A Skin Cancer Centre of Excellence

A Word from Johann de Wet

Founder of the Dermatology and Skin Cancer Institute

“The Dermatology and Skin Cancer Institute was established in March 2020 with a specific focus on skin cancer screening, diagnosis, and treatment. The objective was to provide Western Cape residents with a centre of excellence for world-class skin cancer treatment.

Although international guidelines have recommended Mohs Micrographic Surgery as the gold standard treatment for skin cancers for many years, access to this
treatment in South Africa has been minimal. With the establishment of the Mohs Micrographic Surgery service in Somerset West, this world-class treatment is now available for both patients and their treating dermatologists.

The first Mohs Micrographic Surgery procedure at the Summerhill Surgical Centre in Somerset West was performed on the 9th of October 2020. Merely eight months later, and we have already treated over 400 skin cancers. Patients who will benefit from Mohs surgery are those with larger cancers, cancers with more aggressive growth patterns, cancers recurring following previous treatment, incompletely removed cancers, or cancers involving important cosmetic and functional areas such as the face.

I would like to thank all our referring doctors for supporting this service.”
Dr Johann De Wet

 

A Skin Cancer Centre of Excellence

The Mohs surgery service consists of a multi-professional team of local medical specialists comprising plastic and reconstructive surgeons, oculoplastic surgeons, head-and-neck cancer specialists, general surgeons specialising in cancer treatment, and oncologists.

In this newsletter, we introduce other members of our team. They are Dr Mpopi Lenake, oculoplastic surgeon, and Dr Rory Dower, plastic and reconstructive surgeon.

Dr Mpopi Lenake
MBChB (Stell); FCOphth (SA); MMed Ophth (UCT)

Dr Lenake is an ophthalmologist with a special interest in oculoplastic surgery. Soon after her specialist training, she departed for Melbourne, Australia, where she completed the Orbital, Plastics, and Lacrimal fellowship at the prestigious Royal Victorian Eye and Ear Hospital.

Apart from reconstructive surgery of the periocular region following cancer surgery, she treats all medical and oculoplastic conditions in adults and children, including a wide variety of conditions involving the orbit (eye socket), eyelids, and tear ducts. She was the recipient of the Justin Van Selm medal, awarded to outstanding candidates in the fellowship examination of the College of Ophthalmologists of South Africa. She was also awarded her MMed degree with distinction (Cum Laude) from the University Cape Town.

She is the current president of the South African Society of Oculoplastic Surgeons (SASOPS) and a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). She continues to be involved in various academic pursuits. She has published articles in oculoplastic and general ophthalmology journals and holds sessional posts at Groote Schuur Hospital and Red Cross Children’s Hospital.

Dr Lenake’s opinion on Mohs surgery and the eyelids

After skin cancer excision, eyelid reconstruction goals include restoring eyelid structure and function while attaining acceptable aesthetic results. Mohs surgery achieves high cure rates while preserving healthy tissue, making it a useful technique for removing skin cancers around the eyelids, where small amounts of tissue excision may involve important structures that affect the normal function of the eyelids.

Recurrent tumours and those involving the canthi (medial canthus specifically) are particularly challenging as they can spread into the orbit. Mohs is especially useful here. It is also helpful in removing squamous cell carcinomas or morphea-form basal carcinomas, which are notorious for their extensive microscopic spread, well beyond the clinically apparent margins. Another advantage of working with a Mohs surgeon is that the excising and the reconstructing surgeons are different people. If a reconstructive surgeon is available, the Mohs surgeon has no hesitation in performing one more excision that might make the defect more difficult to reconstruct. A surgeon performing both the tumour excision and reconstruction may subconsciously hesitate to do this. This division of labour results in the best benefit for patients.

I am very excited to know that there is a service now available to patients with periocular skin cancer that will result in higher cure rates while preserving their eyelids.

 

Bringing skin cancer cure to more South Africans.

 

Dr Johann De Wet was awarded the Discovery Foundation Academic Research Fellowship award for his work on Melanoma in situ and Mohs Micrographic Surgery. He is currently involved in research through Stellenbosch University in conjunction with Prof Johan Schneider looking at ways to improve the diagnostic accuracy when assessing surgical margins of excised Melanoma in situ tumours.

Read full article here: Discovery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr Rory Dower

Dr Rory Dower obtained both his MMed (Plast Surg) and FC Plast Surg (SA) before completing two international fellowships in microsurgery. The first was at St Thomas’ hospital in London, the second, an advanced microsurgery fellowship in Taiwan.

Dr Dower has done an aesthetic fellowship at the prestigious London Clinic on Harley Street and observerships in rhinoplasty at the Marienhospital in Stuttgart and implant breast reconstruction at the Memorial Sloane Kettering Cancer Centre in New York.

During his specialist training, APRSSA awarded Dr Dower Best Clinical Paper in 2009 and 2011 and Best Publication in 2012. He presented at the European Association of Plastic Surgeons (EURAPS) Annual Meeting in 2014 on breast reconstruction.

His Clinical Interests areas are Skin cancer reconstruction; Breast cancer reconstruction; Aesthetic surgery; Fa-cial
aesthetic surgery and Rhinoplasty. His Professional Affiliations include APRSSA; ISAPS; HPCSA; GMC (General Medical Council UK); RCSENG (Royal College of Surgeons England).

Dr Dower’s opinion on Mohs

“Being introduced to Mohs surgery has changed my practice completely with regards to how I treat skin cancers. In the past, I would excise all my own skin cancers and do the reconstructions, but I was always worried about leaving tumour behind or taking away a lot of normal tissue, especially in the facial area, where every bit of normal tissue makes a difference. With normal wide local excision, there is also a higher risk that tumours may recur after excision.

All the skin cancers that are referred to me, I now treat with Mohs surgery in conjunction with Johann. I know that the tumour will be completely excised, and the tissue that remains is normal tissue, i.e., no normal tissue is sacrificed, and only the tissue with skin cancer is removed. This allows me to do the best possible reconstruction I can without worrying about the skin cancer recurring or doing a bigger reconstruction that was actually needed.

I am extremely happy and grateful to be working with Johann because I really feel that my patients benefit enormously from his skill and this technique.”