Cancer of the Skin (Mohs Surgery, Reconstruction)

Cancer of the Skin (Mohs Surgery, Reconstruction)

Written by Dr Julian De Silva

Dr De Silva always advises it is better to be safe when it comes to lesions on your face. Removing a lesion usually warrants sending for microscopic analysis to determine the cause of the lesion—and although lesions are often thought to be moles, 2-3% turn out to be something else.

Moh’s Technique

The Moh’s technique is a specialised way of removing all the microscopic cells in skin cancer while ensuring the least amount of non-cancerous tissue is excised. It is performed by detailed mapping and onsite microscopic examination 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 skin cancers.

Types of Skin Cancer

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 are raised, ulcerated and bleed easily.

They are the most common type representing 80% of all skin cancers.

Squamous cell carcinoma is often found on the hands, arms and eyelids. It presents as a rough flaky red or pink patch of skin and comprises 16% of skin cancers.

Melanoma is the most dangerous form of skin cancer. If not detected early this cancer may metastasise (spreads to other sites in the body) and could lead to death. It presents as a dark mole that has changed appearance in the following ways:

  • asymmetry (if split in half, one half is different than the other)
  • irregular—not smooth border
  • colour changes within the mole
  • a diameter greater than a pencil eraser I

Most cancers are treatable if caught early. Regular skin examinations, minimising 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 on the skin. The most common of these are moles, cysts, small white lumps (milia), enlarged oil glands (sebaceous lesions), red bumps (haemangiomas: a collection of blood vessels) and fibrous papules.

Often, it is difficult to be absolutely sure what the cause of a lump is 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 if they are on the face. They can be present at birth, and often enlarge over the teenage years.

Moles are bothersome to some people. They can lead to dangerous health risks if they start changing during adult life when they may be cancerous (malignant melanoma).

If one has many moles on the face or body or any of them are changing form or colour 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 a decision whether the lump should be removed given:

  • the location on the face
  • the size
  • the unsightly cosmetic nature of the lump
  • 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 the lump is not cancerous.

Dr De Silva uses his own technique for excising the lump in some patients, which may include the use of wrinkle injections before lump removal 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 relying on buried, dissolvable sutures to further limit stretch back in the months during healing that can lead to scarring.

The use of eversion to the wound edges using the final layer of stitches avoids contracting of the wound as it heals, which can lead to a depressed skin edge.

Dr De Silva only removes lesions in a fully CQC accredited surgical facility, to minimise adverse events and ensure the 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 elevated, depressed, darkened or lightened area of skin that can result from scarring.
  • 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 may be given.
  • 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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