The
skin in the largest organ of the human body. Its size
(about 20 square feet in an average sized adult) and
external location make it susceptible to a wide variety
of diseases, disorders, discolorations, and growths,
as well as to damage from the environment and the
aging process.
The severity and appearance of skin problems vary
considerably. Most can be removed or improved with
a minimum of pain and risk in a dermatologist's office.
Indications for Skin Surgery
Dermatologists cite four reasons for performing skin
surgery: 1) to establish a definite diagnosis with
a skin biopsy; 2) to prevent or provide early control
of disease; 3) to improve the skin's appearance by
removing growths, discolorations, or damaged skin
caused by aging, sunlight, or disease; 4) cosmetic
skin improvement.
A change in a mole can indicate a serious problem.
A dermatologist should be seen if a mole or skin lesion
becomes larger, changes color, or develops an irregular
border. Other warning signs include itching, crusting,
pain, and bleeding. Extensive and potentially disfiguring
surgery can often be prevented by prompt surgical
removal, by specialized freezing, by treatment with
chemicals applied to the diseased tissue, or with
the aid of a laser.
Types of Skin Cancer
There are two kinds of skin tumors, benign
(non-cancerous) and malignant (cancerous). Of the
three main types of skin cancer, the most common and
least serious is the basal
cell cancer. Typically, it appears as a shiny,
small lump on sun‑exposed areas of persons who
have spent a lot of time outdoors. Though the tumors
grow slowly, they can reach a very large size and
penetrate deeply if they are not treated. They may
often bleed, develop a crust, seem to heal, and then
bleed again.
Squamous cell cancer may show up as a lump or
red scaly growth. Untreated, squamous cell cancer
can spread and even cause death.
Malignant melanoma is the least common but most serious form of skin
cancer. It appears as a dark brown or black mole with
uneven borders and irregular color, in shades of black/blue,
red, or white. Malignant melanoma most commonly occurs
on the upper backs of men and women, and on the lower
legs of women, although it can also develop on the
face and other areas of the body. There is a rare
form of melanoma that occurs in families with atypical
moles. These individuals have many unusual moles,
some of which may need to be removed.
Treatment for Skin Cancer
Treatment for skin cancer varies according
to the location, extent, and aggressiveness of the
cancer and the patient's general health. In most cases,
the dermatologist will take a small piece of the abnormal
tissue called a biopsy. The tissue is examined under
a microscope by a dermatopathologist to determine
whether it is malignant.
Malignant tumors require more treatment such as curettage,
surgical excision; cryosurgery; Mohs microscopically
controlled surgery; topical chemotherapy; laser surgery
or radiation therapy. These can be performed in a
dermatologist's office or at an outpatient surgical
facility.
Curettage and electrodessication involve scraping
away the malignant tissue with a sharp surgical instrument
called a curette. An electrosurgical unit may then
be used to stop bleeding and remove a zone of normal
tissue.
Surgical excision involves cutting into the skin, removing the growth,
and then closing the wound with stitches.
Biopsy means to remove a small piece of the
skin for examination under the microscope and diagnosis.
Cryosurgery involves the use of a machine that sprays liquid nitrogen
directly onto the skin, or contacts the skin with
an instrument, which freezes the cancerous tissue.
Freezing can destroy cancer cells, and wound healing
will occur with minimal scarring.
Mohs surgery is a way of removing a tumor where each bit of tissue
is examined under the microscope to determine the
site and extent of malignant cells before more tissue
is removed. While the procedure is time consuming,
it yields a very high cure rate and is indicated for
recurrent tumors and tumors located in areas of high
risk for recurrence, such as on and around the nose.
Topical chemotherapy involves the application
of a chemical, 5-fluorouracil, which destroys precancerous
growths and sometimes cancerous tissue.
Radiation therapy can also destroy cancerous tissue
and is useful in certain types of skin cancer, as
well as in selected individuals for whom surgery is
not possible.
Improving the Skin's Appearance
Many blemishes that occur on the skin, such as
age or "liver" spots, birthmarks, moles,
warts, wrinkles, and scars, can be eliminated or at
least improved by an appropriate dermatological surgical
procedure.
Age or liver spots are large freckles which develop on sun-exposed
areas. They can be minimized by using a sunscreen
and respond well to treatment with chemical peeling,
cryosurgery, or laser removal.
Moles are common skin growths which are usually
small and tan or brownish, are sometimes raised, and
may occasionally change shape or color. Dermatologists
remove moles to improve appearance, to prevent the
mole from enlarging, or to prevent cancer. They are
usually removed by cutting.
Warts are caused by a virus and consist of piled up layers of skin.
Warts may develop on people of all ages anywhere on
the skin. Some warts require, cryosurgery, curettage,
electrosurgery, injections with chemicals, or laser
surgery.
Broken blood vessels on the skin can be eliminated by electrosurgery,
microinjection or laser surgery.
Scars resulting from acne, chickenpox, accidents, or previous surgery
may be improved by dermabrasion. The skin is frozen
with a spray medication, after which a high speed
rotary abrasive wheel is used to remove the outer
layers of skin and soften the irregular edges of the
scar. A substance containing collagen can be injected
into the skin which will fill in the
surrounding skin. Raised scars can be surgically
leveled or flattened with corticosteriod injections.
Any operation results in some scar formation; however,
a dermatologic surgeon places incisions so that the
resulting scar will be minimal. In addition, soft
tissue augmentation in the form of injectable collagen
or collagen-enhancers may raise depressed scars to
normal levels.
Wrinkles can be improved with dermabrasion, laser surgery, or topical
chemical peeling with dilute acids. These methods
can also be used on discolored skin, resulting in
a more youthful appearance.
Actinic keratoses are thick, warty, rough, reddish growths which appear
on the sun‑exposed areas of the body. They sometimes
develop into squamous cell cancer and are usually
treated with cryosurgery, curettage, dermabrasion,
laser, or chemical peeling to prevent the change to
cancer.
Seborrheic keratoses are raised, tan or brown growths. They often
become itchy and irritated by clothing. They may be
removed by cryosurgery or cutting.
Cysts are small closed sacs that contain fluid or solid material.
Infection often means that the dermatologist must
drain the contents and sometimes surgically remove
the cyst. The site may or may not be closed with stitches.
Baldness can be corrected by transplanting hair-bearing grafts or
strips from the back and sides of the scalp to balding
areas on the top or front. The dermatologist uses
a special knife to remove the hair, which is then
inserted into spaces on the bald scalp. There is a
three to six week waiting period between transplants
so that healing and new growth can take place. Within
six months, transplanted hair grows to one half inch
in length. Removal of large areas of bald skin by
scalp reduction will improve the balding area with
less need for hair transplants. This can be combined
with hair transplantation.
Unwanted Fatty Deposits may be removed by dermatologic
tumescent liposuction. This can be done as an office
procedure with local anesthesia, insignificant blood
loss and exceptional safety.
In the Dermatologist's Office
During
the patient's office visit, the dermatologist will
discuss the person's medical history, examine and
diagnose the skin problem, explain what could happen
if it is not treated, and then describe treatment
options and follow-up care. In most cases, the dermatologist
will select and carry out the appropriate treatment
procedure at that time. However, if the examination
indicates a likelihood of cancer, the dermatologist
may take a biopsy and schedule the patient for surgery
at a later date. Typically, consultations are required
before cosmetic surgical procedures are performed.
During the consultation, the dermatologist will explain
the procedure and how much discomfort, if any will
result, outline any postoperative restrictions, and
answer questions the patient may have. The patient
should always feel free to discuss any surgery and
its cost with the physician.
