Evening Spotlight Seminar Dermatology ASPH
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1 Evening Spotlight Seminar Dermatology ASPH Foxhills Country Club 30th September 2010
2 Who s Who in Dermatology- Consultants Dr Sam Vaughan Jones 7PA Clinical Lead Dr Melissa Barkham full time Dr Pawan Kumar full time Dr Tasos Stavrakoglou full time Dr Maria Roest 5PA Dr Olivia O Gorman-Lalor - 5PA Dr Stefanie Williams- 2PA (Associate Specialist)
3 Dermatology Nursing Staff Penny Hawkes SN Phototherapy Lucy Daffarn SN Nurse-led Surgery, Isotretinoin monitoring & wound care clinics Jacky White SN Phototherapy Jane Woods Clinical Nurse Specialist Melanoma (shared with cancer network)
4 Dermatology Nursing Staff Lucy Daffarn Penny Hawkes Jacky White
5 Dermatology Secretaries Susan Hawkes SPH Karen Cordery - SPH Sybil Greene - SPH Sue Carroll -SPH Michelle Ratcliffe - Ashford
6 GPSIs in Dermatology Dr Richard Moore Dr Janet Krol Dr Anne Marie Christie Dr Jo Skilbeck Minor surgery Dr Simon Bellamy Minor surgery Dr Sami Morcos
7 Current Challenges Outpatient-based specialty Government targets TWR and cancer 18 week pathway Choose and Book In-patient review (Emergency Dermatology) Up to 25% of all GP consultations are skin-related High demand for our service Threat from AWP for our activity
8 Dermatology Demand Age and demographics of population Large elderly population with high incidence of skin cancer Increasing allergy and eczema incidence Increasing skin cancer incidence TWRs Rx cytotoxics, Biologicals, more follow up New: Follow up ratios PCT targets
9 Some challenging patients Large SCC lip Suberythrodermic psoriasis Difficult BCC Hypertrophic acne scarring
10 Latest Developments 2 New Consultants expertise in advanced skin surgery and paediatrics Picsara database images and patient details and diagnoses stored for Audit Phototherapy TL-01, broad band UVB and PUVA now available 4 days/week One-stop clinics for rapid diagnosis and management of skin cancer Nurse led clinics surgery, isotretinoin monitoring, wound care clinics
11 Phototherapy Dr Stefanie Williams Phototherapy lead Treatments available UVB, TL-01, PUVA, hand and foot PUVA 4 days per week Wait time <4/52 Iontophoresis Discussion regarding location of service
12 Specialist Interests Dr Stavrakoglou and Dr Roest advanced skin surgery Dr Barkham paediatrics and systemic treatments Dr Vaughan Jones pregnancy dermatoses Dr O Gorman-Lalor allergy prick testing and patch testing Dr Williams phototherapy and cosmetics Dr Kumar systemic treatments
13 Primary Care Links GP ITP posts rotation 4 months in Dermatology OPD clinics from August 2010 GP Annual Study Day - June Special Cases Clinics GPSIS are invited to attend and bring difficult cases for advice and discussion on management GPs sitting in clinics GPs are welcome to contact us to come and attend OPD clinics to gain Dermatology experience
14 Future Developments Photodynamic therapy for management of extensive actinic keratoses or BCCs in difficult sites e.g. scalp, lower legs Specialist clinics e.g. allergy, paediatric, pregnancy dermatoses, skin cancer, psoriasis, computerised mole scanning, biologicals Community Clinics Cobham Day Surgery unit, Woking Community Hospital, Ashford, Feltham - expansion
15 May-10 Jun-10 Jul-10 Aug-10 Mar-10 Apr Seasonal Rise in Referrals/TWRs OTHER TWR Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10
16 Cosmetic Referrals The following Cosmetic referrals are not accepted under current PCT guidelines Skin tags for removal Treatment of warts and mollusca Benign moles Seborrhoeic keratoses Xanthelasma Spider naevi Sebaceous/epidermoid cysts
17 Pregnancy Dermatoses
18 Common Skin Diseases in Pregnancy Atopic eruption of pregnancy (AEP) Acne vulgaris or Rosacea Psoriasis Infections (candida, viral warts, varicella) Infestations (scabies) Autoimmune (SLE, Dermatomyositis, pemphigus) Metabolic (porphyrias, acrodermatitis) Connective tissue (Ehlers Danlos, PXE) Tumours (melanoma, mycosis fungoides)
19 Specific Dermatoses of Pregnancy Dermatosis Pemphigoid gestationis PG Classification Holmes & Black Shornick Polymorphic eruption of pregnancy PEP Holmes & Black Shornick Obstetric cholestasis OC Shornick Atopic Eruption of pregnancy AEP Ambros- Rudolph Classification: Holmes & Black (1983), Shornick (1998) Ambros-Rudolph (2008) (Ambros-Rudolph et al JAAD 2006; 54: )
20 The Perfect Referral Letter History of presenting complaint For pigmented lesions site, size, shape Past medical history Drugs (esp. aspirin, clopidogrel, warfarin) Previous treatments and response Degree of certainty about diagnosis (uncertain/certain/no idea) Diagnosis
21 Histopathology Meetings
22 Teamwork
23 Absent Friends
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