Practice Matters Magazine

The magazine for Healthcare Professionals from The Wellington Hospital

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Articles written by professionals from The Wellington Hospital for Healthcare Professionals.



As Chance Would Have it

Mr Ciaran Healy talks to us about the Integrated Skin Cancer Service at the Platinum Medical Centre, and how a chance meeting led to swift intervention for one member of staff.


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The Service

The London Skin Cancer Specialist Service at the Platinum Medical Centre is a fully integrated multidisciplinary programme, providing excellent comprehensive care throughout the disease continuum. This dedicated unit brings together dermatologists, plastic surgeons, pathologists and oncologists with specific expertise in the evolving techniques of diagnoses and treatment of basal and squamous cell carcinoma, melanoma, dermatofibrosarcoma and cutaneous lymphoma etc.

The Team

Chaired by Mr Ciaran Healy, Consultant Plastic Surgeon, the team at the PMC is lead by Prof Sean Whittaker in Dermatology, Dr Nick Francis in Dermato-Pathology, Dr Paul Nathan in Oncology, and co-ordinated by Charge Nurse Ali Bautista. Each participating consultant in the London Skin Cancer Specialist Service has held senior positions at NHS teaching hospitals and contributes to the ongoing development of the speciality.

Case Study: Carolyn's Story

"This time last year I had what I thought was a gnat bite appear on the bridge of my nose. It started like a tiny whitehead but then turned into a red lump; because of its prominent position I did not touch it. Over the next week or so it grew larger and soon became an open sore.

"Just as I was beginning to think I would need to make a GP appointment, Mr Healy noticed my skin lesion whilst I was at my desk and arranged an appointment to see him promptly. It was just prior to Christmas when Mr Healy took a proper look and said it could be one of three things:

  1. An infection
  2. A self-healing lesion
  3. Or a form of skin cancer

"We agreed that he should take a biopsy of a large enough area that would deal with the first two scenarios. I had the wound dressed and I then went back to work. It was my last day at work before the Christmas holiday, so meeting my sister at Heathrow the next morning I warned her that I had what looked like a mask covering my forehead and nose and resembled the Phantom of the Opera."

"The following week I learnt that I had a skin cancer and Mr Healy made a prompt appointment for me to have it removed completely, using a technique known as MOHS surgery."

"From then on everything happened in a whirl. Mr Healy clearly explained everything that was going to happen - and I was booked in for the procedure and overnight stay at The Wellington Hospital. I woke from surgery to the news that the skin cancer was completely removed. A flap of skin from my forehead was now covering the damage to my nose. Christmas came and went and I had two further procedures in February and March to fix and tidy up my nose. Now it's hard to even notice the join."

"Looking back it all happened so quickly. I didn't have time to worry about what would happen - but now it scares me to think what could have happened. If it had been a mole that changed or became sore I would have gone to the GP straight away, but because I assumed it was a harmless bite, I delayed an initial GP appointment. Considering this all happened just before Christmas, my treatment was both efficient and effective. So I can only thank my lucky stars (and Mr Healy) for being in the right place at the right time."

Consultant's Assessment

"This lady's case is a good example of the integration of care this service provides, in that she had a rapid diagnosis of a life threatening skin cancer by what was ultimately a chance meeting with me.

"As her squamous cell carcinoma was growing rapidly an initial biopsy, having confirmed the nature of the lesion, meant we were able to proceed rapidly to the complete removal of the cancer using micrographic surgery."

"This was performed under local anaesthetic and sedation, enabling the patient to remain comfortable throughout the procedure, while the pathologist confirmed the lesion had been completely removed."

"We proceeded with the first stage of her planned three stage nasal reconstruction using her forehead skin. This provides an ideal match in terms of colour, texture, and thickness for the nasal skin. Though the three stages may seem daunting, they do take up to several weeks to complete."

"Carolyn's long term progress has been excellent, she is completely clear of her skin cancer and has a more than satisfactory atheistic outcome from her reconstruction. Many people on the hospital staff, who have known her for many years, have failed to notice that she has had most of her nose removed and reconstructed."

"The London Skin Cancer Specialist Service are now in the position to offer rapid access to skin cancer patients with integrated, prompt and excellent service, both in terms of curing the tumour and reconstructing the often devastating defects."


Keywords

MOHS, Treatment of Skin Cancer, Patient Case Study, MOHs, London Skin Cancer Specialist, Squamous cell carcinoma, Mr Ciaran Healy



Issue
Number:
11
Title:
A new chapter in cancer care
Published:
January 2013
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Contributor/s
Mr Ciaran Healy

Consultant Plastic and Hand Surgeon

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