Skin Cancers

Actinic Keratosis is considered as a precancerous lesion as some can evolve to become squamous skin cancers if they are not treated. They usually appear in middle age (50s) mainly on the face, balding scalp, and the back of the hands and less often on other parts of the body. They are treated with cryotherapy, using a cream that acts as a local chemotherapy made of 5-Fluorouracil (Efudix^R) or Imiquimod (Aldara^R), with phototherapy using methyl aminolevulinate cream (Metvix cream^R) through conventional Photodynamic therapy (c-PDT), Daylight PDT or Simulated Daylight PDT(SDL-PDT) combined with fractional CO2.

Squamous cancers usually involve surgery.

Many people with sun damage will also develop basal cell carcinomas. Depending on where they are and how they look, basal cell carcinomas can be treated using local chemotherapy such as Imiquimod (Aldara cream^R) or through surgery.

Melanoma is a cancer that emanates from melanocytes or pigment cells. It can appear within an existing beauty spot or not. It can occur at any age except in children where the appearance of melanoma is extremely rare. It can appear on any part of the body, bearing in mind that the calves are a favourite place for women as is the torso for men. People at risk are people who have already had a melanoma or other skin cancer or who have a direct relative who has had a melanoma, along with people of phototype 1 or 2 and people with significant sun damage. These high risk patients need a regular check-up of their skin.

Skin Check-up

Not everyone has the same risk of developing skin cancer. Several factors are considered: genetics, history of sun exposure and phototype.   People who have had skin cancer, people who have a direct relative who has developed melanoma, people with a large number of large, irregular-shaped beauty spots (> 6 mm), people of phototype 1 and 2, people with sun damaged skin due to frequent unprotected sun exposure and people with a weak immune system due to immunosuppressants should all have their skin checked.

During the consultation, the doctor will look at the lesions using a dermatoscope. Full Body Mapping of all beauty spots is reserved for high-risk cases and is not used in our surgery. If necessary, the doctor will suggest seeing you again to carry out a biopsy or surgical removal of one or more lesions under a local anaesthetic so that they can undergo laboratory analysis.

Most beauty spots and other brown spots are benign. The ‘ABCDE’ rule or ‘ugly duckling’ sign should serve as a warning. The ‘ABCDE’ rule is a rule that might suggest a possible melanoma, even in the case of self-inspection. A is for Asymmetric, B is for Borders (uneven), C is for Colour (uneven), D for Diameter (> 6 mm) and E for Evolution. Melanomas are generally asymmetric, they have uneven borders and colour, a diameter greater than 6 mm and they evolve over time, i.e. they change in appearance, size, or colour and sometimes thickness.

Atopic Dermatitis

Atopic dermatitis is a chronic and recurring inflammatory skin disease in children and adults alike and is characterised by recurring, itchy, eczematous patches. There is a hereditary factor that may appear in other forms such as asthma or allergic rhinitis. There may also be allergies. Prevention is based on moisturising the skin with suitable emollients and avoiding allergens. Treatment varies depending on the clinical presentation and severity, and will involve using corticoid-, tacrolimus- or pimecrolimus-based topical medicines, phototherapy (UVB or PUVA), antihistamines, immunosuppressants or a systems biology approach.

Phototherapy does not take place at The Skin Practice but at Dr. K. Verhulst’s Gilsoul Surgery, Avenue Victor Gilsoul 47, 1200 Brussels. To make an appointment, please call +32 02/771 45 40.

Actinic Keratosis

UV rays are harmful to the epidermis and the dermis. Alterations to the epidermis can be characterised by dull skin, pigmented spots or lentigines, fine lines or wrinkles, telangiectasia (small, dilated vessels) and actinic keratoses. Actinic keratosis is a form of precancerous lesion characterised by irregularities in the keratinisation of the skin, like a scab that never really disappears. Some can evolve into skin cancer, more specifically squamous carcinoma, which is why they need to be treated. Treatment can be by cryotherapy, local chemotherapy using a 5-Fluorouracil (Efudix^R) or Imiquimod (Aldara^R) cream or by conventional photodynamic therapy (c-PDT), Daylight PDT or Simulated Daylight – PDT in combination with a fractional CO2 laser. It is also necessary to consider the long term by using suitable creams and a high-protection sunscreen every day.

Prior consultation with a dermatologist is compulsory. Together, you and your doctor will assess which treatment is best suited to your needs and what the possible side effects might be. Based on this discussion, the doctor will also provide a quote.

Phototypes

The Fitzpatrick scale, or phototype, classes people according to how their skin reacts to sun exposure.

Phototype 1: does not tan, always gets sunburn. Skin is very fair, has freckles, blond or ginger hair.

Phototype 2: difficulty to tan, frequently gets sunburn. Skin is very fair, blond, or light-brown hair, freckles appear when exposed to sun. Light-coloured eyes.

Phototype 3: sometimes gets sunburn, tans progressively. Skin is fair, hair is blond or light brown.

Phototype 4: occasionally gets sunburn, tans quickly. Skin is dark, hair is light brown, brown or black. Dark eyes.

Phototype 5: rarely gets sunburn, tans quickly. Dark skin, eyes, and hair.

Phototype 6: Never gets sunburn. Black skin and hair. Dark eyes.

Psoriasis

Psoriasis is monitored by Dr Valerie-Anne Lizin and Dr Katrien Verhulst.

Phototherapy is not performed at The Skin Practice but at Dr Katrien Verhulst’s Surgery, Avenue Victor Gilsoul 47, 1200 Brussels. To make an appointment, please call +32 (0)2 771 45 40.