What you should know about skin cancer removal

What is a skin tumor?

The cells of the skin change with age and after intensive sun or UV irradiation. Certain changes in the genetic material can lead to uncontrolled cell proliferation. The external appearance of the skin change in question does not always allow an exact assessment of whether the skin appearance is good or malignant. In the case of benign changes, the cells remain in the compound; in the case of malignant changes, the cells scatter in the body and form metastases. The histological examination of the removed skin area offers the greatest possible certainty in distinguishing between benign and malignant skin changes.

Common benign skin tumors are:

  • Mother moles (nevus cell nevus) are an accumulation of pigment cells of the skin. Certain properties may indicate a malignant change (ABCDE rule: A for asymmetry; B for limitation; C for colour; D for diameter; E for development).
  • Blood sponges (hemangiomas) are vascular malformations.
  • Feuermale (Naevus flammeus) are flat vascular malformations that are already present at birth.
  • Xanthelasma are cushion-like fat deposits in the area of the upper and lower eyelids, occasionally an expression of a fat metabolism disorder. They are harmless, do not cause any discomfort, but are perceived as cosmetically disturbing.
  • Stielwarzen (Fibrome) are a growth of cells of the connective tissue.
  • Age warts (seborrhoeic keratosis) are a growth of horn-forming cells.
  • Warts are growths of epithelial cells that can be caused by viruses and are therefore contagious.


Frequent malignant skin tumours are:

  • White skin cancer (basalioma) is a malignant proliferation of skin cells in the basal layer of the epidermis. Tumour metastases are very rare (0.0028-0.55 %).
  • Black skin cancer (malignant melanoma) is a highly malignant proliferation of pigment cells of the skin.
  • Light skin cancer (squamous cell carcinoma, spinalioma) develops from cells of the epidermis. It can destroy the surrounding tissue and also form tumour metastases.

How is a skin tumour removed?

The procedure is performed under local anesthesia, twilight sleep or general anesthesia as required. For local anaesthesia, either the skin in the operating area is anaesthetised or the nerve that supplies the operating area is specifically anaesthetised. During a twilight sleep you will also receive sedatives and painkillers via the bloodstream. The skin is injected with an adrenaline solution for an optimal gentle surgical technique and to minimize blood loss. The visible skin change is cut spindle-shaped. Smaller vessels are sclerosed with the bipolar technique. Benign skin changes that can be easily separated are then closed.

In the case of malignant skin tumours, surrounding healthy tissue is also removed in order to increase the safety of complete removal. The rim, in which no visible tumour tissue is visible, is called the safety margin and can be up to 2 cm. For certain malignant skin tumours, the removal of sentinel lymph nodes may be recommended. Methylene blue and/or radioactive technetium is used to visualize these lymph nodes. Correspondingly marked lymph nodes are removed for histopathological examination. Malignant skin changes that cannot be clearly defined are initially only connected sterile. The wound may remain open until the final result of the tissue examination is available. Only when it is certain that the tumour has been completely removed is the wound closed in a second procedure. Ideally, very fine sutures and an optical magnification are used. The wound edges are gently and precisely adapted so that the wound heals as inconspicuously and quickly as possible. Depending on the size and location of the tumour, the operation can be performed on an outpatient or inpatient basis. Local flap plastic surgery (local tissue displacement) is often necessary to close the wound.

How are wounds closed?

In a normal healing process, wounds tend to heal themselves. Replacement tissue is formed, which over time is transformed into scar tissue. The scar tissue contracts and can lead to a cosmetically and functionally unsatisfactory result. Depending on the initial findings, the wound can take months to heal or fail to heal. As long as the wound is not closed, germs can colonize the wound and lead to inflammation. A wound closure should accelerate healing and make it more difficult for germs to penetrate the body. Wounds differ with regard to the affected body regions, the healing process, the size, the causes and the risk of inflammation. There are therefore different techniques for restoring the body surface. The choice of the method depends on the personal ideas of the patient, the characteristics of the wound and the general state of health.  A sterile or low-germ wound is a basic prerequisite for surgical wound closure. Superficial wounds with a well supplied with blood wound bed are in principle suitable for skin transplantation. There are essentially two types of skin transplantation which differ according to the layer thickness of the skin transplant. A thin-layer graft (split skin) has a lower resilience, a greater tendency to shrinkage and a noticeably different shade. In comparison, a thicker skin graft (full skin) is more resilient and elastic. The shade depends, among other things, on the part of the body where the skin was removed. Deep and large wounds can be closed by shifting adjacent tissue (flap plastic). Due to the thickness of the tissue and the proximity to the wound, flap plastic surgery is characterised by a high resilience and elasticity as well as a favourable cosmetic result. In order to be able to move the adjacent soft tissue of the skin, it must be loosened. This inevitably results in further scars and smaller vessels and nerves are injured.

How can you prepare for the procedure?

  • All your questions about possible complications and alternative treatments should be answered in advance.
  • Keep nicotine and alcohol consumption to a minimum!
  • If necessary, take hormone-containing medication (the pill) temporarily.
  • Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least 10 days before the operation after consultation with your doctor.
  • Vitamin preparations (A, E) and food supplements (omega-3 fatty acids, St. John's wort preparations, etc.) must be discontinued at least 4 weeks before the operation.
  • Surgery limits the ability to travel by air. Therefore, do not plan any professional or private air travel during the 6 weeks after the operation!

How is the procedure performed?

  • First, the suspicious tissue is removed, usually on an outpatient basis and under local anaesthesia.
  • Until the histological examination confirms the complete removal, the wound is dressed with a special bandage.
  • The duration of wound closure depends largely on the complexity of the wound (20 minutes to 4 hours).

What do you need to keep in mind after the procedure?

  • After the outpatient removal of the skin change, driving a car should be strictly avoided due to possible medication.
  • The skin threads are removed after 7 to 14 days according to the affected body part.
  • Showering is possible immediately before the wound control on the 3rd postoperative day.
  • Scar care (scar massage, sun protection, silicone overlay) from the 3rd postoperative week onwards helps to create inconspicuous scars.
  • Sport, saunas, swimming, heavy work and sunbathing should be avoided for at least 4 weeks.
  • Postoperative clinical check-ups are recommended on the 3rd postoperative day and after 1, 2 and 6 weeks.
  • After removal of skin cancer, regular follow-up care by the dermatologist is recommended every 3 to 6 months.

Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

 

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