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00:01The Skin A&E Clinic is back.
00:04Morning.
00:06But this time, they've relocated north.
00:08Hi, I'm here for my appointment.
00:10And everything's bigger.
00:12My God, that's huge.
00:14Wow.
00:15You want to get rid of that.
00:17Whoa.
00:18Our team of top dermatologists
00:20have moved into a new purpose-built clinic.
00:23Doors opening.
00:25The doctor's ready for you now.
00:28They're tackling more conditions.
00:30Gosh, you've got so many.
00:32Helping scores of patients.
00:34That's like toothpaste.
00:36Is it?
00:37It's coming.
00:38Put years of bad skin behind them.
00:41Wow, you are a magic man.
00:44Wow.
00:45It's amazing.
00:46Can't believe that was inside my head.
00:48Restoring confidence.
00:50He's gone.
00:51And transforming lives.
00:53Oh, thank you so much.
00:54You're excited.
00:56This is Skin A&E.
01:05This week in the clinic.
01:06There we go.
01:07It's all coming out now.
01:08Love is in the air.
01:10I'm getting married in three months' time.
01:12We're really good bridesmaids.
01:15A child is born.
01:17I can see the head.
01:18It's time to push.
01:19And the first cut is the keenest.
01:23Oh, that's too painful.
01:25Oh, that's too painful.
01:26Oh, that's too painful.
01:27I'm scared.
01:28I'm scared.
01:29It's another early start for Skin A&E's top team of dermatologists and nurses.
01:37Not a busy day, huh?
01:38I think we have, yeah.
01:39I think that breakfast has just hit me.
01:44On time and keen to be seen is the day's first patient.
01:49Hi.
01:50I'm here for my appointment.
01:52I'm Sean.
01:53I'm 62.
01:54I'm currently unemployed and I live in North Hertfordshire.
01:58Have a seat for me, Sean.
01:59I'll let you know in her anyway.
02:00Okay.
02:03I went to art college and because I haven't worked for a year, I've quite seriously got
02:09back into doing it.
02:10I make things out of cardboard and newspaper.
02:13Cheap.
02:15Okay, Sean.
02:16The doctor's ready for you.
02:18Down the hall, on your left.
02:20Thank you very much.
02:21Sean will be seeing the clinic's face specialist, Dr Magnus Lynch.
02:28Hello.
02:29How are you?
02:30Sean.
02:31Hello, Sean.
02:32How are you?
02:33Lovely to meet you.
02:34I'm Magnus.
02:35Come and sit down for me.
02:36Take a seat.
02:37So, tell us what we can help you with today.
02:39As you can see, I have a little friend here.
02:42Okay.
02:43How long has that been there for?
02:44It's been maybe 12, 13 years or so.
02:46A long time there, yeah.
02:47It's been there quite a long time.
02:48Yeah, yeah.
02:49When I wear my glasses, they're slightly...
02:54Oh, yeah, so it's sort of...
02:55So they do...
02:56A bit lopsided, isn't it?
02:57Yeah.
02:58They do sort of go lopsided.
02:59It's difficult for you to put them where you'd normally put them, isn't it?
03:00Yes, yeah.
03:01Presumably you don't like the appearance of it.
03:02No.
03:03I mean, it does get mentioned.
03:05My mum, particularly, was like,
03:07well, you need to get that looked at, you know, like mums do, you know.
03:11What kind of work do you do?
03:12At the moment, I'm a gentleman leisure.
03:15I was an engineer.
03:16Yeah.
03:17You're a man of leisure.
03:18Yes.
03:19So what do you do with your time then?
03:20Mess about in my garden shed, making little sculptural things out of cardboard.
03:25Figurative stuff.
03:26Do you want to have a look?
03:27Yeah.
03:28You want to have a look?
03:29You know, just think of something and make it so it's not really thought out.
03:34It just, it will change as you go along.
03:36So that one...
03:37Wow.
03:38That's more elaborate than I anticipated.
03:40That's incredible.
03:41Wow, that's great, isn't it?
03:42Yeah.
03:43I was honestly amazed.
03:44I mean, who would have thought that you could make something like that out of what
03:48is basically rubbish?
03:50And impressive.
03:52So you mentioned it gets the way of your glasses.
03:54Yeah.
03:55Can I have a look at it for you?
03:56You can indeed.
03:57Yeah.
03:58Sure, sure.
03:59A cyst is a collection of dead skin cells under the surface of the skin with a lining which
04:16is producing those dead skin cells.
04:18It certainly wasn't the biggest cyst that I've seen but it's a very prominent location
04:22on the face and it's obviously inconvenient for him.
04:27So what I would propose to do is to remove some of the extra skin by making a cut like
04:32this.
04:33Okay, yup.
04:34Remove the cyst through it and then stitch that up as a straight line like that.
04:37Happy with that?
04:38Yeah.
04:39Very good.
04:40The cyst had stretched out Sean's skin and if I only removed the cyst then he'd be left
04:44with a baggy piece of skin so we needed to remove some of that.
04:47And I was thinking about where I wanted the scar to lie.
04:49An ideal place would be along the side of the nose so that's what I was aiming for.
04:57So first thing I'm going to do is just put some numbing injections in.
05:01Okay.
05:03So just coming now.
05:07It'd just be nice to be symmetrical.
05:10My niece is hoping to get married to her other half.
05:14It would be nice to be on the wedding photos without my little friend peering over the
05:20tops of the heads.
05:21Just going to cover your eyes because it's a very bright light.
05:24Mm-hmm.
05:25You okay?
05:26Yep.
05:27Yep.
05:28All right.
05:29That's good.
05:30So there it is.
05:31Nice.
05:32So after I removed the skin overlying the cyst I could see the lining of the cyst but it's
05:36pretty much popping out at me.
05:37See I feel lots of stretching.
05:43So, there it is.
05:56So after I removed the skin overlying the cyst, I could see the lining of the cyst pretty
06:00much popping out at me.
06:02See, I feel lots of stretching, feel a bit weird, okay.
06:08A little bit coming out there, just squeeze a little bit of that out, give that a little
06:16squeeze.
06:17There we go, it's all coming out now.
06:19There we are.
06:22There we are.
06:26Some of the contents has come out.
06:29I decided to puncture the cyst in order to make it smaller because that allowed me to
06:33remove the cyst through a smaller incision to keep the scar as small as possible.
06:38I'm just carefully making sure that we're getting all the lining as well as the cyst
06:43itself.
06:44It's all going very, very smoothly actually, not bleeding too much at all.
06:50It's coming out nicely, hasn't it, Angela?
06:56Really?
06:57Really nicely, yeah.
06:58Yeah.
06:59Thank you very much.
07:00You're going to hear a buzzing noise.
07:01It'll sound a bit strange.
07:02Mm-hm.
07:03You'll smell a bit of a burning smell maybe.
07:06We're just sealing off some tiny, tiny little blood vessels now.
07:11This is an area where there's lots of blood vessels.
07:13It's really important to seal off those blood vessels, otherwise you can get a collection
07:16of blood or bleeding, which can lead to poor cosmetic outcome.
07:19What I'm doing now is I'm just putting tiny stitches in gently to bring things back together
07:23again.
07:24So your sutures, particularly on the face, are really critical because this is going to
07:28determine what the scar looks like.
07:30So I'm going to give you the mirror, have a little look at things.
07:33OK.
07:34You see that?
07:35So all the cyst has gone.
07:36Yeah.
07:37Wow, that's amazing.
07:38Very swollen from the anaesthetic.
07:40Don't worry about that.
07:41That will all go down.
07:42Pleased with it?
07:43Yeah.
07:44Fantastic.
07:45Well, not me old self.
07:46Good.
07:47So you're going to have a big dressing.
07:49OK.
07:50It's going to be an impressive dressing.
07:53Yeah.
07:54Pressure dressings are very important.
07:55They reduce bleeding and they support the area so that it can heal.
08:00You OK?
08:01Yeah.
08:02Yeah.
08:03Yeah.
08:04Yeah.
08:05What?
08:06Were you laughing?
08:07I just wanted to see what my nose looks like.
08:10It's an impressive dressing.
08:11Very amusing.
08:12OK.
08:13You'll get a lot of sympathy.
08:15You'll definitely get a seat on the train.
08:18Sean started laughing because when we're doing a pressure dressing, sometimes they can be
08:22quite bulky.
08:23You'll be able to make a few of your artistic sculptures out of your bandages at this stage.
08:28I will, yeah.
08:29I'll have to include them in the next artwork I make.
08:32I know.
08:33Because it starts turning nearly into a mummy when they're getting these dresses done.
08:38I might get it stuck on me nose.
08:43If they're not blowing my nose too much, it might come off.
08:48Do you want to have a look at the cyst?
08:50I do.
08:51There you are.
08:52All right.
08:53So feel free to have a little touch of it if you want to.
08:56How does it feel?
08:57My God.
08:58That was inside your nose for 15 years.
08:59It's like chewing gum.
09:00It is.
09:01I'm leaving a little bit of me behind, which is a bit weird.
09:02But when I look in the mirror and put my glasses on, it would be nice that it's not... I might actually go and buy some more glasses to celebrate.
09:19Lovely to meet you.
09:20Nice to meet you.
09:21Thank you very much.
09:22Brilliant.
09:23You know, going to my niece's wedding, it would be nice for her to have photographs of me looking symmetrical.
09:32Do I look after?
09:33I feel lighter.
09:34I feel lighter.
09:35I feel lighter.
09:36Genuinely lighter.
09:37You've lost weight.
09:38Yeah.
09:39What?
09:40About 30 grams?
09:41In about two or three weeks' time, hopefully, it will be light.
09:43It will be great, because I'll just look a bit more normal.
09:47Once I've taken my covering off.
09:50I bet it was art.
09:53It was something else, wasn't it?
09:55I'm not very artistic, I'll be honest with you.
09:57No, I'm neither.
10:00Coming up...
10:01I can see the head.
10:02I can see the head.
10:04I think Dr Shui's sweating now.
10:08There we go.
10:10Oh, wow.
10:11It's weird.
10:17Got you a cuppa.
10:18Oh, lovely.
10:19Brilliant.
10:20Thank you so much.
10:21It's mid-morning, and whilst the team takes stock...
10:22Right, let's get these out.
10:23Let's get these out.
10:24So these are here, and they're ready.
10:25Just arriving is a patient who's very familiar with a clinic setting.
10:41My name's Tara, I'm 54, and I'm a midwife.
10:46Hi, I'm here for my appointment.
10:48Lovely.
10:49I'll check you in here.
10:50My favourite thing about my job is watching people become new parents.
10:55I'm able to become that woman's advocate during their journey.
10:58It's a very rewarding place to be.
11:01Doctors ready for you down the hall?
11:03On the left.
11:04Okay, thanks.
11:05No problem.
11:06Today, Tara's on her own journey, and hoping Dr Adil Shiraz can deliver.
11:11Hello.
11:12Hi.
11:13Hi.
11:14Hi there.
11:15Hi.
11:16Come through.
11:17Thanks.
11:18Take a seat.
11:20What can we do for you today?
11:21So I've got a large lipoma on my back, which has been getting bigger over the years.
11:26It's been there since about 2012, and I just want it gone.
11:32How does this lipoma impact you generally, day to day?
11:36I'm just very conscious that it's there because of where it is.
11:40If it was more hidden, then it probably wouldn't cause me the same mental health issues really.
11:46It's just that it's on show a lot of the time, even through clothes, I can see it pointing out my back.
11:50Yeah.
11:51The fact that people have come across and actually literally touched it and asked me what is that in a yoga class,
11:56it makes me well aware that it's really on show.
11:59And it just makes me feel very uncomfortable and, you know, it's very upsetting.
12:05Do you work at all?
12:06I do.
12:07What do you do?
12:08I'm a midwife.
12:09Okay.
12:10Does it impact work at all?
12:11It doesn't.
12:12No, it doesn't impact my job.
12:13So it's not painful movement?
12:14No.
12:15Is it okay if we have a look at it?
12:16Absolutely.
12:17Let's get you across here.
12:18I think without that lump, I would feel the true me and feel free.
12:24I don't really feel I'm wholly myself because I've got this foreign body thing attached to me and I just want it gone.
12:33Are you allergic to anything?
12:34Latex.
12:35So latex, long latex gloves.
12:38Yeah, we have some latex-free gloves especially for you.
12:41Yeah, you can see it.
12:44Can we get a marker?
12:45Yeah.
12:46Can we get a marker?
12:47A marker?
12:48Yeah.
12:49Yeah.
12:50So I can feel it just here.
12:52I guess the only thing with these type of lipomas is sometimes is it one solid lump or is it lots and little bits of acid tissue joined together?
13:03A lipoma is an abnormal division of fat cells.
13:07They are benign, harmless tumors.
13:09They generally form one solid structure but occasionally, particularly on the back, they can break up and they may be harder to remove because they won't come out as a solid lump.
13:19What will happen here is I will give you an anesthetic injection to numb it.
13:23Mm-hmm.
13:24I will then make a cut along the centre.
13:26Mm-hmm.
13:27I will also try to keep it as small as I can but I will need to make it big enough to get a lump out.
13:32Okay.
13:33If the lipoma doesn't come out as one whole lipoma then you're essentially worried that you may have left behind parts of that lipoma which would increase the chance of it growing back.
13:44All right, step one, the anesthetic, which will unfortunately sting.
13:49Coming up now, so deep breaths.
13:52You've said that a few times, haven't you, deep breaths?
13:55It's okay.
13:57It's your turn.
14:00Right, you okay there, Tara?
14:03Mm-hmm.
14:04Good.
14:05I'm nervous.
14:07I can't come to this point.
14:09You can be fine, you'll be fine.
14:11Are you nervous because you know what's going to happen?
14:14I just thought of it, I think.
14:15Yeah, of course.
14:16It's just all very real now.
14:19Yeah.
14:20Once I was laying on the bed and even though I'm a health professional, I really felt quite nervous at that point.
14:28I started feeling a mixture of anxiety and nerves and just, I don't know, it's like, it's happening.
14:36Right, so you shouldn't feel anything and if you do, you tell me and I'll give you some more, okay?
14:40Yeah.
14:41I'll tell you.
14:42Yeah, of course, I'm sure you will.
14:43Right.
14:44How's that?
14:45Good.
14:51How long have you been a midwife?
14:53Ten years.
14:54Oh, wow.
14:55Lots of babies.
14:57Any idea how many?
14:59I've actually written them down.
15:01I do have a list.
15:02I think it was 300 and something.
15:04Wow, 300 lives.
15:05Amazing.
15:06Mm-hmm.
15:07How are you feeling?
15:08Are you okay?
15:09Mm-hmm.
15:10Yeah, I can see the, I can see the head.
15:13That was a pun.
15:17How's it got hair?
15:20Well, it's bald.
15:23Yeah.
15:24Mm-hmm.
15:25Middle thing.
15:26Mm-hmm.
15:27We don't know yet.
15:28You could, yeah, you could tell me.
15:29Depends, I don't know, are boys harder to deliver or girls?
15:32Of course it's the boys harder.
15:34Are boys harder?
15:35No.
15:36They will draw on the queens.
15:38It feels like it's one lump.
15:41Good.
15:42Which is good for you.
15:44The head is almost out.
15:47It's just the crown.
15:49It was the crown.
15:51Mm.
15:52So we've attached it to the forceps as well.
15:56It is a forceps delivery.
15:59It's time to push.
16:03Yeah.
16:07This was quite a fun procedure.
16:09It was like delivering a little round orange baby.
16:16It's a little bit here.
16:17Do you have your still a touch?
16:19Now there's a little bit just there.
16:21There's a bit more, I think, just there as well.
16:23I'm not sure I'm sweating now.
16:27It's a bugger, is it?
16:28It won't come out.
16:29Yeah.
16:30Pretty much at the bottom now.
16:32You've got your baby out.
16:33Yeah.
16:34Yeah.
16:35Just need to make sure we have a left leg behind or something.
16:36Oh, yeah.
16:37In the end I was quite relieved it was all one sodded lump.
16:38This essentially means that there's a much lower chance of this coming back.
16:55All done.
16:56Just going to pop the stitches in and then you're done.
16:58I'm going to look forward to wearing certain clothes and just not feeling like people are
17:03looking at me and wanting to come and prod me.
17:06Now I want to see it.
17:09Yeah.
17:10So it will be exciting to go out and buy a new dress.
17:13Something that will be a bit more revealing that can show a bit more of my back that I
17:16don't have to feel so self-conscious.
17:18Right, Tara, how was that?
17:20It was pain free.
17:22Good.
17:23And let me just show you your scar on your back.
17:28If you look after that it should heal really well.
17:30Yeah.
17:31I'm really pleased.
17:32It looked flat.
17:33The lump's gone.
17:35Thank you for coming.
17:36Thank you for having me.
17:38You're welcome.
17:39Okay.
17:40Good.
17:41Take care.
17:42Bye-bye.
17:43Bye.
17:44See you.
17:45Dr. Adil, you've actually changed my life today, so a wholehearted big thank you.
17:52Without you, I'd still be living with this little creature in my back.
17:57So I'm so grateful.
18:02How many do we have today?
18:03Six?
18:04We're back on time.
18:06Woo-hoo!
18:07Woo-hoo!
18:12Dr. Adil isn't the only dermatologist with a long list of patients.
18:16Busy day today, isn't it?
18:18Barely busy.
18:19I'm here for an appointment.
18:20Lovely.
18:21Can I take your name, please?
18:22Yes, Carl.
18:23I'm 45.
18:24I'm from Suffolk.
18:25I've got a fiancé.
18:27We're planning to get married in a couple of months' time.
18:30The proposal was Valentine's.
18:33I just wrote in Valentine's card, let's run away and get married.
18:37And she looked at me, she looked at the card, smiled.
18:41And just the look on her face, I could just see that that's just what she really wanted.
18:46And then, obviously, from that point, then we start planning a wedding.
18:51But before his big day, Carl would like some help from Dr. Emma McMullen.
18:59Hello, is it Carl?
19:00Hiya.
19:01Hello, I'm Donna.
19:02How are you doing?
19:03Come on in.
19:04Have a seat.
19:05Dr. Emma there.
19:06Nice to meet you.
19:07You too.
19:08What can we do for you, Carl?
19:09I have what I've been told is lipomas.
19:12Okay, yeah.
19:13The most prominent ones on my forearm.
19:16Oh, yeah.
19:17Those are quite visible, aren't they?
19:19So how long have them been developing for?
19:21Well, I'm 45.
19:22Yeah.
19:23And I remember around about the age of 14, 15.
19:27And how many do you think you've got now?
19:29Oh, I've got lots.
19:30Lots.
19:31Lots.
19:32But they're the two most prominent ones.
19:33Okay.
19:34That are quite visible to me.
19:35I've got a large one underneath here.
19:37And there is one.
19:38It's kind of almost golf ball-like.
19:39Okay.
19:40Are any of them painful or really?
19:42The ones, if I knock them, they can be.
19:45And do you worry about them now or do they cause you much in the way of...?
19:49It's the mental health side of things.
19:54Mm.
19:55It affects your confidence and how you come across to people.
19:58I mean, I guess I'm quite good at hiding the feelings.
20:02I want to do something about it.
20:05What has prompted you to come today?
20:08Why do you suddenly want to get some of them removed?
20:11Well, my fiancée and I are getting married in a few months.
20:15Oh, wow.
20:16Oh, lovely.
20:17If I wanted to roll my sleeves up in the evening.
20:19Yeah, yeah.
20:20You know?
20:21I mean, when you greet people, you greet people with your arm out.
20:23Of course.
20:24You know, so it's just...
20:25Shaking people's hands, you can see it.
20:26Yeah, so it's just that whole aspect of it's there.
20:29Yeah.
20:30Is it OK if I just have a little examination of a couple of them?
20:34I'll just put my gloves on.
20:35So, lipomas are really common.
20:37They can run in families.
20:39There's certain genetic diseases that predispose you to them.
20:42But more often, they're just random.
20:44Oh.
20:47Oh, they're quite soft.
20:48They're a bit softer than they look when you were squeezing them.
20:51Can I feel the one?
20:53Yeah.
20:54On you?
20:55I'm always quite excited about doing a lipomas,
20:58particularly when they're on the arms,
21:00because they generally do pop out in a really satisfying way.
21:03Feels a bit deeper.
21:04Let me see.
21:05Does it move?
21:06Just move it flat.
21:07It's a bit deeper, that one.
21:09What we could do is we can numb them all.
21:10And if these two pop out dead easily and quickly,
21:13we'll do that one as well.
21:14Sure.
21:15Yeah?
21:16Does that sound OK?
21:17Yeah.
21:18Thought we'll definitely do the two on the forearm
21:19and see how they went before we tried the one on his upper arm
21:22because it was a little bit deeper
21:24and it's kind of near some nerves and blood vessels and things.
21:29It was not an area you want to dig around too much.
21:31So where's your wedding?
21:33It's in a little castle.
21:35Oh, there it is.
21:36Is it?
21:37It's in a little castle.
21:38Yeah.
21:39Now, we have tried this with previous patients
21:41and nobody's ever taken us up on it,
21:43but, you know, we're really good bridesmaids.
21:45Emma and Donna offer their services as bridesmaids,
21:50and, well, I think I'd have to check that with the boss
21:53before we confirmed any further bridesmaids.
22:03So I'm going to pop your local in now,
22:05just think of something nice.
22:06To not have them there,
22:08it's almost like I could have that confidence level back again.
22:11Does that feel sharp at all?
22:12No.
22:13I could feel the sense of relief and excitement just building,
22:20and knowing that this is now happening,
22:23it was almost overwhelming.
22:25If you feel any discomfort at any time,
22:27just let us know and we can put more local in, OK?
22:36It's quite close up.
22:38Just, we're just loosening it off.
22:40Sometimes they'll just pop out without hardly anything, but...
22:45See how loose we can get it.
22:48It certainly looks weird.
22:49Yeah, right.
22:50Are you ready?
22:51I think this is going to be a nice, easy one.
22:57There we go!
22:59Oh, wow.
23:00Just seeing it up close, it was just so surreal.
23:09That one come out really easy, didn't it?
23:10It did.
23:12The fact that Carl wanted to watch didn't really worry me.
23:15In a way, it's quite nice when a patient isn't too squeamish.
23:17I know they're not going to faint and pass out on me.
23:21It's weird.
23:25I hope they're all going to come out as easy as that.
23:30Coming up...
23:32Oh!
23:33It's too painful.
23:34No, it's too painful.
23:36I'm scared.
23:37I'm scared.
23:39There we go.
23:41I've been wanting to do that for years.
23:43For years.
23:44It's mid-afternoon.
23:54Very nice and well behaved, wasn't it?
23:56Yes.
23:57And Dr Emma's removed Carl's first lipoma with ease.
24:01But there's two more.
24:02One on each arm that he wants rid of before his wedding.
24:06Let's see how this one goes.
24:08It's okay, yeah?
24:09Yeah, it's fine.
24:10Oh, that looks so weird.
24:11One more.
24:12Oh, there's one bit.
24:13Oh, I'm giving it a squeeze.
24:14I'm giving it a squeeze.
24:15Oh, this one's a funny shape as it comes out, isn't it?
24:18It's got like little bits.
24:19Little...
24:20Got a little arm here.
24:21I might need to...
24:23Yeah.
24:24Just need to...
24:25I'm giving it a squeeze.
24:26I'm giving it a squeeze.
24:27Oh, this one's a funny shape as it comes out, isn't it?
24:30It's got like little bits.
24:31Little...
24:32Got a little arm here.
24:33Might need to...
24:35Yeah.
24:36Just need to free it up from the bottom.
24:38That one's hanging on.
24:39It is.
24:40It's a bit stuck at the bottom, I think.
24:41Oh, here, look.
24:42Needs a bit of encouragement.
24:43You can see it's like stuck on this bit of the skin over here.
24:51Oh, there...
24:52Oh, hang on.
24:53There was a bit of a surprise bit at the end.
24:55A bit hiding.
24:56Yeah.
25:02Right, so that's going below.
25:04Oh, it is a bit bigger looking, that one, than the other, isn't it?
25:07Yeah.
25:08Even though the second one was a bit trickier to get out,
25:11his lipomas were very well defined,
25:14so I was quite happy to give the third one a go.
25:16No, this one looked a little bit deeper, it feels a bit deeper.
25:23This one, it's the one that I catch on a lot of things,
25:27and actually having Emma confirm that,
25:31OK, we'll give the third one a go,
25:33I was like, OK, this is good.
25:35I can't see it.
25:36Oh, there.
25:37There you are.
25:38Can you see it now?
25:39Oh, yeah.
25:40OK.
25:43Is this one a bit of a misshape?
25:45I don't know, it's just a bit stuck down underneath them,
25:48but always worried that it's a little bit in the muscle
25:51or something like that, you know, and then it starts to hurt.
25:54If they're sort of going into the muscle,
25:57it's painful for the patient,
25:59and it's really difficult as a doctor
26:01to put a patient through that.
26:03They...
26:04Yeah.
26:05There we go.
26:06Oh, that bit popped.
26:08I was really relieved when it came out.
26:10Oh, look at that.
26:11Yeah.
26:16Sometimes you just can't tell when you do the examination
26:19how big they're going to be,
26:21so it was quite funny how we had baby bear,
26:24mummy bear and daddy bear.
26:27Let's get that space closed down.
26:32Right now, I feel fantastic knowing that they're gone.
26:37It's just out of this world.
26:39It's just...
26:40You can't imagine what sense of relief and excitement
26:45that leaves me going forward.
26:49Have you got any questions or anything you're worried about?
26:52Er, no.
26:53So good luck with the wedding.
26:55Thank you very much.
26:56And hopefully you can just relax a bit more.
26:58Yes, sure.
26:59Because you're not feeling as lumpy.
27:00Yeah.
27:01Yeah.
27:02Dr. Emma and Donna have given me the confidence
27:05going into my wedding.
27:06I can just roll my sleeves up on my shirt,
27:08and I can just have that sense of freedom
27:11and not care any more.
27:14Well, it was lovely to meet you.
27:15Lovely.
27:16I'm really glad we could help.
27:17Thank you very much.
27:18Brilliant.
27:19Have a safe trip home.
27:21Okay.
27:22Take care.
27:23Lovely.
27:24Thanks a lot.
27:25Thanks again.
27:26Cheers.
27:27Bye-bye.
27:28Bye-bye.
27:29Bye-bye.
27:30Walking out of that treatment room,
27:31I could just feel myself smiling from the inside out.
27:35It's onwards and upwards for me.
27:43Sorting embarrassing problems is all in a day's work for our team.
27:48That's it.
27:49You're done.
27:50But one patient wants to know if they've had any awkward moments of their own.
27:54I've always wondered,
27:56what is the most embarrassing thing you have ever done in front of a patient?
28:00Or, you know, ask them when the baby's due and they're just fat.
28:05Play football with the cyst that fell from the scalp.
28:09I think I probably called a patient by the wrong name.
28:15It hasn't happened to me,
28:16but I've certainly been in theatre working with another nurse who's lost her trousers.
28:22They fell down, and they fell down to my ankles.
28:25Literally, she hadn't tied them up,
28:27and down they came.
28:29Oh, God!
28:35Trousers up!
28:36These trousers are driving me insane.
28:39Nurse Duta and Dr Natalia Spearings are preparing for their next patient.
28:4539-year-old beauty pageant contestant, Michelle.
28:52Hello!
28:54Hello!
28:55Hi!
28:56Hello!
28:57Hi!
28:58How can I help you today?
29:00I got this skin condition that I don't know too much about.
29:05Okay.
29:06They look like moles.
29:07Yeah.
29:08Like lots and lots of moles.
29:10Or all the way here.
29:12And up.
29:13Up on...
29:14Up here.
29:15Okay.
29:16Yeah.
29:17Right.
29:18Okay.
29:19I get a little bit self-conscious because I have so many of them.
29:24And sometimes when I look in the mirror, I feel like I'm getting more and more,
29:30and I just want to take them off.
29:34I got this in my pregnancy.
29:37Okay.
29:38In 2016.
29:40My first pregnancy was in 2006.
29:43Okay.
29:44And I got the same thing, but I had them taken out in the Philippines.
29:48It was in a shopping centre.
29:49Right.
29:50And they just put a cream.
29:52And then I left it for an hour, and then they took this, like, sheet off.
29:57I don't know exactly what they put on.
29:59I didn't even ask them.
30:00But then they went away in a week.
30:02Interesting.
30:03Right.
30:05When Michelle told me about the treatment she'd had in the Philippines,
30:08I was intrigued, and I'd never heard of that before.
30:11It sounds great, though.
30:13Oh, and they came back again after the second pregnancy.
30:15Yeah.
30:16The second pregnancy.
30:17And were they worse the second time?
30:19Um, yes.
30:20Yes.
30:21They just keep on increasing.
30:23Let's have a look.
30:24Okay.
30:25I'm nervous.
30:26Okay.
30:27What I'm going to do is have you stand up and face that window for me.
30:30Sure.
30:31So what are you nervous about with these?
30:34Um, nervous about, like, a discovery.
30:36Like, oh, I discovered you have this and that.
30:41I worry about this condition because it could spread all over my body.
30:47Or they could just keep on getting bigger and bigger like they seem to be doing.
30:52Okay.
30:53Have a seat.
30:54Okay.
30:55So these are called seborrheic keratoses, and that's, um, a fancy word for basically
31:03warty growths you get as you get older or due to pregnancy.
31:06So they're very common in pregnancy.
31:08Um, they often shrivel up and fall off a few months or years after pregnancy, but unfortunately
31:12yours didn't do that.
31:13They're totally benign and they can be removed.
31:15Oh, perfect.
31:16Okay.
31:17Yeah.
31:18So some of them are so tiny.
31:19I wouldn't bother injecting with anesthetic.
31:20Yeah.
31:21I would just snip them off.
31:22And the bigger ones, you probably want a little bit of anesthetic in there to stop you from
31:26having, um, too much discomfort when it happens.
31:29How do you feel about doing it now?
31:30Um, excited and nervous.
31:34Okay.
31:35Yeah.
31:36But if you get too stressed and let us know, but it's going to go pretty quickly.
31:38So, um, you know, they'll be off before you know it.
31:41Okay.
31:42Is that okay?
31:43Yeah.
31:44Okay.
31:45I know it sounds a little unusual, but sometimes the anesthetic injection can be more painful
31:49than the snipping.
31:50And when it comes to little ones like this, just snipping it off is much easier.
31:56So what we're going to do is I'm going to go around and start snipping off the tiny,
32:03tiny ones.
32:04Okay.
32:05And you're going to feel me lifting something.
32:06Do you feel anything?
32:07Yeah.
32:08Oh, you felt that.
32:09How was that?
32:10Pinch.
32:11Um.
32:12One, two, three.
32:13When she told me she was able to take them all out, I was happy and I was also scared
32:21about how painful it would be because I really don't like pain.
32:26You did very well, Michelle.
32:31Oh, sorry.
32:32Oh, that's too painful.
32:33No, too painful.
32:34No.
32:35The lower part is too painful.
32:37I'm sorry.
32:38Let me just try one more here.
32:40I'm scared.
32:41I'm scared.
32:42I'm scared.
32:43Or not.
32:44Maybe it's too much.
32:45It's possible that Michelle felt more pain on the chest area because she could see what
32:50I was doing as opposed to the neck.
32:52So I'm going to do some anesthetic now.
32:54How many shots?
32:55Are you happy for three?
32:57Yeah.
32:58Ready?
32:59And the first one's now sharp.
33:00Good.
33:01Well done.
33:02You can squeeze my hand if you like.
33:05Good.
33:06It is an important part of my job to keep patients relaxed.
33:09Ultimately, when the patient is relaxed, you can kind of do the procedure a lot faster.
33:15Okay.
33:16Do it this way.
33:22This is a curette, so it's a round blade.
33:26And I'm just scraping it off because it's too big for me to snip.
33:32And now you're going to hear a buzzing sound.
33:37One, two, three.
33:38Oh.
33:39Wait.
33:40Two more.
33:41I'm scared.
33:42You're going to be okay?
33:43One, two, three.
33:44Good.
33:45Well done.
33:46And last one.
33:47I'm not going anywhere.
33:48Good.
33:49Sorry.
33:50The sound is probably off-putting as well.
33:52That's it.
33:53That's it.
33:54Well done.
33:55Thanks.
33:56We're done.
33:57Okay.
33:58So there's nothing you need to do for these.
34:01Just leave them alone.
34:02Mm-hmm.
34:03And they'll just heal and the little red bumps will go away.
34:08I think I removed about ten of Michelle's sub-kays and I would have removed more if she hadn't found it so uncomfortable.
34:17Oh, it looks amazing.
34:18Good.
34:19Excellent.
34:20It does.
34:21I'm super happy that I had all these taken out.
34:25It's a dream come true.
34:27Thank you so much.
34:28Nice to meet you.
34:29You're welcome.
34:30Have a good journey with us.
34:31Nice meeting you.
34:32All the best.
34:33Bye.
34:34Bye.
34:37Okay.
34:38Look at all these little guys.
34:40Little morsels of skin goodness.
34:42Yes.
34:43Great.
34:44Like caviar.
34:45Oh, caviar.
34:49Coming up.
34:50Okay.
34:51Just a bit fiddly now, okay?
34:52Okay.
34:53I had to be careful.
34:54In the neck is the accessory nerve.
34:56If you cut it, it's quite a serious complication.
34:59There's been lots of exciting talk in today's clinic.
35:14We might go to Sri Lanka.
35:16That's why I was talking about Sri Lanka the other day.
35:19Oh, yeah.
35:20Well, I'm going to see the pretenders on Wednesday.
35:22Yeah, interesting.
35:23Everybody's got something big going on.
35:25Yeah.
35:26I feel a bit left out.
35:29And 46-year-old Alan has big plans, too.
35:32Hence his appointment today with Dr Dev Shah.
35:40Hiya.
35:41Alan.
35:42Hi.
35:43Come on in.
35:44How are you doing?
35:45Yeah, good.
35:46Good.
35:47Hello, Alan.
35:48Jerry.
35:49So, tell me, how can we help today?
35:52Um, I'd like to get this gone.
35:55It's been scanned.
35:56It's been looked at.
35:57Yeah.
35:58Um, it's what I've been told is a vivacious cyst.
36:03When Alan said he had a vivacious cyst, I was expecting something quite lively and sort
36:09of obvious.
36:10And it was quite obvious, so it's not a bad description.
36:14I've had it checked numerous times just to make sure it's not turning into anything else.
36:18Okay.
36:19They've always said, no, it's fine.
36:20But, obviously, it's classed as cosmetic, so.
36:23Okay.
36:24I'm getting married in three months' time.
36:26Congratulations.
36:27And, thank you.
36:29The wedding photos is now a big thing.
36:32Okay.
36:33With getting married, obviously, there's going to be a lot of photographs.
36:36My partner likes photographs.
36:39Um, and I tend to try and keep it out of pictures, which I don't want to do that.
36:44So, as well as doing it for myself, I'm doing it for her, just so I can relax on my wedding
36:48day and have some nice pictures and create some nice memories.
36:52How long have you had it for?
36:53About seven years.
36:55Okay.
36:56So, what I would like to do is come over, have a little look at it, decide what it is,
37:02and then we will decide, um...
37:04I have a little needle phobia.
37:06That's the only thing that's sort of bothering me.
37:08Oh, okay.
37:09Yeah.
37:10If you've got a needle phobia, how have you managed to have your tattoos?
37:12Because you can't really see the needle in a tattoo gun.
37:15What if I tell you we're going to do a tattoo?
37:17Yeah, that's fine.
37:18Yeah.
37:19We'll treat it as a tattoo.
37:21People always say to me, but you're covered in tattoos.
37:24There's a difference.
37:25There's a big difference.
37:27Take your top off.
37:28Yeah.
37:29Let's have a look.
37:31So, we've got...
37:34It's very soft, actually.
37:36Yeah.
37:37Before I had the lump, I was quite a confident person.
37:40I find myself wearing t-shirts with collars on now just to try and cover it up.
37:45So, it's very soft.
37:47Yeah.
37:48Seven years of a cyst, normally they go a bit harder.
37:51Right, okay.
37:52So, it's never been infected before.
37:53No.
37:54We can treat you today.
37:55Okay, brilliant.
37:56So, that's...
37:57That's brilliant.
37:58Good news.
37:59Very good.
38:00Can I take some pictures?
38:01Yeah, come around.
38:02And then we'll show you what we're going to do.
38:03Okay.
38:04So, when a cyst is soft, sometimes it means that there's a lot of fluid in there.
38:10So, you really don't want to burst it because it's going to go everywhere.
38:13It makes the whole procedure dirty and really difficult to make sure that that cyst is fully
38:19removed.
38:20Right.
38:21That's where your cyst is.
38:22Yeah.
38:23So, we'll be putting local anaesthetic in around there.
38:26Can you see the sort of natural lines on your neck are going sort of that way?
38:30Okay.
38:31So, we'll hide it, put a line there.
38:34Right.
38:35So, that's the scar that you're going to have.
38:36Okay.
38:37All right?
38:38Yep.
38:39Happy with that?
38:40Yeah, yeah.
38:41Perfect.
38:42Good.
38:43Well done.
38:44Right, sir.
38:46So, just don't look and I'll pop some local anaesthetic in.
38:54Sharp scratch coming up, okay?
38:57How are we doing there?
38:58Yeah, that's fine.
38:59Coping?
39:00Sure you're all right?
39:01Yeah.
39:02What do you do as a living?
39:03I'm a chef.
39:04So, what's your best meal?
39:05Your favourite meal?
39:06I'd say steak and ale pie.
39:08Ah.
39:09Steak and ale pie.
39:10Yeah.
39:11And you make that fresh on site?
39:12Really?
39:13Yeah, we make pretty much everything.
39:14Will you tell me your recipe?
39:16No, it's a secret.
39:19Often, you tend to find that people are very worried about needles.
39:25So, it's a very natural thing to get them to take their mind off it by talking about anything else.
39:31Let me know if you feel any pain at any point, all right?
39:34Okay.
39:35Well done.
39:36Are you feeling anything?
39:37Nothing at all.
39:38Really?
39:39Well done.
39:40Okay.
39:41Just a bit fiddly now, okay?
39:42Okay.
39:43Okay.
39:44Okay.
39:45So, in the neck, there's lots of nerves.
39:46The most important of the nerves is the accessory nerve here, exactly where his cyst was.
40:01If you cut it, he'd be unable to move his shoulder and that would affect his work.
40:07So, it's quite a serious complication of something that is not cancerous.
40:12Lots of pulling.
40:13Sorry.
40:14And are you hearing a little bit of a snip-snip-snipping going on?
40:17Yeah, yeah.
40:18Sorry about that.
40:19It's all right.
40:20It was like a hairdresser's and they're snipping very, very fast.
40:25That's the only way I can explain it.
40:27Yeah, it's very strange.
40:29And it's come out like a...
40:44Oh, like a walnut.
40:47Have you ever had a cyst pasta?
40:50Oh, yuck.
40:52It would probably spread on toast quite nicely.
40:54Oh, yuck.
40:55On a scone.
40:56Stop it.
40:57Yeah.
40:58When Dev talks about food and cystic matter, it just turns my stomach.
41:06I think they were quite gross suggestions, so my apologies.
41:11Do you feel OK?
41:12Yeah, fine.
41:13Yeah.
41:14You can turn your head.
41:15Yeah, that's...
41:16OK?
41:17It's gone.
41:18It's quite strange.
41:20Your friend for life is gone.
41:22Yeah, I know.
41:23I really wanted to see the cyst after I'd been attached to it for so long.
41:28I wanted to see actually what it was.
41:30There we go.
41:31You know, you can have a squeeze of that.
41:33There we go.
41:34You like that, don't you?
41:35That's brilliant.
41:36I've been wanting to do that for years.
41:37For years.
41:38It kind of reminded me of a bit of cheese spread.
41:39What was inside.
41:40Yeah.
41:41So, I'm going to show you your pictures.
41:42OK.
41:43All right.
41:44That's what we said we would do.
41:45Yep.
41:46And that's what it looks like now.
41:47Oh, wow.
41:48So, can you see?
41:49It will just fit into the natural lines on your neck.
41:51And that's it.
41:52All right?
41:53I feel quite emotional.
41:54It's...
41:55Yeah.
41:56No, it means a lot.
41:57Do you?
41:58Yeah, it means a lot.
41:59Yeah.
42:00Good.
42:01Because of the wedding and the photos.
42:03Yeah.
42:04You won't have a lumpy neck.
42:05Yeah, exactly.
42:06Now I know I can marry my partner without having to worry about photographs is a massive, massive
42:25relief.
42:26So, yeah, it was quite an emotional moment to see it.
42:30Very grateful for what Dr. Dev did.
42:34Yeah.
42:35Excellent.
42:36Thank you very much.
42:37All right?
42:38Yeah, I really appreciate what you've done.
42:39Look after yourself.
42:40Yeah.
42:41Take it easy.
42:42I will.
42:43And congratulations and hope the wedding goes well.
42:44All right?
42:45Thank you very much.
42:46Yeah.
42:47Take care.
42:48Bye.
42:49Bye.
42:50So, I'll be leaving feeling a completely different person today.
42:51I'm now going to walk out them doors and I'm going to show the world my neck.
42:56I have nothing to hide.
42:57Just a tiny little scar, which is amazing.
42:59Absolutely amazing.
43:00Absolutely amazing.
43:01Now, did he say it was a vivacious cyst?
43:05Yeah, yeah, yeah.
43:06Because I liked a vivacious cyst.
43:09You're certainly vivacious.
43:11Healing really nicely, but unfortunately, I managed to stand on them the other day, so they
43:26are still a little bit wonky.
43:28I think I've healed really well.
43:35I'm just left with a neat scar now.
43:38And it means I can now wear these kind of clothes with my back showing with far more confidence.
43:43So, thank you Skin A&E.
43:44I'm happy to be Miss Endurance 2021.
43:58And I'd like to say thank you to Dr Natalia.
44:02I'm really, really appreciative.
44:03Short sleeves, as you can see, me and my future wife have got lots to look forward to.
44:17From this point on, it will be short sleeves all the way.
44:20Next time on Skin A&E.
44:23Oh, wow.
44:24Wow.
44:25Is it a difficult one?
44:27There's just bits everywhere.
44:29I had to keep digging to find it.
44:31I was hoping it would just pop out, but it actually was a bit more tricky.
44:36The main concern we had is trying not to damage the nerves.
44:42An ex-government agent can't leave his past behind.
44:45Alan Cummings stars in Instinct.
44:47Seasons 1 and 2 streaming now on 5.
44:49Next, Car Pound Cops.
45:01Hold on.
45:03Please are letting me know if you're not here in a video.
45:07Let me know if you're not here.
45:08Once, I'm ready.
45:09Thanks.
45:10You're welcome.
45:11How to reach out.
45:12You're welcome.
45:13I knew it's a bit too.
45:14I knew it was the first time in the comments section.
45:15I'm happy to be with you.
45:16I'm happy too.
45:18A better time.
45:19If you're not here, I'm really not here.
45:21I want to be with you.
45:22I'm sorry, ain't it.
45:23I can't be asked.
45:24You're not here.
45:25Like, I'm happy to have a opportunity.
45:27I'm happy to run.
45:29I'll never forget.
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