the context of what is the most appropriate treatment and regimen for you.
- Each of us has a unique profile in terms of our in built or genetic risk, determined by our skin type, and the environmental factors of what our skin has had to cope with.
- Growing up and living in Queensland poses an increased risk, the rates here being double the rates across the whole of the Australian population. Of course the rates in Australia are the highest in the world.
- If you and your family are from Queensland then there’s a good chance you have the fairer skin type. We all know that in growing up before the 1970’s, there was little said about the risks of sun damage. That means that if you’re over 40 there is a good chance you have sun damage already.
How do we detect skin cancers?
Many times you will notice some change on the skin. Other times a doctor will.
- Computers and scans play very little role in detection – the key factor that determines detection is the experience of the doctor. An essential tool is the dermoscope – a magnifying light that is either used in contact with the skin or held over. In some clinics the dermascopic image is fed into a computer for convenient display on a large monitor screen. An added advantage of this method is the ease of capturing that image digitally – for later comparison or monitoring.
- Dermoscopy– the gold standard for diagnosis of skin cancer. To the experienced doctor using dermoscopy provides the best tool widely available for assessing skin lesions – to detect any skin cancer at an early stage whilst avoiding unnecessary removal of harmless lesions – therefore it improves the rate of detection and reduces the number of unnecessary removals and biopsies.
- Photography plays a part in some cases. Changes in pigmented skin lesions can be almost imperceptible and more easily noticeable on dermoscopic pictures taken 3 months apart. This is usually referred to as short term digital monitoring.
- Total Body Photography is sometimes appropriate for patients with a very large number of moles to assist them in home monitoring. Digital photography including “mole mapping” and “molescanning”. Whilst it’s the doctor’s skill in assessing the image (not a computer programme) that counts, we use high quality photography to allow detailed comparisons – again, sifting out the serious from the benign.
The commonest biopsy technique is the shave biopsy – a simple sampling of the skin after a small injection of local anaesthetic. Approximately 1mm depth of tissue is removed and analysed by a pathologist. No stitch is required and in the right hands produces invaluable information to assist the doctor treating you.
Treatment of skin cancer - Surgery vs non-surgical
We will sit down with you after a biopsy and discuss your options. Some superficial skin cancers can be treated with non-surgical methods. These are some of the methods available:
- Cryotherapy – liquid nitrogen is released as a spray. It causes damage to the tumour and also to some of the surrounding tissue. A blister often forms – leave this until it parts spontaneously and fresh healing tissue will emerge.
- Curettage and diathermy – under local anaesthetic a special tool is used to “curette” or peel off, the damaged layers. Electrical energy is used to cauterize the wound Topical treatments – Aldara and Efudix are both used in certain circumstances to treat skin cancers. Discuss in detail the cure rates of these treatments and where their use is appropriate.
- Surgery – Dr Julian Fox has had training within the Skin Cancer College, and with local plastic surgeons and skin cancer surgeons, to develop his skills in repairing the skin after skin cancer removal, including the use of skin flaps and grafts.
Working with other specialists enables us to give the best care:-
- Telehealth consultations with a dermatologist from selected locations
- Second opinions over digital media
- Expert advice and networks
- Speedy referrals when needed
- Superior local facilities
- Photodynamic therapy – we use this in 2 distinct situations. It has proven effectiveness in treating sun damage and precancerous changes, with the purpose of reducing the number of new cancers. It is also an emerging therapy for acne, where it reduces the activity of oil glands and helps clear the acne bacterium (P Acnes) from the skin.
- Specialist acne prescribing – see information on telehealth for details on how we can arrange a telehealth dermatologist opinion regarding specialist prescribing of anti-acne medication.
We use both anti-wrinkle injections and natural fillers to enhance appearance and reduce the signs associated with aging. We also have a number of high quality and affordable medical grade skin products available to purchase, complimented by prescription and specially compounded creams.