Adult Dermatology

There has been a Mohs service provided in Nottingham for over 20 years. Currently we have three experienced Mohs Surgeons, Dr Sandeep Varma, Dr Anand Patel and Dr Ashish Sharma.

We run a yearly fellowship programme to train the next generation of Mohs surgeons. Our 14^th and current fellow is Dr Alex Gan. 

 

What is Mohs surgery?

This is the Gold Standard treatment for facial skin cancers and is mostly performed for basal cell carcinoma in cosmetically sensitive areas such as the eyelids, nose, lips and ears. It has the highest cure rate for skin cancers. It can also be used for Squamous Cell Carcinomas and some rarer cancers.

We receive referrals from Nottingham Dermatology and Ophthalmology as well as patients from Derby, Kings Mill, Newark and other hospitals.

Because we are the only hospital in Nottinghamshire to undertake Mohs surgery, the volume of cases and the COVID pandemic has meant that waiting times for Mohs surgery have to be considered when deciding which method to treat a skin cancer. It is perfectly acceptable to consider having simple [wide] local excision, radiotherapy, photodynamic therapy, cryotherapy, curettage or cream treatment if this is appropriate. Feel free to discuss these with your Doctor.

 

Please see link: https://jamanetwork.com/journals/jamadermatology/fullarticle/2764796

 

Research

Our Mohs service is currently involved in research aimed at detecting BCC automatically during Mohs surgery with a machine which we have invented.

 

Meet the Team

Dr Sandeep Varma

I trained as Dermatology registrar in Cardiff and undertook a Mohs Fellowship in Portland, Orgeon, USA with Dr Neil Swanson and Dr Ken Lee.

I have been involved with Mohs surgery for about 23 years and I have trained 13 Mohs fellows during this time. I am currently Honorary (Consultant) Assistant Professor, Lead for Skin Cancer services, Lead for Skin Surgery and Chairman of the Nottinghamshire Multidisciplinary Team for Skin Cancer. My theme of Research is the automated detection of basal cell carcinoma during Mohs surgery.

 

Dr Anand Patel

I completed my specialist training in Nottingham and was awarded my Certificate of Completed Training (CCT). I then went on to complete a board certified and nationally approved Mohs Micrographic Surgery fellowship here in the UK under the guile and supervision of 2 experienced UK Mohs surgeons.

I perform over 200 Mohs procedures a year and have been involved in the training of 8 Mohs fellows to date. I am currently Head of Service for the whole Dermatology service, Vice Chair of the Nottinghamshire Multidisciplinary Team for Skin Cancer, as well as adviser to the Divisional Board. I am heavily involved in Research and publications which in the main encompass Skin Cancer, Skin Surgery and Wound Healing.

 

Dr Ashish Sharma

I graduated from Cambridge University, with further study at University College London. Following specialist training in the West Midlands, I completed a formal post-CCT fellowship and now perform around 140 Mohs cases per year. I am member of both the Skin Cancer and Lymphoma MDT’s.

I have authored scientific articles, learning modules, a textbook chapter and UK guidelines for cancer management. I participate in research at the level of Principal Investigator.

 

Dr Alex Gan

I completed medical school at the University of Nottingham, achieving first class honours in the Bachelor of Medical Sciences (BMedSci) degree as part of the programme. I then did my foundation training at Southampton General Hospital, before moving back to the East Midlands to undertake my core medical training. This was followed by a dermatology clinical fellowship year at Imperial College Healthcare NHS Trust in London, before I undertook higher specialty registrar training at Derby and Nottingham.

Throughout my training I held numerous leadership roles at every stage and have actively contributed to teaching, publications, clinical improvement and presentations at local, regional, national and international level. I was proud to be awarded the Topol Digital Fellowship in 2022, with my work culminating in the development of a remote monitoring biologics clinic at the Nottingham dermatology department.

I look forward to my post-CCT Mohs Micrographic Surgery fellowship year at Nottingham and hope to be a valuable asset to the formidable team here. With the excellent track record of this programme, I am confident that I will develop into a competent Mohs surgeon by completion of this fellowship.

The Consultant and CNS clinics run daily occupying all 12 clinic rooms.

Skin Cancer SSMDT meetings are held every Thursday afternoon to discuss treatment options for complex patients. Oncology, Radiology, Plastics and Ophthalmology colleagues attend and help form the SSMDT.

The Light therapy and dermatology day treatment unit runs every Monday, Wednesday and Friday and treats up to 80 patients a day.

The dressings and biopsy clinic runs daily, treating 25-30 patients per day, and finally, the Patch clinic runs on Monday and Friday, and our photodynamic therapy runs on Tuesday and Thursday.

The department runs a yearly MOHS fellowship for dermatology doctors to specialise in Mohs surgery. Mohs surgery is considered the most effective technique for treating many basal cell carcinomas and squamous cell carcinomas, the two most common types of skin cancer.

For very complex reconstruction post-Mohs surgery we work alongside the ocular surgeons and plastic surgeons.

Treatment Centre switchboard: 0115 919 4477
Gateway A admin team: 0115 919 4477 ext. 78990
PA hunt group: 0115 919 4477 ext. 78941
On-call number to be used out of hours: 07812 275471

Head of Service
Dr Anand Patel

Matron
Helen Magee 

Specialty General Manager
Beverley Simpson

Consultants
Dr Sandeep Varma
Dr Shanti Ayob
Dr Ashish Sharma
Dr Rosalind Simpson
Dr Sowjanya Ayyalaraju
Dr Kyle Tang
Dr Jane Ravenscroft

PAs
Wendy Adams
Kim Ball
Tamara Coyne
Gerry Twigger

• British Association of Dermatologists Patient Information Leaflets
• British Association of Dermatologists Support Groups
• Centre of Evidence Based Dermatology
• DermNet NZ
• Primary Care Dermatology Society
• NICE
• Nottingham Support Group for Carers of Children with Eczema

Referrals are accepted from other hospitals, consultants within the Trust and from GPs within primary care through the NHS e-Referral service

The NUH adult dermatology will provide a full elective and outpatient service Monday to Friday and a limited acute service as described below.

The Paediatric Dermatology service will continue to run independently within the Family Health Directorate and will provide a full service to local children.  The remaining Paediatric consultants will not be able to see adult patients.

 

Adults	In medical emergencies with primary dermatology issue (90% BSA affected, widespread desquamation, skin failure, systemically unwell, with or without established skin diagnosis), please arrange admission via ED to general medical ward.
Adult Dermatology Emergencies (NUH Inpatients & A&E)	Referral to dermatology should be made by the medical team Consultant via Nervecentre. This is a Monday-Friday 9am-4pm service and the on-call dermatologist is alerted via a mobile device once certain referral criteria are met. There is no on-call dermatology service for out of hours. Appropriate referrals will be picked up the following morning via Nervecentre. In extreme emergencies that a dermatology opinion is going to significantly affect the patient's outcome, the attending medical consultant can contact consultant dermatologist via switch for advice remotely.
Urgent outpatient referrals (Primary Care/A&E)	For outpatient/GP advice: Contact dermatology via NUH switchboard (stating whether it is for adult dermatology or paediatric dermatology) between 9am-4pm, Mon-Friday.  The message will be reviewed by consultant in-hours who will call to offer advice or arrange an appointment if deemed necessary by Dermatologist. In case of dermatology emergencies which cannot wait until next working day, see above under Emergencies.
NUH Inpatients	Please avoid referrals which can be dealt with post-discharge. Chronic conditions should, in general, only be referred by primary care to dermatology service. For advice regarding skincare for patients with established dermatology diagnosis, please refer to the last clinical letter on DHR. For patient require dermatology input during inpatient care, please referral to NUH dermatology via Nervecentre. This is a Monday-Friday 9-4 service and the on-call dermatologist is alerted via a mobile device. Please take photos via Nervecentre or arrange medical photographs of skin condition so that they can be reviewed by the Dermatologist. Where appropriate, patients who are ambulatory, systemically stable and non-infectious may be offered an appointment at the Treatment Centre during their inpatient stay at NUH.  If this is not possible, the Treatment Centre consultant will offer advice but will not be responsible for the management of the patient – this will remain with the consultant under whom they have been admitted at NUH.
Suspected Skin Cancer	NUH inpatients: For incidental finding of suspected skin cancers during inpatient stay, please refer via Skin Cancer 2 week-wait referral to Dermatology-NTC2@nuh.nhs.uk.
Routine Referrals (GP or NUH)	Please consider Advice & Guidance via ERS or Teledermatology service for diagnostic uncertainties. Always use F12 guidance/intranet guidelines to ensure compliance with referral guidance. We can only accept your referral if it complies with the referral guidance. For routine referrals, refer to Treatment Centre on NHS E-Referral system.   For appointment queries, please contact Treatment centre on (0115) 919 4477 Ext: 78990. For secretaries to dermatologists, Ext: 78941
Post-operative complications from TC	A wound check nurse is available at the Treatment Centre and patients will have been given the contact details on discharge.  If call received at NUH, advise patient to contact the nurse at TC direct on 07812 268 113.   Out of hours, contact the NUH Plastics Registrar through switchboard on 0115 924 9924.