Cancer of the Skin (Mohs Surgery, Reconstruction)

Written by Dr. Julian De Silva
Dr. De Silva always advises to be safe when it comes to lesions on your face, removing a lesion usually warrants sending for microscope analysis to determine the cause of the lesion. Although often the lesions are thought to be moles it is have them analysed as 2-3% turn out to be something else.

The Moh’s technique is a specialized way of removing skin cancer where the least amount of non-cancerous tissue is excised, while allowing for all the microscopic cancer cells to be removed. It is performed by detailed mapping and onsite microscopic exam of the removed skin. The defect is immediately reconstructed to allow for the most aesthetic outcome. The Moh’s technique allows for a 95% cure rate and is the procedure of choice for many of the skin cancers.

There are many types of skin cancer, but the most common are basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal cell is the most common type of skin cancer and often found on the face. It usually presents as a raised red or brown lesion with pearly borders that raised and ulcerated and bleeds easily. They are the most common type representing 80% of all skin cancers.
Squamous cell carcinoma is often found on the hands and arms and eyelids. It presents as a rough flaky red or pink patch of skin, comprising 16% of skin cancers.

Melanoma is the most dangerous form of skin cancer. It presents as a dark mole that has changed appearance, by involving any or of the following: asymmetry (if split in half one half is different then the other), irregular, not smooth border, color changes within the mole, and a diameter greater than a pencil eraser. If not detected early this cancer may metastasize and could lead to death. Most cancers are treatable if caught early. Regular skin exams minimizing sun exposure and always wearing sunscreen are the best prevention.

Lumps & Bumps Removal and Repair

There are a variety of different lumps and bumps that can occur in the skin. The most common of these are moles, cysts, small white lumps (milia), enlarged oil glands (sebaceous lesions), red bumps (haemangiomas: collection of blood vessels) and fibrous papules). Often it is difficult to be absolutely sure what is the cause of lump unless it is removed and assessed under a microscope. Lumps and bumps on the face are often unsightly and can be cosmetically disturbing to the patient. Removal of these lumps requires meticulous assessment and planning, to ensure that the removal avoids any hallmarks of surgery and no scar.

Moles are spots or irregularities found within the skin, medically they are termed a naevus or naevi. They come in various forms and sizes and could be flat, raised, dark (pigmented) or light in colour (non-pigmented). These lumps can appear anywhere on the body and may be cosmetically disturbing to the patient on the face. They can be present at birth, and often enlarge over teenage years. Moles are bothersome to some people and can even lead to dangerous health risks if they start growing during adult life when they may be cancerous (termed malignant melanoma). If one has many moles on the face or body or any of them are changing form or color a Dermatologist should perform regular checks on them. Mole removal, whether by laser or other surgical approaches is a cosmetic surgery procedure that provides a solution to getting rid of unwanted lesions on the face or elsewhere.

What is Cleansing (woman's face)

Lump Removal Assessment

A skin lump removal workup involves a thorough assessment and decision whether the lump should be removed given the location on the face, the size, the unsightly cosmetic nature of the lump, or if the lump possesses other attributes that would suggest a malignancy. That is also why Dr. De Silva sends removed specimens for pathological evaluation to ensure that the lump is not cancerous. Dr. De Silva uses in some patients his own technique including the use of wrinkle injection a day or a week before lump removal in many cases in order to limit “stretch back” of the skin that can compromise the aesthetic result. The removal of a lump on the face requires careful planning and design, the pattern of the removal is based on how collagen bundles align on the skin (so-called relaxed skin tension lines) to avoid unsightly scarring. Dr. De Silva performs every lump removal using microscope loupe magnification for ultimate precision and multi-layered wound closure, he relies on buried, dissolvable sutures to further limit stretch back in the coming months during healing that can lead to scarring. The use of slightly eversion of the wound edges using the final layer of stitches avoids skinning inwards of the wound edges that can lead to a depressed skin edge. Dr. De Silva only removes lesions in fully CQC accredited surgical facility, to minimise adverse events and ensure maximum quality of care. At present Dr. De Silva is only able to remove lesions and lumps in combination with other procedures including blepharoplasty, rhinoplasty, face and neck lifting.

Lump Removal Aftercare

Lump removal aftercare requires meticulous follow up to ensure a hidden scar that avoids scarring (elevated, depressed, darkened or lightened area of skin). All patients are reviewed after 1-2 weeks when stitches are removed. For some patients a combination of non-invasive laser therapy to modulate the scar and/or anti-inflammatory medications to reverse the tendency toward scarring. Subsequent to the lump removal, sometimes a modified mechanical dermabrasion is used to blur the visibility of the incision edges. Careful follow-up for the entire first year helps ensures you the best outcome following your lump excision.

Scars - female model

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