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
• Centre of Evidence Based Dermatology
• DermNet NZ
• Primary Care Dermatology Society
• NICE

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 service 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.

Dermatology Referral Guidance

Referral Type	Details
Adults	In medical emergencies with a primary dermatology issue (90% BSA affected, widespread desquamation, skin failure, systemically unwell, with or without an established skin diagnosis), please arrange admission via ED to a 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 out of hours. Appropriate referrals will be picked up the following morning via Nervecentre. In extreme emergencies where a dermatology opinion is critical to the patient’s outcome, the attending medical consultant can contact a consultant dermatologist via switch for remote advice.
Urgent Outpatient Referrals (Primary Care / A&E)	For outpatient/GP advice: Contact dermatology via NUH switchboard (state whether it is for adult or paediatric dermatology) between 9am–4pm, Mon–Fri. The message will be reviewed by a consultant in-hours who will call to offer advice or arrange an appointment if necessary. In case of dermatology emergencies that cannot wait until the next working day, see the Emergencies section above.
NUH Inpatients	Please avoid referrals for conditions that can be managed post-discharge. Chronic conditions should generally be referred to dermatology via primary care. For advice on skincare for patients with an established dermatology diagnosis, refer to the last clinical letter on DHR. For patients requiring dermatology input during inpatient care, refer to NUH dermatology via Nervecentre (Monday–Friday 9am–4pm). The on-call dermatologist will be alerted via a mobile device. Where appropriate, ambulatory, systemically stable, and non-infectious patients 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 provide advice but will not take responsibility for patient management, which remains with the admitting consultant.
Suspected Skin Cancer	For incidental findings of suspected skin cancer during inpatient stays, refer via the Skin Cancer 2-week wait referral to Dermatology-NTC2@nuh.nhs.uk.
Routine Referrals (GP or NUH)	Consider Advice & Guidance via ERS or the Teledermatology service for diagnostic uncertainties. Use F12 guidance/intranet guidelines to ensure compliance with referral criteria. We can only accept referrals that comply with the referral guidance. For routine referrals, refer to the Treatment Centre via the NHS E-Referral system. For appointment queries, contact the Treatment Centre at (0115) 919 4477 Ext: 78990. For dermatology secretaries, call Ext: 78941.
Post-Operative Complications from TC	A wound check nurse is available at the Treatment Centre, and patients receive contact details upon discharge. If a call is received at NUH, advise the patient to contact the nurse directly at TC on 07812 268 113. For out-of-hours concerns, contact the NUH Plastics Registrar through switchboard at 0115 924 9924.