Tag Archive: skin health

Skin Cancer Dermatologist Singapore

January 18, 2021

Skin cancer is the 6th most common cancer in Singapore. As in the case of all suspected cancers, early detection is crucial for a positive prognosis. Are you searching for a skin cancer dermatologist in Singapore? Dr. Teo Wan Lin is an expert skin cancer dermatologist in Singapore who performs mole screenings, diagnosis of skin cancers and surgical treatment. She has published on the topic of skin cancers, including a first author publication on T-cell lymphomas in the prestigious Journal of Clinical Oncology and on morpheaform basal cell cancers in the International Journal of Dermatology.

Book an appointment here.

The basics of skin cancer

There are two main types of cancers that occur on the skin. The first is what we term as malignant melanoma, and the second category would be non melanoma skin cancers.

We’re gonna start with the diagnosis of a skin cancer. The two main types of skin cancers can be distinguished primarily by the presence of pigment, specifically melanocytes. Melanocytes are the cells that produce pigment and appear commonly as what we describe as moles. When a skin cancer arises from a mole known as melanocytic naevus, it has the potential to be a melanoma.

What are the warning signs of a mole that is cancerous?

We use the acronym ABCDE, which stands for the following A for asymmetry B for borders C for two different colors and D represents diameter. So, a mole that is larger than 6 millimeters large in diameter
is more suspicious than one that is smaller than that. Lastly, E for evolution, meaning if an existing mole changes or evolves, either by becoming itchy, if it bleeds, if there is a sudden increase in size or if the mole or part of it disappears. Now these are warning signs.

Non-melanoma skin cancers

Moving on to non-melanoma skin cancers. Now, these are actually the more common type of skin cancers in Asia, and can be further divided into the following the basal cell cancers and the squamous cell cancers. These two types of cancers are distinguished based on The origin of the cancer, whether they come from the basal layer of cells, or whether they arise from the superficial layer known as the keratinocyte layer.

The key thing about non-melanoma skin cancers, is that the prognosis is generally good, as long as one gets diagnosed and treated early. Diagnosis is via clinical examination and may require biopsy.

If you have a family member who has had a skin cancer before you are considered at higher risk than the general population. Especially if you develop a mole, or a new growth that seems to be changing. If you have not noticed it before and you have suddenly noticed it, it may be time to get evaluated by an accredited skin cancer dermatologist.

What does a skin cancer dermatologist do in the context of management?

First of all, if you have a suspicious growth, it is important to rule out the diagnosis of a skin cancer, which, in the context of this article can be either melanoma, or non melanoma skin cancer. Most moles, however, are not melanoma. They may appear atypical, meaning slightly different from your regular most because they present with features of dysplasia. Dysplastic moles can have irregular borders, multiple colors and can be fairly large as well.

An accredited skin cancer dermatologist who specializes in the treatment of skin cancers will be able to diagnose a melanoma or a dysplastic mole using tools such as clinical examination, dermoscopy. If necessary, your skin cancer specialist will suggest a biopsy.

The most important thing to note is this. If you have a diagnosis of a dysplastic mole, which is a histological diagnosis, you are on the average at higher risk of acquiring melanoma in your entire lifetime, compared to an individual who does not have the diagnosis.

Skincare Bible Skin Cancer Dermatologist

The Skincare Bible- Dermatologist’s Tips on Cosmeceutical Skincare is your ultimate guide to the commonest skincare and beauty questions. Available in bookstores islandwide, via the Dr.TWL Dermaceuticals Education/Bookstore and on Amazon Kindle.

Diagnosis of melanoma

The good news is that early stage melanoma can be effectively cured with surgical acquisition, as long as there is no lymph node or organ involvement. However, the danger is a lot of moles may be hidden, such as on the buttock area or on the soles of your feet, which is not easily self-monitored. When you may discover that a mole has been growing there for some time, it may be a little late.

If a mole has any of atypical features, it needs to be diagnosed promptly. For the treatment of non-melanoma skin cancers, the prognosis is generally good as long as the diagnosis is made early. The problem with non melanoma skin cancers is that when it’s diagnosed and treated late, there is significant morbidity. Realistically, it leaves a larger surgical scar, there may be a lot more tissue loss, as opposed to if it were diagnosed in the early stage and removed at that time.

Melanoma: skin cancer dermatologist

Credit: American Academy of Dermatology Association

Basal cell cancers

Some of the characteristic diagnostic features of basal cell cancers would be a pearly pink or pearly white nodule or papule, located on any part of your body. The face is one of the commonest areas. A basal cell cancer when closely examined shows signs of increased blood vessels from the surface, also known as telangiectasia.

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Credit: American Academy of Dermatology Association

Squamous cell cancers

For squamous cell cancers, a lot of these look like bumps, where there is excessive dead skin. Some individuals who have had significant amount of sun exposure in their lifetime may develop several precancerous growth known as actinic keratosis. Actinic keratosis are not squamous cell cancers
but must also be treated in order to prevent transformation into squamous cell cancers.

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Credit: American Academy of Dermatology Association

Actinic keratosis can be treated with liquid nitrogen, as well as surgical excision, if there is suspicion of transformation to squamous cell cancers.

Are you looking for an experienced skin cancer dermatologist in Singapore? Book for a consultation with Dr. Teo Wan Lin, an accredited dermatologist with our online booking tool here. 

References:

Teo WL, Tan SY. Loss of Epstein-Barr virus-encoded RNA expression in cutaneous dissemination of natural killer/T-cell lymphoma. J Clin Oncol. 2011 Apr 20;29(12):e342-3. doi: 10.1200/JCO.2010.31.4096. Epub 2011 Jan 31. PMID: 21282547.

Teo WL, Wong CH, Song C. Morpheaform facial basal cell carcinoma – a 16-year experience in an Asian center. Int J Dermatol. 2012 Nov;51(11):1396-8. doi: 10.1111/j.1365-4632.2010.04767.x. Epub 2011 Dec 16. PMID: 22171721.

On Fillers and Vaccines, and Safe Aesthetic Treatments

December 29, 2020

The following is a transcript from Dr. Teo Wan Lin’s podcast, Dermatologist Talks: Science of Beauty on fillers and vaccines. Subscribe to her podcast on a journey to discover the science of beauty. We’ll cover the science behind active ingredients and get deep into the cosmetic formulations. Stay on trend with the latest on botanical actives, technology and be part of our FUTURE OF BEAUTY.


29 DEC 2020: Hi guys, this is Dr. Teo Wan Lin, and welcome to this week’s dermatology flash briefing. The Moderna COVID-19 vaccine apparently causes swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine, has come out to state this very specific side effect that has involved several trial participants who have had cosmetic facial fillers. I want to just quickly share with you guys today what exactly this is about, how it occurs, and if that’s something we ought to be worried about.

What exactly are dermal fillers?

Dermal fillers are used primarily for facial augmentation. The filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications. The ideal facial filler should have the following properties: first of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, it doesn’t degrade with time. But this is, of course, untrue for the commonest type of facial filler which is used in most cosmetic practices – that would be hyaluronic acid based and they should be relatively easy to administer. You also have alternatives such as those that are collagen based, or hydroxylapatite based – for example, Sculptra is from poly l lactic acid.

What are the side effects of facial fillers?

In terms of the known side effects from using these facial fillers as injectables, some of the common complications that occur would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected.

So what’s the deal with the fillers and vaccines?

Now what’s happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, its best thought of as an allergic reaction, or basically an immunological reaction. The key thing here is the process of injecting a vaccine, essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler in that case, is not a part of the body tissues, and the body starts to mount an immunological reaction against it. Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids, anti-histamines, and was observed that their reaction resolved.

What exactly is an allergic reaction?

Typically it is considered a medical event due to an immune system respond to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is because facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances that were injected, are actually not part of your body tissues.

What are your thoughts, as a dermatologist?

As a dermatologist, I have some opinions with regards to the observation of these adverse events. First of all, we do expect that massive rollout of vaccinations against the COVID19 virus is expected to be happening internationally, and I feel that it is a very important part in ensuring that we get some level of control and immunity in a very severe pandemic like COVID 19. In terms of immunological reactions that are occurring in response to facial fillers in this case, we note that the attendings have actually treated these patients with oral steroids.

We know that oral steroids suppress your immune system, and in fact, make you more vulnerable to the virus. Personally, I have not given oral steroids as far as possible to many of my patients in the last few months. For patients who otherwise would have benefitted from steroid therapy for chronic inflammatory disorders such as severe eczema, I have certainly been a lot more cautious in terms of exploring other therapies before using oral steroids. The reason is because it’s been known to worsen the prognosis in the event you do get COVID, and also, because it reduces your body’s natural immune system response – you’re going to be more susceptible to catching COVID.

The answer is not an easy one. Facial fillers are used in millions of people internationally, and it is not as if it is the first time we are hearing of an adverse reaction. Another known complication from facial filler injections that is relevant in the context of the modern vaccine would be non-allergic inflammatory responses- we call these granulomatous reactions. These don’t occur so quickly, and we right now have no long term data as to what the vaccination would do in terms of individuals who are going to have fillers or have had fillers, and who are going to receive the vaccine.

What are granulomatous reactions?

These granulomatous reactions are usually non-painful lumps, and it is all a part of inflammation that is caused by the immune system being stimulated. In fact, in 2017, there was a case report about a granulomatous reaction to a dermal filler that was hyaluronic acid based in the Journal of Cosmetic and Laser Therapy. A granulomatous reaction is a delayed onset inflammatory nodule that is usually painless, that occurs much later than the so-called allergic reaction in individuals who have painful swellings, such as those who have received the Moderna vaccine and found that the site of the facial filler injection previously became painful. The key thing here is that in order for us to diagnose a granulomatous reaction, it’s going to take a longitudinal study for as long as 5 years before we can determine if it was truly a problem in individuals who received the vaccine, and also had the facial filler injected.

In 2015, in the Journal of Dermatologic Surgery, there was a series whereby the author conducted a retrospective chart review of patients who were treated with HA fillers, within a 5 year period, to evaluate for delayed onset nodules. The conclusion was that although they are pretty uncommon, it is important to be aware of this side effect, and to have a management protocol in place. In their conclusion, the authors also said that from the patients responses and from the literature, that these nodules are immune-mediated in nature.

What I’m trying to say is that because we are currently in an unprecedented public health situation internationally, where we have a raging pandemic that’s deadly, we may have to reconsider the risk that we might be taking with aesthetic treatments. Now, I do perform facial filler and botox injections, but the truth is, vaccinations are going to be a priority for most people and most countries in order for us to get the pandemic under control. I feel that the public should realize that we are also not going to be 100% certain how these facial fillers will further on be affected by these vaccines -for example, the development of granulomatous reactions. The truth is, if you already had a facial filler, I certainly don’t think that should deter you from getting a vaccines because these are established complications. If you do have it then, visit an accredited dermatologist who will be able to diagnose it accurately and will be able to treat it.

A word of caution here, not all painful filler related swellings are due to an immunologic response to the vaccine, depending on the characteristics observed during clinical examination, your dermatologist will also evaluate you for other differential diagnoses which may also include atypical infections. These are usually a result of poor aseptic technique, which introduces environmental bacteria into the deeper tissues.

Final thoughts

Overall, my two cents is that if you are thinking of getting a facial filler, as a dermatologist, I feel that you certainly can wait. The reason is really because the cost of human life in this pandemic, simply outweighs any other considerations that one may have.

The human facial structure is a composite of skin (the epidermis and dermis) the subcutaneous fat, the SMAS layer, the muscle and ageing affects all these structures dynamically, fillers only address one part of the ageing equation – restoration of volume. In terms of restoring facial structure and facial sagging – which can be corrected with other technologies such as: radiofrequency, High Intensity Focused Ultrasound, which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.

The CollagenUp Facial Wand is a FDA approved device that includes cleansing + treatment + toning + radiofrequency + red photon + blue photon + EMS functions for the ultimate home-based skin rejuvenation system.

Advances in our understanding of textile cosmeceuticals in the form of polysaccharides, polymers and nanoparticle materials can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.

Fillers and vaccines - filler alternative

Application of the Qraser Cosmeceutical Transdermal Delivery Patch optimises skin healing microenvironment to regulate healthy collagen production, reducing wrinkles.

Vaccines and fillers - filler alternative

The MoistureMax™ Skin Healing Polysaccharide Facial Mask has a unique porous structure that traps cosmeceutical active ingredients in mini-reservoirs within the mask, with enhanced delayed release of cosmeceuticals with minimal transepidermal water loss.

In conclusion, if you’ve had a facial filler before, don’t let that deter you from getting the vaccine, as the cost of human life is much greater and this is a known filler complication (definitely enhanced by the vaccine) but the benefits will outweigh the risks. If you ARE thinking of getting fillers done, my personal opinion is that you may wish to consider alternatives, given the current context of our pandemic.

Vaccines and fillers Science of beauty podcast

This article contains excerpts taken from Dr. Teo Wan Lin’s podcast Episode 10 ‘On Fillers, the COVID-19 Vaccine & Safe Aesthetic Treatments’ Subscribe to the podcast here.
© Dr. Teo Wan Lin 2020

Ring Finger: A Singapore Dermatologist Discusses Why It Is The Best For Applying Skincare Products

August 29, 2019

WHY YOU SHOULD APPLY YOUR SKINCARE PRODUCTS WITH YOUR RING FINGER

How we apply our skincare is very important. Have you ever wondered why most skincare brands recommend in their product directions to use the ring finger and not any other fingers in applying and gently massaging the product unto your skin especially when it involves the eye area? That is because out of our 5 fingers, our ring finger is said to have the weakest touch. The manner on how you massage your face while cleansing it and how you apply your skincare and makeup products, even just simply scratching it or wiping it can add up to protecting the quality of your skin.

Our skin is very delicate and we want to avoid excessively tugging it whenever we apply our skincare or makeup products because this can cause our skin to show early signs of ageing. Applying with our ring finger gives an equal amount of pressure when applying products. You can easily cause wrinkles with too much pressure, and our ring finger is recommended for the least amount of pressure and pull.

Most especially when it comes to applying eye creams, using our ring finger is the best. The skin around our eyes is the most delicate among the rest, and it is most commonly the first to show the earliest sign of ageing. Mishandling of the skin around our eyes like aggressive removal of eye makeup and heavily dragging eye care products and any other skincare product unto our skin can cause eye wrinkles, crow’s feet, and other skin irritations.

That being said, no matter how the ring finger is said to be the lightest, we still have to be mindful whenever we use it to come into contact with our skin. Same with any other finger. Always work your serums, eye creams, and any other product into your skin using light, tapping motions making sure to avoid rubbing and tugging. No matter how expensive your skincare product is, the manner on how you apply it will tell how to get the most out of it.

 

HOW TO APPLY YOUR SKINCARE- EYE CREAM

Ever looked in the mirror and thought “My eye wrinkles are becoming more obvious each day”?

The Elixir-V™ Eyes is an eye cream that is meant to prevent dark eye circles, excessive puffiness of the eyes and eye wrinkles. Like the Elixir-V serum, it contains potent oligopeptides used for lifting and repair and our signature Larecea™ extract for regeneration. An additional ingredient is niacinamide, used for brightening. While the Elixir-V serum is meant for the skin, the Elixir-V Eyes is focused on protecting the beauty of your eyes. We believe that your eyes are the most noticeable and beautiful parts of your face. Hence, it is meant to anti-age the sensitive skin around your eyes.

 

References:

https://www.aad.org/public/skin-hair-nails/skin-care/skin-care-products

https: //www.futurederm.com/using-the-ring-finger-to-apply-eye-cream-is-it-really-the-weakest-finger

https://drtwlderma.com/dermatologist-designed-anti-aging-solution-elixir-v/