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Tristan de Chalain Limited
Private Service, Plastic Surgery
Skin Lesions
Skin lesions can be divided into two groups:
- benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
- malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. It is best to remove them before they get too big to avoid a bigger operation or before they damage a vital structure e.g. eyelid.
Melanoma is a serious skin cancer that can spread to other parts of the body if allowed to go untreated. Urgent removal is recommended. Even though melanoma has a nasty reputation, if it is removed before it has grown 0.75 mm into the skin from the surface, it is usually completely curable. Hence the need to have early diagnosis and surgical treatment.
Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches.
Small tumours can be excised and closed directly. Large ones will leave big gaps in the skin after removing a safety margin of 4mm around the edges. In this situation a skin graft or skin flap repair is needed . On the face we try and use flaps of adjacent skin to repair cancer defects as the appearance is much better due to good colour and skin texture match. If a suitable flap cannot be devised then a full thickness skin graft is taken from behind the ear or sometimes from infront of the ear or from the lower neck depending where loose /surplus skin is available.
With difficult or extensive invasive tumours we often get a pathologist to come along and check the tissue from the margins of the excision at the time of surgery . This is called a 'frozen section' technique as the samples are frozen, sliced, stained and checked for tumour while we wait. Getting clear margins this way is very reassuring. A similar method is Moh's micrographic surgery where the margins and under surface of the tumour are all checked. We apply a waterproof dressing. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.
Small tumours can be excised and closed directly. Large ones will leave big gaps in the skin after removing a safety margin of 4mm around the edges. In this situation a skin graft or skin flap repair is needed . On the face we try and use flaps of adjacent skin to repair cancer defects as the appearance is much better due to good colour and skin texture match. If a suitable flap cannot be devised then a full thickness skin graft is taken from behind the ear or sometimes from infront of the ear or from the lower neck depending where loose /surplus skin is available.
With difficult or extensive invasive tumours we often get a pathologist to come along and check the tissue from the margins of the excision at the time of surgery . This is called a 'frozen section' technique as the samples are frozen, sliced, stained and checked for tumour while we wait. Getting clear margins this way is very reassuring. A similar method is Moh's micrographic surgery where the margins and under surface of the tumour are all checked. We apply a waterproof dressing. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.
