SKIN CANCER AND DERMATOLOGIC SURGERY
Dermatologic surgery comprises minimally invasive surgical procedures which deal with the management of alterations to the skin and related tissues (glands, nails, hair), not responsive to treatment with medication. Dermatologic surgery is mainly performed on an outpatient basis – no hospital stay and the patient is discharged shortly after the treatment – under local anaesthetic. There are many different reasons for dermatologic surgery:
- excision of benign skin lesions: naevi (moles), seborrheic keratosis, warts, and angiomas. These skin lesions are excised because of trauma, itching or for cosmetic reasons;
- excision of pre-cancerous skin lesions, i.e. lesions which are at risk of becoming malignant: actinic keratosis. These are excised as a preventative measure;
- surgical biopsy of suspect skin lesions, whose diagnosis could not be defined following a clinical examination;
- excision of malignant skin lesions (skin cancer): basal cell carcinoma, squamous cell carcinoma, melanoma;
- excision of subcutaneous (under the skin) lesions: cysts, lipomas and xanthelasma. These are removed as they may get inflamed, cause discomfort or for cosmetic reasons;
- treatment of congenital or acquired conditions such as correction of phimosis with circumcision and/or frenulum lengthening, split earlobe repair and treatment of ingrown toenail with lateral onychoplasty (eversion of skin around the nail) to prevent recurrence;
- scar revision: this is performed on surgical or post-traumatic scars which, due to problems during the healing process, became anti-aesthetic and functionally impaired (e.g. retraction or adherences).
Benign superficial skin lesions (seborrheic keratosis, warts and angiomas) usually undergo laser treatment. Some lasers eliminate superficial skin layers, others are absorbed by specific tissues ( e.g. blood vessels) and destroy them. No stitches are used in these cases.
Deeper benign skin lesions and malignant lesions are removed by removal of a full-thickness ellipse of skin. If the resulting defect is small, it can be closed with a suture: direct closure. If the defect is larger, it can be repaired by transplanting skin from a distant donor site: a graft, or by rearranging the neighbouring skin: a flap.
Subcutaneous lesions are removed, either by incising the overlying skin or removing an ellipse of skin incorporating deep tissues, on a case-by-case basis. In most cases the removed samples are sent for histological examination, which is used for the final diagnosis.
Skin lesion excision and reconstruction aims to achieve complete removal, keeping scarring to a minimum and re-establishing the normal anatomical configuration at the operation site. Therefore, although dermatologic surgery is minimally invasive, it is critical to perform it applying the basic principles of plastic surgery. Incisions must be planned and oriented in such a way as to minimise tension on wound edges. Additionally, scars are hidden in shadows, running along grooves and wrinkles.
The fact that dermatologic surgeries are minimally invasive and require only local anesthesia improves both patient safety and reduces the all-important “downtime” and recovery period.