Dermatology is the branch of medicine dealing with the skin and it is a speciality with both medical and surgical aspects. A dermatologist is a specialist doctor who manages diseases related to skin, hair, nails, and cosmetic skin issues.

There are many conditions that can affect the skin, some causing mild symptoms while others can be serious and interfere with everyday life. Skin redness, itching, pain, rashes and pus are all signs you need to see a Dermatologist. Dermatology is a recognised medical specialisation and a Dermatologist is the best person to treat skin, hair and nail problems. Dermatological treatments can range greatly from improving the look of your skin, treating acute or chronic skin diseases like acne and eczema, to the screening and surgical removal of skin cancer that can save lives.

At Dermatology & Surgery Clinic, our dermatologists are specialists who have received extensive training in the use of various modalities to treat this skin and these include injectables and lasers for cosmetic enhancement. We also have a Sub-Speciality Clinic focusing on Aesthetic and Laser Dermatology.

In addition, it is good to note that most of the recent innovative cosmetic skin treatments and procedures were developed and introduced by Dermatologists. These include treatments for acne scarring, sun damage, wrinkles, fine lines and brown spots, Mohs Micrographic Surgery for skin cancer, dermabrasion, hair transplantation, chemical peels, laser surgery, tumescent liposuction (a safer form of liposuction), sclerotherapy for leg veins, fat transfer, Botox, fillers like collagen, Restylane and Sculptra, laser resurfacing, facial rejuvenation, and high tech vein treatments.

Some patients may decide to see a provider with a different medical specialty; However, when it comes to your skin, hands-on experience, continual training, and specialised knowledge of the skin is optimal as a poor treatment outcome could take months and additional treatments to fix.

You should make an appointment to see a dermatologist if you notice changes in a mole's color or appearance. In addition, you also should have moles checked if they bleed, ooze, itch, appear scaly, or become tender or painful. It would be ideal if you know your body and existing moles well, and perform regular self-exams to be aware of changes.

Psoriasis often appears as thick scaly areas located on the scalp, elbows, knees, and buttocks. It is a chronic skin condition that can range from mild to severe and can also be linked to joint inflammation and arthritis.

The exact causes of psoriasis is not known but there is a definite genetic component to this skin condition.

Psoriasis is a chronic condition that tends to change in severity over time. It can be treated effectively with medications and the symptoms can be improved dramatically. There remains to be a definitive cure for psoriasis at this time.

The causes of hair loss can be very varied. It is most commonly genetic and age related. Both men and women tend to lose hair thickness and amount with age, while inherited or pattern baldness affects significantly more men than women. Other causes of hair loss are stress, illness, trauma, medication-related, and autoimmune diseases. Alopecia areata is one common auto-immune disorder causing patches of hair loss.

Seeing a dermatologist may help to define the cause of the hair loss, following which, the dermatologist can work with you to develop a treatment plan to counter the condition. Sometimes a small (and relatively painless) biopsy or laboratory evaluation may be necessary to understand the reason for hair loss and its corresponding treatment.

A combination of sebum and bacteria on the skin is what causes acne.

Sebaceous glands are found in hair shafts in a unit called a sebaceous follicle. The cells of the skin that line these follicles shed in the normal course of the skin renewal cycle and when these shed cells mix with sebum being produced, they can clog the opening of the follicle. A natural skin bacteria called P. acnes multiplies rapidly in the clogged hair follicle causing inflammation. Sometimes the wall of the follicle can burst, spreading inflammation to the surrounding skin. This is how acne lesions like blackheads, pimples and nodules are formed.

Unfortunately washing alone will not clear up or prevent acne. Acne is actually caused by a variety of biologic factors that are beyond the control of washing. For that reason, you should consult a dermatologist for the appropriate acne treatments for your skin condition.

Washing your face will help to remove some excess surface oils and dead skin cells. However, do note that some washing may be counterproductive. Be careful of using harsh products like alcohol-based cleansers or scrubbing your skin vigorously as these can irritate the skin further and worsen acne. Do wash your skin twice a day gently with water and a mild soap, rinse clean and pat dry gently.

Mohs micrographic surgery (MMS) is a precise surgical technique used to treat skin cancer. During MMS, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. MMS has been recognised as the skin cancer treatment with the highest reported cure rate.

Some skin cancers can be deceptively large – reaching far deeper and more extensive than what is visible on the skin’s surface. These cancers may have “roots” in the skin, or along blood vessels, nerves, and cartilage. In addition, skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site.

MMS is specifically designed to track and remove these cancerous “roots” with minimal damage to surrounding healthy tissue. MMS is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurrence, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.

A Mohs Surgeon (a doctor with specialised training in MMS) equipped with adequate surgical and laboratory facilities, and aided by highly trained staff can perform this surgery.

There are three steps involved in MMS.

1.The skin is cleansed, marked and made completely numb using a local anaesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes a few minutes and the patient may then return to the waiting area.

2. The specimen is then processed. It is sliced thinly, stained and placed on microscope slides so that the margins of the specimen can be fully examined. This is the most time-consuming part of the procedure, often requiring a number of hours.

3. The Mohs Surgeon carefully examines these slides under the microscope. All microscopic “roots” of the cancer are precisely identified. If residual cancer is found, the Mohs Surgeon will proceed to remove additional tissue only where cancer
is present.

The above 3-step process is repeated as many times as necessary to locate any remaining cancerous areas. When microscopic examination confirms that there is no remaining cancer, the wound is then ready for repair.

This allows the MMS technique to leave the smallest possible surgical defect as only tissue around the “roots” and extensions of cancer is removed.

When the cancer is removed, the Mohs Surgeon will discuss with you the options of closing the wound.

These may include:
- Allowing the wound to heal naturally without additional surgery.
- Wound repair by the Mohs Surgeon.
- Wound repair by the original referring physician or another surgeon.

Yes, the site to be treated is numbed using local anaesthetic injections. While this may cause some discomfort, especially in sensitive areas on the face, the sensation only lasts a short while. The anaesthetic lasts for around 2 hours. Top ups of anaesthetic injections may be required during the next stage(s) of surgery and repair.

Most cases can be completed in three or fewer stages and you can be discharged by mid-afternoon. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer’s “roots” cannot be estimated
in advance.

Therefore, it is advisable to reserve the entire day for this surgical procedure in case the removal of additional layers is required. Rarely, in more complex cases, the surgery may be continued at a later date. Occasionally, you may need to stay in hospital overnight, in which case we will aim to inform you as soon as possible.

Get a good night’s rest and eat normally on the day of surgery. If you are taking medications, continue to take them unless otherwise instructed.

If you are on Warfarin, Aspirin or another blood thinner or if you have a bleeding disorder: The dermatologist who arranged your surgery would usually have told you if you need to stop these treatments or take other actions. If you are uncertain, please call us, two weeks before operation if possible.

- Remove make-up if the operation is on your face.

- You may wish to bring a book or magazine with you to occupy your time while waiting for your tissue to be processed and examined. It is best to have a family member accompany you as well. You should arrange for someone to drive you home after the surgery is completed.

- Smoking slows down wound healing and there is a greater risk of wound breakdown or infection if you are a smoker. You are advised to stop smoking 2 weeks before and until 3 weeks after surgery.

- Avoid alcohol at least 3 days before surgery

Patients may experience minor post-surgical discomfort. Most patients do not complain of significant pain. If there is discomfort, you may wish to take Paracetamol for relief. You may experience slight bleeding, bruising and swelling around the wound (especially if it is near the eyes).

While all skin surgeries will leave a scar, MMS typically minimises the possible surgical scar. A keloid (an exuberant type of scar) may develop on certain sites, but this is very rare.

Your doctor will arrange for follow-up appointments, usually at 1-2 weeks and then at 3 months to chart your progress.

As with any skin surgery, the possible complications include bleeding, swelling and bruising, wound infection, nerve damage, pain, discolouration of skin, and wound or scar breakdown. Your doctor will discuss these risks with you before you proceed with MMS.