Clare Abbey Skin Cancer Clinic is a dedicated unit of Clare Abbey Primary Health Centre (CAPHC).

CAPHC is located close to the M18 outside Ennis and serves patients across Clare and the Mid-West Region.  With 5,000 square foot of accommodation, it includes nine clinical rooms, extensive administrative, storage and waiting, play, parking and ancillary facilities.  It also accommodates an on-site pharmacy and hosts a wide range of consultant clinics, diabetic retinopathy, audiology, dietetics, psychiatry, counselling and allied health professionals.  Clinically we are compliant with HSE and HIQA guidance and the Centre has full fire and disability access certification.  The Centre and its associated Clinics have successfully completed the ICGP Minor Surgery Accreditation process.

 

ACCOMMODATION & FACILITIES

Within the Skin Cancer Clinic, accommodation comprises consulting room, operating theatre, side room scrub area with elbow taps, administration space, waiting area and self-contained decontamination room.   The Unit complies with and exceeds the standards required by HIQA for Primary Care facilities e.g. specific operating room, marmoleum flooring, coving, IPS panelling, elbow taps, central couch with underfloor power source, theatre-standard paint etc.  The theatre space features mechanical ventilation delivering fifteen air changes per hour and a touchless gesture-controlled overhead light featuring six LEDs and unparalleled spot quality featuring WelchAllyn Sure Colour for accurate tissue colour rendition.                                                MINOR SURGERY CLINIC (59)

The Decontamination Room has been designed in accordance with HSE guidelines for effective Decontamination of Reusable Invasive Medical Devices (RIMD).  It contains hand-washing sink, double instruments sink and draining area, bioSonic cleaner, autoclave and mill washer. Instruments are subject to a fully validated, traceable path, overseen by a dedicated theatre nurse with specific experience in these practices.  The purpose-built, non-clinical space for decontamination of RIMD minimises cross-infection risks.  The Class B autoclave and associated equipment are serviced regularly and validated annually.

All clinical instruments comply with EU Standards.  Installation, commissioning, servicing and annual validation of decontamination equipment complies with medical directive 93/94/EEC.  All instruments are traceable back to individual patients via labelling, printouts and electronic recording.

A ‘Traffic Light’ system applies to Decontamination Room practices i.e. Red Zone (where RIMD are returned for processing), Amber Zone (where RIMD are inspected, packaged and prepared for sterilisation) and Green Zone (where medical devices are released or dispatched etc prior to reuse).

 

ASSESSMENTS  &  TREATMENTS

The Skin Cancer Clinic offers a full-service spectrum from initial assessment to preventative therapy to repair of complex defects.

Assessment options include
  1. mole checks
  2. full body skin cancer checks using latest dermoscopy technology
  3. diagnosis with biopsy (incisional, excisional, shave and punch) if indicated.  All samples are forwarded to University Hospital Limerick for histopathological examination.

Dr Gavin is a member of the Multi-Disciplinary Cancer Team at UHL where histopathology results and complex cases are reviewed with secondary care colleagues.

Preventative Therapy

Preventative therapy includes field treatment for Actinic Keratosis, a pre-malignant, pre-cursor of squamous cell carcinoma e.g. Cryotherapy, Aldara, Picato, Efudix and Daylight PDT utilising Metvix.

 

Treatment Options

The following surgical and non-surgical treatment options are available:

  • Non-surgical: Cryotherapy, Electrodessication, Curettage and Topical Agents e.g. Efudix, Picato, Eldara, Metvix-Daylight PDT.
  • Surgical options include a wide range of excisional procedures with elliptical excision and variations for closure. Larger skin cancers can require complex reconstruction including skin flaps and graphs which are carried out on-site.

Follow-up skin checks are carried out at appropriate intervals depending on pathology.

 

A review of the Clinic’s tracking and tracing system for pathological examples confirmed exceptionally high accuracy in pre-biopsy diagnosis correlated with histopathology diagnosis by examining pathologist at University Hospital Limerick.  The presentation of these findings led to the award of the Ross Ardill Memorial Prize in 2015 and was included for consideration of the National Cancer Control Programme Guidelines for the management of non-melanoma skin cancer in Primary Care settings.

 

Every interaction in the Clinic is subject to risk assessment for infection transmission.  Compliance with the following quality standards is applied

  • Guidance for Application of Standards and recommended Practices for Local Decontamination Units in Primary Care, Dental, Podiatry and GP Practice (HSE, 2016)
  • Code of Practice for Decontamination of RIMD (HSE, 2007)
  • Guide: Manufacture of Medical Devices within Healthcare Institutions (Irish Medicines Board, 2005)
  • Safe and Effective Use of Benchtop Steam Sterilisers (Irish Medicines Board, SN 2009)
  • Cleaning and Decontamination of Reusable Medical Devices (Irish Medicines Board, SN 2010)
  • Infection Prevention and Controls for Primary Care in Ireland (HSE, 2014)

 

 

PERSONNEL

Colum Gavin

Since graduating from UCC Medical School in 2000 and the Mid-Western GP Scheme in 2004, Dr. Gavin has pursued and built a specialist service in Dermatology.  His post-graduate qualifications and memberships include

  • 2008 – Diploma in Practical Dermatology, Cardiff University
  • 2009 – International Diploma in Dermoscopy, (Distinction), University of Graz, Austria
  • 2011 – Certificate of Skin Cancer Medicine, Skin Cancer College of Australasia
  • 2012 – Diploma of Skin Cancer Medicine & Surgery, Skin Cancer College of Australasia
  • 2015 – Fellowship Part 1, Skin Cancer College of Australasia
  • 2016 – 18-month Residential Fellowship in Brisbane, Australia (5-day week on management, predominantly surgical, of complex skin cancers with at least 20 weekly cases in fully-equipped and assisted Operating Theatre on multiple  body sites. Scholarship awarded for highest mark in Fellowship Exit Exam, Skin Cancer College of Australasia                           Skin Cancer College Accredited
  • Member, Multi-Disciplinary Team, University Hospital Limerick
  • MICGP/FRACGP

Since 2009, Dr. Gavin has utilised his post-graduate qualifications in Dermatology to provide specialist services for patients in Clare and the wider Mid-West Region and has been developing the service on an incremental basis since then –

  • 2009 – set up Community Surgery-based Procedure List
  • 2014 – set up Clare Abbey Skin Cancer Clinic: full service spectrum including assessment, full skin check, dermoscopic examination, biopsy, repair of complex defects etc. In recognition of the ‘robust treatment management, results-tracking system, complexity of surgical repairs and significant improvements in patient outcomes’, Dr Gavin was awarded the Ross Ardill Memorial Prize for 2015.

 

He lectures widely in Non-Melanoma Skin Cancer in Ireland and abroad and builds his knowledge through regular peer- based exchange and learning such as at the World Congress of Dermoscopy, Greece, 2018.

Dr. Gavin continues to develop the Clare Abbey Skin Cancer Clinic, which receives referrals from across the Mid-West region and beyond, with a mission to meet and exceed the standards achievable in hospital settings.

Nurse Antoinette Guthrie

Antoinette Guthrie is the Decontamination Lead and Surgical Assistant to Dr. Gavin.  She qualified as RGN (1994) and Theatre Nurse (2000) in St. Vincent’s University Hospital, Dublin.

She continued to work in St. Vincent’s, specialising in Theatre prior to her appointment at the Clare Abbey Skin Clinic in 2017.  She is the Decontamination Lead, ensuring all theatre processes are carried out in line with recommended best practice.