Surgical Dermatology

 

Surgery is generally used for many benign and malignant growths. There are a variety of surgical techniques for benign lesions, such as the minimal incision punch excision or a shave removal, but for malignant tumors, it is wise to do a complete excision with clear surgical margins. Mohs surgery is a specialized type of surgical excision where the tumor is removed in layers only where needed, thus sparing the removal of normal tissue and making the eventual residual skin defect smaller.

Skin surgery also involves a component of plastic surgery. When a malignancy is removed, the defect left may require a flap closure (moving tissue from other areas) or a graft (removing skin surgically from another area and “patching” the defect). Dr. Mehrabi is a Board Certified Dermatologist and is trained for these types of dermatological surgery. Below is additional information on different types of surgical procedures. The information on this site is provided solely for educational purposes and should not be used as a substitute for medical assessment by a professional physician or dermatologist.

 

Surgical Excision

Most skin cancers can be excised with regular elliptical surgical excision and closure. Both Basal Cell Carcinomas and Squamous Cell Carcinomas can be cut out in the shape of a football and closed into a simple line, both on the face and the body. The cancer is taken out with 4-5mm margins of healthy normal skin around the tumor in order to ensure clear margins verifying that the tumor is completely out. Surgical excision is also appropriate for removal of atypical nevi and some benign growths. Cure rate for most surgical excisions are above 95%.

 

Mole Removal

Mole removal can be accomplished by shave removal, punch removal, surgical excision, and laser. Removing a mole on the face for cosmetic purposes must be done carefully as the resulting scar will depend on the technique used, the type of mole (raised vs flat), the size of the mole, the exact location of the mole, and the skin color of the patient. For smaller and flatter moles, a punch excision is usually the best technique utilizing a small hole punch and 1-2 stitches, and will result in a small line scar. For larger or raised moles, a punch technique can be used, but may result in pouching of the edges. Surgical excision an option where these pouches are removed automatically and reserved for the larger moles. A shave removal may be considered in this case as shaving the mole flat will likely result in either a white/dark flat scar that may be unnoticeable over time. The main disadvantage of doing this is that there may be remaining mole cells in the flat portion of the scar that could result in repigmentation of the scar. Independent of technique is the possibility of undesired scarring due to the healing process, a variety of external factors, and skin color (darker skin color results in more noticeable scarring).

Laser mole removal is a very contentious subject amongst dermatologists. Theoretically it is not wise to laser any mole as you must be sure it is not melanoma before simply firing a laser at it. While this point is obvious, many nevi are apparently benign by every clinical measure and using a laser to remove a flat, small, perfectly symmetrical and unsuspicious mole may be fine.

It is imperative to discuss all possible mole removal possibilities with your dermatologist in order to determine the right procedure for you. Knowing the different removal options and understanding the scarring risk are essential to making a decision to remove your unwanted mole.

 

Liquid Nitrogen Cryotherapy

Liquid nitrogen cryotherapy is a destruction method using liquid nitrogen to freeze, or essentially “frostbite”, the diseased tissue to get complete destruction of the tumor/growth and allow replacement healing with normal tissue to occur. This treatment can be used for some superficial cancers (Squamous Cell Carcinoma in Situ), but is primarily reserved for benign growths (warts, molluscum contagiosum, seborrheic keratoses, lentigos) and precancers (actinic keratoses). The advantage of this treatment is that it is fast and can be used to destroy multiple lesions quickly with just a minor scab. The disadvantages of cryotherapy include hyper and hypopigmentation, scarring, blistering, and pain.

 

Electrodessication and Currettage

Elecrodessication and currettage (EDC) is a method by which the tumor is “scraped” out with a currette and then “burned” with electrocautery to cause further destruction and prevent bleeding. This technique can be used for superficial Squamous Cell Carcinomas and Basal Cell Carcinomas. This technique can be used for treatment of molluscum contagiosum as well, although treatment with cantharone or liquid nitrogen is usually preferred. The cure rate of EDC is around 83-85% and is very dependent on the dermatologist’s experience with this technique.

 

Mohs Micrographic Surgery

Mohs surgery is a specialized method of skin cancer excision using a tissue-sparing technique developed in the 1930s by Dr. Frederic E. Mohs that allows intraoperative assessment of 100% of the peripheral and deep tumor margins prior to wound closure.

The cure rate with Mohs surgery approaches 99% in most cases. Click here to read more about Mohs surgery.

 

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