PATIENT INFORMATION / AFTER CARE INSTRUCTIONS

A shave biopsy or curette has been performed to remove or treat a skin lesion. This procedure
removes the lesion from the surface of the skin — similar to a graze or superficial wound.
There are no sutures (stitches). Healing occurs naturally from the base upward.

Initial Dressing

• The treated area has been covered with an absorbent dressing.
• This helps control bleeding and protect the wound.
• You may remove this dressing after 2–3 days.

After Removing the Dressing

• Shower as normal and allow the area to dry completely.
• Cover with a bandaid or small non-stick dressing for the next 1–2 days.
• A dry scab will usually form. After 3–4 days, you can leave the area open to air.
• Apply Vaseline/paw paw 3–4 times a day to keep the area moist and comfortable.
• The wound typically heals within 2–3 weeks, depending on the site and your healing rate.

Wound Care Tips

• Daily showers help cleanse the wound and aid healing.
• Avoid: Soaps, creams, antiseptics, or liniments (e.g., Betadine™, Savlon™, Dettol™).
• Dry dressings help reduce the risk of infection.
• If the dressing becomes wet or soiled, replace it with a clean, dry one.

When to Contact the Clinic

Please contact the clinic if you notice:

• Increasing redness, swelling, or pain
• Persistent bleeding or discharge
• The wound appears infected (yellow crust, pus, or odour)
• Fever or feeling generally unwell

Additional Tips

• Protect the healing area from the sun using SPF 50+ sunscreen or clothing once the skin has healed.
• Do not pick at scabs — they will fall off naturally as new skin forms underneath.

If you have any concerns, please contact the clinic.

Your wound has been closed after skin lesion excision. Depending on the surgical site and tissue
tension, it may have been closed with internal (absorbable) sutures only or a combination of
internal and external sutures. Both types require care to support healing and reduce infection risk.

1. Buried / Internal Sutures

If your wound was closed with internal (absorbable) sutures:

• The wound has two layers of sutures beneath the skin and skin glue on the outside.
• After applying the glue, your doctor covered the area with Micropore™, Steristrips™, Hypafix™, or Mefix™.
• These dressings support the wound and are porous, allowing air and water through, so they can get wet in the shower.
• Leave them undisturbed until your wound review (7–14 days).
• Continuous sutures may have small ends visible at either end of the scar — these will be trimmed flush with the skin during your review.
• The internal stitches will dissolve on their own over several months. You might feel small firm lumps under the skin as they heal — this is normal.

2. External / Non-Absorbable Sutures

In some cases, a combination of internal and external stitches is used to strengthen wound closure.

You will have:

• A direct wound tape (Micropore, Steristrips, or Mefix) placed directly over the scar.
• An outer absorbent dressing (Melolin or gauze) secured with Mefix, Micropore, or Tegaderm applied on top of the direct wound tape. These outer dressings absorb oozing or bleeding, provide gentle pressure, and help support the wound.

Dressing Care

• Keep the outer dressing dry for the first 5 days.
• After 5 days, you may remove the outer absorbent layer. If the gauze sticks, soak it under the shower to ease removal. Do not remove the tape or surface dressing (Micropore™, Steristrips™, or Mefix™) until your sutures are removed at review.
• After the outer dressing is off, you may shower daily, allowing water to run over the wound. Gently pat dry or air-dry.
• If the initial surface dressing becomes wet or soiled, replace it with a clean, dry one.

Pain & Healing

• Mild discomfort is normal. Use Paracetamol (Panadol) if required.
• Avoid Aspirin or anti-inflammatory medications unless prescribed.
• Avoid strenuous activity or stretching near the wound for 2 weeks.
• Healing continues for several months. Some tightness, itching, or firmness under the scar is expected.

When to Seek Help

Contact the clinic if you notice:

• Increasing redness, swelling, pain, or warmth
• Bleeding, discharge, or pus
• The wound opens up or separates
• Fever or feeling unwell

What are Solar Keratoses?

Solar keratoses, also known as actinic keratoses, are rough, scaly, and often red patches that
appear on sun-exposed skin. These spots are precancerous and can develop into skin cancer if
left untreated. Treating these areas—and the surrounding skin—can help reduce your risk of
future skin cancers.

About the Vitamin D / 5FU Combination Cream

Until recently, the most effective treatment for solar keratoses was 5-fluorouracil (5FU, brand
name Efudix), typically used for about four weeks. The new combination cream, containing
Vitamin D (calcitriol or calcipotriol) and 5FU, is a major advancement in treatment.

Benefits include:

• Shorter Treatment Time: Only 4 days for the face/scalp, 6 days for other body areas.
• Greater Effectiveness: Clears sunspots better than 5FU alone.
• Longer Protection: Reduces risk of future skin cancers for up to three years, compared to one year with 5FU alone.
• Milder Side Effects: Redness, scaling, and stinging may occur but are usually milder than 5FU alone.

How Effective is This Treatment?

• Around 85% of people respond well to this treatment.
• 15% may see little or no response.
• 2% may experience a severe reaction (marked redness and burning).
• If this occurs, contact Dr Jeet or the clinic immediately.
• A prescription cortisone cream may be used if symptoms are severe.

How to Use Vitamin D / 5FU Cream

Before You Start

• If this is your first time using the cream, apply it to a small test area twice daily for 4 days to check for any severe reaction.

Application Instructions

1. Prepare the Skin:
   Wash the area with mildly warm water (avoid soap if it stings).
   Pat dry gently; do not rub.
   Allow skin to dry completely (wait at least 20 minutes after showering).
2. Apply the Cream:
   Use a non-metal applicator or rubber glove to apply a thin layer.
   Apply twice daily (morning and evening).
   Face and Scalp: 4 days.
   Other Areas (arms, legs, chest): 6 days.
   Only treat one region at a time (e.g. face only, or scalp only).
   Do not apply to broken skin, cuts, eyes, eyelids, nostrils, or lips unless directed.
   Wash hands thoroughly after use.
   Do not cover the treated area unless advised.
3. Timing:
   Apply at least 2 hours before bedtime to allow absorption and prevent transfer to bedding.
   During warmer months (September–May in Melbourne), apply sunscreen 20 minutes after the morning dose, and continue daily after treatment.
4. Area Limit:
   Do not treat more than 500 cm² (approx. 23 × 23 cm) at one time.
   Treat larger areas in separate stages.

What to Expect

• Redness, itching, and burning are common and may begin during or after treatment.
• The treated area may look unsightly and feel uncomfortable for up to 2 weeks after finishing.
• Apply a soothing moisturiser (e.g. QV Intensive Cream) to help with discomfort.

If irritation is severe, contact Dr Jeet or the clinic. A cortisone cream may be prescribed, but
use it only if advised, as it may reduce treatment effectiveness.

Sometimes, symptoms appear in areas that previously looked normal — this means the cream is
working on early sun-damaged skin before it becomes cancerous.

Inflammation usually settles within 2–3 weeks.

Do not use antiseptics such as Betadine as they may worsen irritation.

If you develop fever, dizziness, abdominal pain, cramps, diarrhoea, or vomiting, stop using the
cream and contact your doctor.

Precautions

• Do not use during pregnancy or breastfeeding.
• Avoid cosmetics, moisturisers, or other medications on the treated area unless advised.
• Avoid sun exposure during and for several weeks after treatment.
• Even untreated skin may be sun-sensitive — use SPF 50+ sunscreen daily.
• Make a follow-up appointment with Dr Jeet four weeks after finishing treatment.

Availability

This combination cream is not yet approved by the Therapeutic Goods Administration (TGA).
However, both ingredients have long records of safe use in Australia.

The combination has been used by doctors since 2018, available from selected compounding
pharmacies:

PharmacySmart Compounding
Level 2, 2 Wellington Parade, East Melbourne (Corner of Hoddle Street and Wellington Parade)
📞 Phone: 9416 1223
Delivery available.

What are Solar Keratoses?

Solar keratoses, or actinic keratoses, are rough, scaly, and often red patches on sun-exposed skin.
They are precancerous lesions that can develop into skin cancer if untreated.

What is Efudix and Tolak?

Efudix and Tolak contain fluorouracil (5FU) — a proven treatment for early forms of skin cancer
such as:

• Actinic (solar) keratoses
• Bowen’s disease (SCC in situ)
• Superficial basal cell carcinoma

5FU is absorbed by rapidly dividing abnormal cells, destroying them selectively.

How to Apply the Cream

• Apply 1–2 times daily until a good reaction develops (usually after 7 days).
• Then reduce to once daily for the remainder of the course.
• Adjust frequency depending on reaction — if irritation becomes severe, pause for 1–2 days, then restart.
• Continue for a total of 4 weeks.

Where to Apply

• Apply to visible lesions or as a field treatment to sun-damaged skin.
• Multiple regions (e.g. forehead and temples) can be treated simultaneously.
• If widespread damage is present, treat in smaller sections.
• Larger treated areas may cause stronger redness and inflammation.

How Much to Use

• Apply with a clean fingertip or gloves.
• For the whole face, use four pea-sized amounts (chin, cheeks, forehead).
• For smaller areas, use one pea-sized amount.
• Wash hands thoroughly after use.

Application Instructions

1. Prepare the Skin:
   Wash with mildly warm water, pat dry gently.
   Allow at least 20 minutes for skin to dry after showering.
2. Apply the Cream:
   Use as above, avoid eyes, mouth, and nostrils.
   Wash hands after application.
3. Timing:
   Apply at least 2 hours before bedtime.
   In warmer months, apply sunscreen 20 minutes after the morning dose and continue daily after treatment.
4. Area Limit:
   Treat no more than 500 cm² (23 × 23 cm) at one time.

What to Expect

• Redness, itching, and burning are common.
• Treated skin may look unsightly and uncomfortable for up to 2 weeks after treatment.
• Apply QV Intensive Cream or similar for relief.
• Severe reactions: contact Dr Jeet or the clinic — cortisone cream may be prescribed if needed.

Aftercare

• Redness, soreness, and crusting are normal.
• Apply Bepanthen, Pawpaw ointment, Vaseline, or QV Intensive for relief.
• Avoid antiseptics such as Betadine.
• Inflammation settles in 2–3 weeks.
• If infection or systemic symptoms occur (fever, dizziness, diarrhoea, vomiting), stop treatment and contact your doctor.

Precautions

• Do not use during pregnancy or breastfeeding.
• Avoid cosmetics or other creams unless advised.
• Avoid sun exposure during and after treatment.
• Use SPF 50+ sunscreen daily.

Follow-Up

Please make a follow-up appointment 3 months after treatment to assess your skin’s response
and discuss any need for further treatment.

What is Aldara Cream?

Aldara is a skin cream proven to be active against early forms of skin cancer and pre-malignant
conditions such as:

• Superficial Basal Cell Carcinoma
• Actinic (Solar) Keratoses

Aldara is an immune response modifier. It works by stimulating your body’s local immune system
to recognise and destroy abnormal or damaged cells in the skin.

How Should I Apply the Cream?

How often you apply Aldara depends on the condition being treated:

Inflammation is a good sign — it means the cream is working. The skin reaction is often most
noticeable during week 3 of treatment and may take up to 4 weeks to settle after stopping the cream.

Application Instructions

1. Prepare the Skin
   Wash the area with mildly warm water (avoid soap if it stings).
   Pat dry gently — do not rub.
   Allow the skin to dry for at least 20 minutes after showering.
2. Apply the Cream
   Apply before bedtime using a clean fingertip.
   Use a thin film and rub it in gently until it disappears.
   Wash your hands after applying.
   Avoid contact with other skin areas.
3. Timing
   Apply at least 2 hours before going to bed to ensure absorption and avoid transferring the cream onto bedding.
4. Treatment Area Limit

Condition / Frequency / Duration

• Superficial Basal Cell Carcinoma – 5 nights per week (e.g. Monday–Friday) – 6–8 weeks
• Actinic Keratoses – 3 nights per week (e.g. Mon, Wed, Fri) – 4 weeks; may repeat after 1 month

• Do not treat more than 500 cm² (approximately 23 × 23 cm) at one time.
• Treat large areas in smaller sections during separate courses.

What to Expect

• Redness, itching, and burning are common and indicate that the cream is working.
• The treated skin may look unsightly and feel uncomfortable during and shortly after treatment.
• Discomfort usually improves within 2–3 weeks after stopping Aldara.
• Apply a soothing moisturiser (e.g. QV Intensive Cream, Cetaphil, Bepanthen, Paw Paw) for relief.

If the reaction is severe or painful, contact Dr Jeet or the clinic.

A mild cortisone cream may be prescribed, but only use it if advised, as it can reduce the treatment’s effectiveness.

Sometimes, spots may appear on skin that looked normal before — this means Aldara is targeting early sun-damaged cells before they become visible.

Do not use antiseptics such as Betadine, as they can increase irritation.

If you develop fever, dizziness, abdominal pain, diarrhoea, or vomiting, stop using the cream and contact your doctor immediately.

Can You Feel Unwell?

Some people may develop flu-like symptoms such as:

• Fever
• Fatigue
• Aches or swollen lymph nodes

These symptoms mean your immune system is active. Rest and paracetamol can help relieve them.

Precautions

• Do not use Aldara during pregnancy or breastfeeding.
• Avoid sun exposure during and for several weeks after treatment.
• Even untreated skin may become more sun-sensitive — use broad-spectrum SPF 50+ sunscreen daily.
• Expired cream to your pharmacy for safe disposal.

ReTrieve is a prescription-strength cream used to rejuvenate sun-damaged skin and improve
overall skin health. It contains tretinoin, which is the acid form of Vitamin A — a well-studied
ingredient that promotes skin renewal and repair.

Used regularly, ReTrieve can:
• Improve skin texture and smoothness
• Reduce fine lines and wrinkles
• Lighten pigmentation and sunspots
• Support healthier, more radiant skin over time

When used consistently alongside a broad-spectrum SPF 50+ sunscreen, it is one of the most
effective long-term treatments for photo-ageing (sun damage).

How Does Tretinoin Work?

Tretinoin works on a cellular level to accelerate skin turnover and stimulate collagen production.
This process:
• Helps the skin shed old, damaged cells faster
• Encourages the growth of new, healthy cells
• Reduces the build-up of sun-damaged cells
• Smooths the skin’s surface and evens out tone

Over time, this leads to a noticeable improvement in the clarity, elasticity, and brightness of the skin.

Starting ReTrieve (Tretinoin) at Night

Goal: Gradually introduce your skin to tretinoin to improve texture, pigmentation, and fine lines while minimising irritation.

Step-by-Step Plan

Week 1–2: Skin Conditioning

• Use every 3rd night.
• Apply a gentle cleanser (e.g. Cetaphil, QV, La Roche-Posay Toleriane).
• Wait 10–15 minutes after washing to ensure skin is completely dry — applying to damp skin increases irritation.
• Use a pea-sized amount of ReTrieve for the whole face.
• Dot it on the forehead, cheeks, nose, and chin, then spread thinly.
• Follow with a moisturiser (e.g. CeraVe, QV, or Avène Hydrance).

Tip: If you’re very sensitive, you can apply moisturiser before and after the ReTrieve (“sandwich method”) to reduce dryness.

Week 3–4: Alternate Nights

• If your skin tolerates it (no significant redness or peeling), increase to every 2nd night.
• Continue using moisturiser generously, especially at night.
• You may notice mild dryness or flaking — this is expected early on.

Week 5 onward: Maintenance Phase

• Once tolerated, apply nightly.
• Avoid using other strong actives (AHAs, BHAs, vitamin C, benzoyl peroxide) at the same time — use them in the morning or on alternate nights.
• Always use broad-spectrum SPF 50+ in the morning, as tretinoin makes your skin more sensitive to sunlight.

What to Expect

• Mild peeling, redness, or dryness in the first few weeks — this improves as your skin adjusts.
• Purging (temporary breakouts) may occur for 2–4 weeks.
• Results usually become noticeable after 8–12 weeks of consistent use, with continued improvement over 6–12 months.

Avoid

• Applying to broken, irritated, or sunburnt skin.
• Using around the eyes, corners of mouth, or nostrils.
• Mixing with exfoliants or acids on the same night (unless advised by your doctor).

Supportive Skincare Routine

Morning:

1. Gentle cleanser
2. Serum ( vitamin C/nicotinamide)
3. Moisturiser
4. Broad-spectrum sunscreen (SPF 50+)

Night:

1. Gentle cleanser
2. Wait 10–15 minutes
3. ReTrieve (pea-sized amount)
4. Moisturiser

Scars show improvement up to the 2 year mark and most improvement occurs in the first 12 months.
Active scar management for ups 3 months after surgery will make a big difference.

1. When are the stitches removed?

Your wound may be closed in different ways depending on the type and location of your procedure.

a. Internal (Absorbable) Stitches: Your wound may be closed internally in which case you do not need
to have sutures removed. Dr Jeet does leave the edges of the running subcuticular sutures about 1-2 cm away from
either end of the scar. These are trimmed off 7-14 days after the surgery. You may have glue on the skin if the
wound is closed internally. This does not need to be taken off and it will peel off by itself in 2-3 weeks. You may
notice small lumps under the skin while healing; these are the deep sutures and usually disappear within 3–4 months.

b. External Skin stitches: are usually removed 5-14 days after surgery. The time varies according to body site.

Healing skin requires up to 6 months to regain most of its strength.

2. How can I reduce scarring?

Scars are a normal part of the healing process. The way you care for your scar in the first few months can make a big difference to how it looks later.

Here are some simple steps to promote the best possible healing:

A. Sun Protection & Avoidance
Direct sunlight can darken new scars and make them more noticeable.
• Keep your scar covered with clothing, a hat, or a physical barrier such as zinc-based sunscreen.
• Continue protecting the area from the sun for at least 12 months after your procedure.

B. Scar Massage
When your body forms a scar, collagen fibres can be laid down in a random pattern, creating a raised or uneven surface.
Regular massage helps collagen fibres align more evenly, resulting in a flatter, softer scar.

How to do it:
• Start from about two weeks after the procedure, once the wound has healed and there are no scabs.
• Use a slippery ointment (e.g. Vaseline/Cetaphil/QV or a silicone gel like strataderm) on your fingertip.
• Massage the scar for 5 minutes a day, Begin with gentle pressure and gradually increase it as tolerated. Use firm circular movements from about week 3.
(If you press too softly, it won’t have much effect.)

C. Silicone Therapy
Silicone helps flatten and soften scars by improving hydration and controlling collagen production. Although the exact
mechanism isn’t fully understood, many studies support its benefit.

Options:
• Below the neck: use a silicone sheet (e.g. Cica-Care).
• On the face: use a silicone gel (e.g. Strataderm).

For best results, silicone should remain on the scar for at least 12 hours a day.

D. What to Expect Over Time

• Scars continue to improve for up to two years, with most changes happening during the first year.
• Regular care — especially in the first few months — makes a big difference.

If you notice pain, redness, thickening, or itchiness that worsens over time, let your doctor know. Every scar is
unique, and early guidance can help you achieve the best cosmetic outcome.

3. The wound is red. Is this normal?

o Wound edges may be slightly red and is part of the normal healing process. This can last for up to a year.

Call your Doctor if:
o The redness is increasing or spreading more than 1cm from the wound edge.
o The wound is becoming more painful or increasingly tender to touch
o There is pus in the wound

4. Should I limit my activities?

Avoid activities that could cause your scar to pull apart in the first few weeks after surgery. Limiting movement of the wound area will aid in wound healing.
o Avoid lifting, straining, contact sports, intense exercise
o Avoid swimming if you have stitches in place.

5. Should I avoid sun exposure?

A healing scar will darken and be more noticeable if it gets sunburnt.
o Limit your sun exposure for the first 6 months after surgery
o When outdoors, cover your scar with tape or sunscreen

6. Will Lower Leg Surgery interfere with my mobility ?

Wounds below the knee heal poorly mainly due to reduced blood supply, tendency to swelling, venous problems, thin
skin, and underlying health conditions like diabetes. Choosing the most appropriate method for reconstruction, proper
wound care and managing underlying conditions, is important for good wound healing and avoiding complications.

After surgery it is important to keep the swelling down by:
o Keeping the leg elevated
o Compression Stockings / Bandages / Tubigrip™
o Avoiding long periods of standing or sitting
o Avoiding exercise or stretching of the wound
o Protecting the Wound from any direct trauma

What to Expect:

• Slight redness, swelling, or tenderness for a few hours.
• Mild headache or heaviness may occur
• Bruising may occur.

First 4 Hours – Avoid:

• Lying down or bending forward.
• Rubbing or pressing treated areas.
• Applying makeup.

First 24 Hours – Avoid:

• Strenuous exercise.
• Heat (sauna, steam, hot yoga).
• Facial treatments or massages or exercise injected muscle
• Excess alcohol.

Results Timeline:

• Day 3–5: Early results.
• Day 7–14: Full result.
• 3–4 months: Effects wear off
• Regular treatments help maintain results

Cryotherapy is used to treat various skin lesions by freezing and injuring the surface layer of skin with Liquid Nitrogen.
Normal skin healing then occurs.

▪ Symptoms and Signs (are very similar to Sunburn).
o Stinging can occur up to an hour with moderate discomfort afterwards
o The area becomes reddened & swollen and may form a small blister
o The treated areas do not need to be covered. Shower as normal.
o A scab will form after a few days and will drop off by:
▪ 1 – 2 weeks on the face
▪ 2 – 3 weeks on the arms and body
▪ 3 – 6 weeks on the legs

▪ Blisters can become painful and uncomfortable
o It is best NOT to burst them
o If PAINFUL, they can be burst with a small needle
o If they do burst, a bandaid / dry dressing can be applied for a couple of days

▪ Infection can occur, so it is important to check if:
o The surrounding skin is becoming increasingly tender to touch
o The redness is more than 1cm from the treated area
o The redness is increasing

▪ General Notes for Wound Healing:
Apply vaseline/Paw paw 3 times a day
Daily showers are fine
Let the scab peel off by itself

If you have any concerns, please contact Dr Jeet or the clinic.

Photodynamic Therapy is a medical treatment that uses a light-activated cream to destroy abnormal or sun-damaged skin cells.
It is commonly used to treat:

• Solar (actinic) keratoses – precancerous sun spots
• Superficial basal cell carcinomas (BCCs)
• Bowen’s disease (SCC in situ)

How does it work?

A special photosensitising cream (usually aminolevulinic acidALA) is applied to the affected skin.The cream is absorbed by abnormal cells and makes them extremely sensitive to light.  After an incubation period (usually 1–3 hours), the area is exposed to a specific red or blue or white light source.The light activates the cream, destroying damaged cells while sparing healthy tissue.

Before your treatment

• Avoid heavy sun exposure for a few days before your appointment.
• If you have thick crusty spots, use heel balm twice a day for a week before treatment to remove the thick scale.
• Do not apply sunscreen, creams or makeup on the day of treatment.
• If the area is hairy, you may be asked to shave gently the night before.
• Please inform us if you are pregnant, breastfeeding, or taking photosensitising medicines (e.g., doxycycline, retinoids, thiazides, certain antibiotics).

During the procedure

1. The area will be cleaned and any crusts gently removed.
2. The photosensitising cream is applied. Depending on the type of light used, the area may be covered with an occlusive dressing for a 2–3 hour waiting period.
3. The area is then exposed to red or blue light for approximately 8–10 minutes. If white light is used the exposure is for an hour( this is relatively painless)
4. You may feel burning, stinging or heat during light exposure – this is normal and subsides once the light stops. Cooling fans or cold air are used to reduce discomfort.

Aftercare

• The treated area will look red, swollen and sometimes crusted for 3–10 days.
• Keep the area clean and apply petrolatum (Vaseline) or a prescribed healing ointment twice daily.
• Avoid direct sunlight for 48 hours after treatment.
• You may take simple pain relief (e.g., paracetamol) if needed.
• Healing usually occurs within 1–2 weeks.
• Makeup can be used once the area has healed.

Possible side effects

Most effects are temporary and expected:

• Redness, swelling, crusting, mild pain or burning
• Temporary darkening or lightening of the skin
• Rare: infection, blistering, scarring, allergic reaction

If you notice increasing pain, pus, fever, or spreading redness, contact the clinic promptly.

Treatment outcomes

• PDT is highly effective for superficial sun damage and thin skin cancers.
• Cure rates:
  • Solar keratoses: 80–90%
  • Superficial BCC/Bowen’s disease: 70–90% (may need repeat session)
• Some patients require a second treatment after 1–3 months for complete clearance.
• Ongoing sun protection and skin checks are essential to prevent recurrence.