SURGERY OF SKIN TUMORS Posted in: Reconstructive Surgery

It is very convenient to read and re-read these instructions, and to find answers to many of the doubts and questions that are often made about plastic surgery of lesions in the skin that we call “tumors”.

SQUAMOUS CARCINOMA OF ROOT OF NOSE, RECONSTRUCTED WITH A FOREHEAD FLAP

It is impossible to include in this small space all the possibilities of superficial lesions that occur in the skin, but I will just describe the most common tumors and skin lesions I’ve seen in my years as a Plastic Surgeon.

Warts and Moles

Warts are small skin lentil-like protruding in the neck and nape of the neck. There are problematic, but they grow or multiply and often annoy the patient when they are touched by chains al necklaces on the neck, or by turtleneck shirts. They are viral, and get inoculated by ourselves, when we are in contact with something that is contaminated by another person, such as money, dirty hands, wet surfaces in the sinks of the bathrooms, etc.. With the scratching of nails, you plant more viruses in new places, and warts multiply all over your neck. Sometimes your couple or family members can pass on these viruses. Most of them are of unknown origin, thou.

They require a method I call shaving  and electro fulguration. It is virtually painless and only requires anesthesia by cooling with a spray or with local anesthesia with xylocaine. Once eradicated, maintaining proper hygiene and avoiding scratching, they do not come out again.

In people over 40 years, which once were a light brown spots or freckles in childhood, become brown plates slightly raised the level of the skin in adulthood, which we call seborrheic or senile keratosis.

The treatment is with the same process: shaving and fulguration, and usually leave no trace.

Moles are called “nevi” (singular: “nevus”). These nevi are black in color, usually noticed since childhood and finding them anywhere on our skin. They are benign, and can only grow over the years, increasing both in length and size, such as getting more brawny and fleshy.

There are moles with hairs, and sometimes they can be very large. Unfortunately, a child may be born with giant hairy nevi, and this variety is dangerous because of the high percentage of malignancy. We must act and operate as soon as possible, resecting it as completely as possible.

There are other blue nevi and unfortunately they can also become malignant, so it must also operate them as soon as possible after they appear.

Condyloma (Cauliflower Wart)

This type of wart is a small lesion made of clusters of small cauliflowers-like moles, appearing in the fingers, near the edges of the nails, and phalanges of the fingers; they could appear elsewhere in the body, including genitalia.

Are viral in origin, too and can also be spread from person to person and be present in more than two in the same person.

I like to use shaving and electro fulguration also because it is a method that completely removes the tumor.

It should be emphasized that a electrodessication or fulguration in the dorsum of a phalanx of a finger, is very sensitive issue, because lightning can over-expose the tendon of the finger and later on produce an infection that would aggravate the case.

That’s why I recommend a Plastic Surgeon for removal of condylomas. Usually use spray cooling as anesthesia and treatment takes 5 to 10 minutes.

Sebaceous cysts

We call sebaceous cyst to little skin bags, which accumulate within a cheese-like substance, occurring in the skin of the face, behind the ears, back, or chest. Little balls are hard, they bother by their size, and give an unpleasant appearance when in the face. They can grow to larger sizes, and usually if they pop out they can return again. The treatment is surgical, and we remove them with their entire capsule, to avoid reproducing again.

Anesthesia is the same: local and mostly painless and the procedure is performed in the office and takes about 15 to 20 minutes

Lipomas

Lipomas are fatty tumors. They are not malignant, but is an accumulation of fat, but this fat is not normal. They don’t pose a problem of health. I’ve noticed that do not grow very fast, however, treatment is exclusively surgical. They can show up in the face, neck, back, and elsewhere, and I have come to see very large lipomas. There are lipomas that are superficial, and others that are surprisingly under the muscles, even if they appear to be very superficial.

Treatment involves opening the skin and if necessary, muscle, fat and remove the abnormal tissue. This Is done under local anesthesia and requires an incision the size of the lipoma, and depending on the size and location, can be operated in a short stay clinic or my office, and recovery is about 10 days.

Basal Cell Cancer

Do not panic. Although his name is scary and merits caution, and although we are talking about a malignant tumor, this is a type of tumor that grows very slowly, and frequently sends no secondary tumor remote at distance (what is called metastasis). There are more aggressive varieties, which can be highly rapid in their growth, but are the exception.

These lesions are wet or dry, rounded, bean-shaped, infected or scab, which do not heal even though time passes, and ulcerate, bleed, hurt and smell bad. They occur in people over 50, 60. They go near the mouth, nose, and eyelids, and usually occur in people who are exposed to heavy sun environments.

Treatment is surgical; especially when after days or months do not show improvement by itself.

Treatment consists of complete resection of the tumor, sending the piece to pathologic diagnosis.

Generally, I like to call the Pathologist to be in-clinic, so we can make an intraoperative study, namely that during the same operation, examine the piece and tell me if I have completely removed the tumor, so rest assured that no tumor is left in the patient’s skin. Once notified of the results, I close the wound with confidence.

This can be operated on a short-stay clinic under local anesthesia, but in cases of cooperative patients, at the office. Many times the wound closure is simple, but sometimes we have to use some of the surrounding skin as a flap to slide and close a large gap, or place a graft taken from another part of your body.

  This is done under local anesthesia and IV sedation by an anesthesiologist. The stitches are removed in 7 days and the recovery is about 2 weeks.

Squamous Cancer Cell or Epidermoid Cancer

Not as common as basal cell, but is much more dangerous, because it is very aggressive, it grows faster, destroys more tissue and unluckily it can metastasize.

It presents almost in the same sites as basal cell cancer: face and near important structures such as mouth, nose, eyes, and when I suspect it may be a squamous cell cancer, I will consult the oncologist surgeon, for both diagnosis, and assisting in operation.

The prognosis depends on the degree of disease progression and to the extent and deepness of the tumor, and requires the cooperation of the pathologist and oncologist both in the operation and in recovery. This surgery should be performed in a hospital under general anesthesia, depending on the case.

Keratoacanthoma

It is a benign tumor that is sometimes confused with a basal cell, as it also appears as a pimple or non-healing ulcerative lesion, sometimes very remarkable, swollen and colored, and the only clue I have to suspect it, is that it presents a crater in the center, round, fleshy and pink or depending its degree of invasion, blackish.

Like the Basal, they are removed completely, and I also like to call for an intraoperative study, to be sure that this is the case with this tumor, and that it has been completely removed. I operate it under local anesthesia, according to the psychological attitude, health and age of the patient, with or without sedation by an anesthesiologist.

The stitches are removed in 7 days, and recovery is 14 days.

Melanoma

Melanoma is one of the most aggressive and malignant tumors it may be. It can appear in the extremities, feet, hands, and in any part of the body. They are dark black, and grow quickly, without causing more symptoms than their own growth.

Metastasize are very aggressive and frequent, and that is why we must indicate aggressive surgery as soon as possible, and the management with the surgical oncologist. These tumors may require much more elaborate reconstructions.

We recommend general or epidural anesthesia, and hospitalization.

Next, I present recommendations for an operation before and after the surgery except warts and mean:

BEFORE SURGERY:

Do not take aspirin or aspirin products for 2 to 3 weeks; please, click Medicines not recommended for more details. Wash your body part that is going to be operated very well once a day for three consecutive days before operation, with Isodine (Betadine in the US) foam.

Do not drink any water let alone eat meals or snacks from 12 midnight the night before surgery. Do not wear makeup the day of surgery, or nail polish, false eyelashes and earrings, necklaces, rings, etc.. Wear easy clothes and comfortable shoes. If you get a common cold, call the office before.

If you have any questions, call us within office hours is from 10am-8pm, at Tel: (664) 684-25-51.  Or US: 619-730-1917. We work from Monday through Friday.

AFTER SURGERY:

Go straight home and stay in bed for 24 to 48 hours. You can get up to the bathroom and three meals. If you have no discomfort or nausea, you can eat normally.

Avoid the sun, hot meals, hot baths or hot environments to be close for a week.

Put crushed ice into a bag and wear them in operated areas 15 minutes every 4 hours. Usually patients do not complain of any pain, but if it happens, take your pain medication as indicated. You can have a shower as normal until I indicate you over the phone.

Do not expose yourself to blows, however slight in degree. Take your medicine as you were instructed. You cannot drink alcohol during this treatment. Typically you are asked to come back to the office by the 6th and 15th days and thereafter every 15 to 30 days.

In cases of skin tumors, is my custom to see you then every 6 months for several years to be sure that the tumor had no recurrence.

Any questions or emergency, let me know as soon as possible, day or night, at the above telephone or my cell 044-664 – 283-0976 and we will assist you.

To see some pictures of these surgeries, please click Photo Gallery

Any doubts about this surgery, please call the office, 684-2551  (US: 619-730-1917) or my cell 664-283-0976. We wish you a speedy recovery and an excellent experience with your esthetic lid surgery, send an email or click Contact us for more information

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