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From a nursing viewpoint

Service Update: Blanche Heriot Unit

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September 2010

Dermatology Special

The Dermatology Service

It will not surprise you to hear that dermatology is an extremely busy outpatient specialty as skin disease accounts for approximately 25% of all your GP consultations. With an ever increasing incidence of skin cancer, there are constant challenges to manage the high demand for two-week rule referrals and skin cancer surgery in our Department.

We are a well established department with six consultants, one associate specialist and three specialist nurses. We have recently appointed a new colleague, Dr Tasos Stavrakoglou who has a particular interest in skin cancer and advanced skin surgery. We have now introduced Nurse-led Clinics for minor surgery. We plan to expand this service to include Isotretinoin drug monitoring and introduce photodynamic therapy for the management of patients with extensive solar keratoses, Bowen’s disease and superficial basal cell carcinomas. We have an active Phototherapy Unit which also offers iontophoresis for the management of patients with hyperhidrosis.

We are in the process of exploring setting up further specialist clinics and to offer more community-based clinics with the intention of working more closely with our GP colleagues and offering educational and mentoring opportunities for our GPSIs (GPs with Specialist Interest in Dermatology).

For the last five years, we have run a successful GP study day in May/June each year where we have a number of workshops, lectures and invited speakers on a variety of hot dermatological topics.

We have now also been successful in gaining a new supernumerary post for trainee GPs to work in a clinical attachment in Dermatology on a rotational basis for four months (ITP post) from August 2010. The aim of these posts is to offer GPs a taste of Dermatology which will help them gain confidence in managing skin disease and may influence their referral patterns later on in their career.

Did you know?
  • A person will die from skin cancer every four hours in the UK

  • A new case of skin cancer is diagnosed every four minutes. In 4 out of 5 cases this would be entirely preventable with good education about sun protection.

  • Over 100,000 new cases of skin cancer are diagnosed each year, of which 10,000 will be melanomas.

  • 1 million people in the UK suffer from psoriasis and 1:5 children have atopic eczema. The number of people suffering from skin disease grows each day.

The Skin Cancer Service

The one stop clinics which we are currently running are branded as See & Treat Skin Lesion clinics and the clinics are delivered by two doctors working together. One covers the consultation and the other delivers the skin surgery. Each clinic has provision for 15 new and 5 follow up appointments. These clinics are run each weekly, alternating between Ashford and St. Peter’s hospitals.

Patients referred to these clinics receive a letter informing them of the details and the possibility that they may have treatment delivered at the same time.

A patient questionnaire is provided for completion prior to the clinic. This expedites the consultation process. During the consultation, a full skin examination is delivered for skin cancer screening in order to identify skin cancers at an early stage.

The possible outcomes are:
  1. Patient does not have a skin cancer and is discharged back to their GP after advice about sun protection and self skin examination.

  2. Patient is clinically diagnosed with skin cancer.

In the latter case, the possible Treatment Scenarios are:
  1. Appropriate surgical excision is offered and delivered on the same day.

  2. If the skin cancer is not of the type that has to be discussed at an MDT meeting, the patient is discharged back to the GP

  3. If the skin cancer falls within the remit of the MDT, the case will be discussed at the Cancer MDT meeting or the Specialist Skin Cancer Meeting of the Surrey Skin Cancer Network.

  4. Uncertain Diagnosis

  5. Either

    1. A diagnostic biopsy if appropriate is offered and performed on the same day to establish diagnosis. Further management is organised depending on the results, or

    2. Clinical monitoring is required. Lesion (s) will be documented with photography after appropriate consent.

Meet the team ...

From left to right top row

Dr Olivia O'Gorman-Lalor - Consultant Dermatologist
Penny Hawkes - Specialist Nurse in Dermatology
Dr Stefanie Williams - Associate Specialist in Dermatology
Dr Tasos Stavrakaglou - Consultant Dermatologist
Jacky White - Specialist Nurse in Dermatology
Karen Corderay - Secretary in Dermatology
Lucy Daffarn - Specialist Nurse in Dermatology

From left to right bottom row

Dr Melissa Barkham - Consultant Dermatologist
Dr Sam Vaughan Jones - Consultant Dermatologist and Clinical Lead
Dr Maria Roest - Consultant Dermatologist
Sue Hawkes - Secretary in Dermatology

Dermatology resources

Myths about the skin and skin diseases abound amongst the general public

Where can you find factual and reliable patient information?

Where can you access the latest evidence based reviews and clinical guidelines?

We would recommend the following:

    Clinical guidelines on management of many common skin conditions (e.g. actinic keratosis)

    Wide range of patient information leaflets

    Sun awareness section (access sensible advice on sun protection and mole monitoring) – you can request leaflets and posters for your surgery free of charge


    This fantastic site is updated regularly with new resources (e.g. new NICE guidelines, Cochrane reviews and latest research)


    Good range of patient information leaflets

    Clinical images of many different conditions

    Patient support groups

There are a vast number of support groups, and contact details can be accessed via the BAD website.

From a nursing viewpoint

As the largest organ in the body, when skin becomes disordered, whether it is through cancer or inflammatory skin disease in any way shape or form, it affects the whole person. Dermatology is often about building a therapeutic relationship with individuals, whatever their circumstance and whatever their condition, to encourage them with their treatment and educate them as to how they can help themselves. I believe that as nurses we are ideally positioned to do this.

Dermatology is a fantastically exciting speciality for a nurse. The huge variety of conditions and the range of treatments available for patients make for a stimulating environment in which to work. As nurses we can get really involved in the management of the Dermatology patient working alongside the consultant and the patient to achieve the best possible outcome. I believe that this is reflected in the fact that there is an affiliated group to the British Association of Dermatologists (BAD) called the British Dermatology Nursing Group (BDNG). Established in 1989, it is a forum of education, research and the sharing of best practice specifically for Dermatology nurses. Our conference is held alongside the annual BAD Conference and some lecture sessions are joint participation, again echoing the impact that nursing has on dermatology care. The BDNG has a number of sub groups which focus on specialist areas within dermatology. These include Primary Care, Phototherapy, Biologics and Skin Cancer to name a few. It is also indicative of the advanced level of practice at which many nurses are working.

Here at St Peters Hospital we have developed several successful nurse-led initiatives. I am now running nurse-led Isotretinoin monitoring clinics, performing diagnostic biopsies and have established a Dermatology Adviceline for our patients. My specialist nursing colleagues Penny Hawkes and Jacky White manage a very busy phototherapy unit, providing different treatment modalities for up to 60 patients a day. This is just a very small segment of the work that we do and there are so many opportunities for the future expansion of nursing practice.

It is my privilege to be a Dermatology Specialist Nurse and part of my role is to enable Dermatology patients to feel valued and supported. I chose to specialise in Dermatology; I am passionate about my speciality and ensuring that patients receive the best possible care from our service.

By Lucy Daffarn
Specialist Nurse in Dermatology

Service Update: Blanche Heriot Unit

The Blanche Heriot Unit is your local busy sexual health centre which now provides, not only routine sexual health screening, but enhanced services to those with complicated infections, vulval dermatology and smear issues.

HIV services continue to expand and provide new challenges. As the condition has now gained a chronic disease status, people living with HIV face new challenges in addition to the ageing process. Patients requiring HIV testing can self refer or can be referred by their GP for testing and ongoing care.

Vulval dermatology is a specialist area which requires a GP referral. These clinics are held every fortnight and an appointment will be sent to the patient on receipt of the referral form.

Walk in services are not suitable for the HIV and dermatology services and an appointment will be necessary for these services.

We run an up to date website giving patients the daily clinic sexual health screening opening times . It provides information on infections and contact details for other organisations. (

Please see the Service Bulletin sent out with the GP News for the referral forms for these services.