Jonathan Kentley received his Medical degree in 2014 from Barts and the London School of Medicine and Dentistry. Throughout his foundation training in London he has publised several papers and worked on a number of quality improvement projects in both dermatology and medicine.
Skin cancer is on the rise and accounts for a large burden of the dermatologist’s workload. Wide local excision (WLE) may be necessary after incisional biopsy in order to ensure complete removal of the primary lesion and minimize local recurrence of tumours with metastatic potential, most commonly melanoma and squamous cell carcinoma (SCC)(1). At present there are no guidelines on when this re-excision should take place.rn Although there is no evidence to suggest that delayed excision has an impact on survival, the psychological impact of a skin cancer diagnosis on the patient cannot be underestimated(2). Many patients report being distressed by anxiety after diagnosis and 70% of these patients do not feel that doctors adequately addressed their concerns(3, 4). rn At our institution we performed 42 WLEs between September and December 2015. Only 21 of these were performed within 6 weeks of the histology from excisional biopsy being available. We surveyed 14 patients who had been diagnosed with skin cancer and 8 felt that WLE should be done within 6 weeks. 5 wanted the procedure done at the first available slot. Patients appeared to trust the decisions made by their dermatologists. rn Diagnosis with skin cancer is a stressful time for patients and delays in re-excision are likely to exacerbate patient anxiety. Management may impact significantly on surgical capacity in a dermatology department and needs to be planned for. Patients should be well informed and encouraged to voice their concerns. WLE should ideally take place within 6 weeks. rn
Jose Manuel da Costa Mesquita Guimaraes was graduated with distinction from Faculty of Medicine of Porto, in 1961 and is a Specialist of Dermatology and Venereology since 1968. He has completed his PhD with the thesis “Citologia da secreção holócrina”, in 1975. He is the Professor of Dermatology and Venereology of the Faculty of Medicine of Porto since 1977, wrote 282 works alone and in collaboration and in 1983 published a book entitled \"Dermatologia Parasitária e Infecciosa-Venereologia\". He was the Head of the Department of Dermatology and Venereology of Hospital de São João in Porto for 20 years, President of College of Specialty of Dermato-venereology of Order of Physicians of Portugal and Chairman of the Supervisory Board of the Portuguese Society of Dermatology and Venereology for 6 and 5 years, respectively.
With atopic dermatitis I have observed with high frequency, gastritis, enteritis, colitis, irritable bowel syndrome, intestinal dysbacteriosis, constipation and food allergies, besides the already known allergic rhinitis/rhinoconjunctivitis and asthma. The patients itch, scratch themselves and perpetuate the injury in elective characteristic areas of atopic dermatitis. The control of the itching and the inflammations is fundamental. Guidelines about the treatment of atopic dermatitis have recently been published. I have particular attention not to do external interventions causing alterations of the cutaneous film, microflora destruction, atrophy, xerosis and addiction. The cutaneous film has an extremely complex physical-chemical composition and it has no equivalent in the market. About the skin microflora it is common knowledge that it is inseparable from the normal skin morphophysiology and its homeostasis. Sedating and non-sedating antihistamines and oral corticosteroids, in particular these latter, are effective in itching and inflammation control. Moreover oral corticosteroids are also extremely effective in the treatment of systemic inflammations and with proper use never produced rebound lesion or any serious adverse effects. Finally, the patients have high quality of life and are well-controlled if they follow suitable topic and systemic treatment, multidisciplinary, appropriate to each case, in particular the itching, multi-inflammations and allergies.