Look Before You Laser

Posted: Monday 21 March 2011 11:21am

Leading into winter, many of us start to assess the damage the long, hot summer has wreaked on our skin – extra lines and wrinkles, a coarser, dryer texture, uneven tone and hyperpigmentation in the form of “age”, “sun” or “liver” spots.

With an arsenal of anti-ageing technology such as laser and light treatments now at our disposal,  it’s as simple as saving your dollars and booking an appointment at a clinic or salon and coming out the other side a younger, smoother version of you.

But is it really that simple? In a Q&A with Younger You, leading doctor and skin cancer expert Dr Gabrielle Caswell, President of the Cosmetic Physicians Society of Australasia warns how import it is to “Look before You Laser“, a CPSA initiative:

What prompted you to start this awareness drive?

The CPSA has been made aware of patients who saw a beauty therapist to have had “liver spots” treated with a light device when in fact they where melanomas.  As Australia has the highest rate of melanoma and non-melanoma skin cancer in the world – and they do tend to appear when we notice the other signs of ageing – it alerted me to the fact that potential clients and patients should have a skin check by a qualified medical practitioner before they undergo any light device treatment.  The problem is that you can de-pigment a melanoma, but it is still a melanoma and can still spread!

What are the dangers of having laser treatments if, indeed, your “sun” or “liver” spots are

They may be turned into a more aggressive form as they have been stimulated. These devices are, in essence, another form of light radiation. Pigmented lesions can be de-pigmented making them even more difficult to diagnose.  The diagnosis of melanoma is not in the repertoire of a beauty therapist, and there are 5 recognised types of melanoma. Even for doctors it takes additional training to become confident with their diagnostic algorithm.

Can you cite some specific examples that have come to your attention?

The CPSA has recently become aware of two biopsy-confirmed melanomas, both who had sought cosmetic treatment at a beauty salon. Both patients contacted their doctors and gained appropriate referrals when the lesions changed post treatment.

The non-melanoma skin cancers are even more difficult to diagnose as they go through a range of skin changes before they develop their full blown cancer potential.

Though very common, some of the “sun spot” varieties do have “spread” capabilities, and require clearance excisions and in some cases post-surgery radiotherapy.  A dry patch of skin, or an odd indentation in the skin may well be a skin cancer, particularly in the over-40 age group.  So it is very important that it is looked at before any treatment is undertaken.

In 2002, the cost of NMSC management was $345 million dollars. This is expected to rise considerably, but we know that early diagnosis and intervention reduces the cost to the patient, bodes well for the patient and is a wise spend of our health budget.

Would you recommend that any laser treatments are conducted by a doctor (or nurse, under a doctor’s direction) than in a beauty salon?

Absolutely. There are a number of reasons for this: you will probably get a better result, as [doctors'] machines are more powerful and he or she can offer a range of services, as [treatment] is often not dependant on a single modality.

A more through treatment may come with more downtime, but if the results last longer the patient is in a better position.  And of course if there is any adverse event a medically trained practitioner is equipped to manage the issue.

This includes things like coldsore outbreaks.  Doctors do unfortunately see and manage a lot of burns caused by beauty therapists, which we believe to be a lack of understanding with regards to their device and the patient’s genetics which can greatly influence how a treatment may go.

If you  avoid the problem by consulting an appropriately trained medical practitioner then these issues are avoided in the first place.

And finally there is the issue of professional indeminty – which all doctors carry, but very few beauty therapists do. Froma client perspective it means that there is little compensation if they are left with permanent stigmata.

Does this warning include light (eg. IPL, Omnlux) treatments?

Yes. It is important that intending clients and patients realise that they are individuals and that although guidelines are issued, a proper assessment and their entire medical history is needed to determine if they are suited for any light device treatment as they may react differently from “the norm”.

Should a patient as a matter of course be checked first for skin cancers before undergoing any kind of laser/light treatment?

Yes, and the current recommendations, from a health perspective, is that an annual check helps reduce the rate of skin cancers.

* Which website/reference source would you recommend as a trustworthy one for gaining more information about skin cancers and what to look for?

To find a doctor that will do both skin cancer checks and perform laser or light treatments, go to  www.cosmeticphysicians.org.au (most of our members offer a skin cancer service).

Other sites I would recommend are:

www.skincancer.com.au

www.sccanz.com.au

www.skincancercollege.com

The Cancer Council also has some really good information.

by Dr Gabrielle Caswell

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