Skin and soft tissue surgery refers to the surgical procedure which is performed in order to remove properly a skin lesion and restoring skin integrity giving the best possible aesthetic result. These lesions may be present at birth (congenital) or acquired over a patient’s lifetime (acquired). Also, they can be benign or malignant. Dr Karmiris will answer all your questions regarding the risk of your skin lesion and he will recommend you safe treatments, depending on your case.
Malignant skin tumors in general, are divided to non-melanocytic tumors [with the 2 major types being Basal Cell Carcinomas (BCC) and Squamous Cell Carcinomas (SCC)], as well as melanocytic tumors (malignant melanoma).
Basal Cell Carcinomas (BCCs) is the most common form of skin cancer and in most of the cases the easiest to treat. They originate and occur in the so-called basal cell layer of epidermis. Their proliferation is slow and they do not metastasize, except in rare cases. However, their removal is imperative since they spread not only to the skin but also into deeper layers and, therefore, the longer the delay in their treatment, the longer operation is required for surgical excision and reconstruction.
Occasional and long-term sun exposure are the most common causes of Basal Cell Carcinomas development. Body parts exposed to the sun such as face, neck and limbs are affected most often, although torso can also be affected. Patients with lighter skin tone are more prone to develop basal cell carcinomas, as well as people that have multiple sun burns due to periodic sun exposure. Finally, age (most often occurring after the 5th decade of life), heredity and immunosuppressed patients are more prone to skin cancer.
Any new or preceding lesion having a change on characteristics (color, size, fuzzy boundaries, bleeding) that did not exist before, requires examination from a Plastic Surgeon or Dermatologist.
Squamous Cell Carcinomas (SCCs) is the second most common type of skin cancer. Squamous cells are flat cells located near the surface of the skin that shed continuously as they renew. SCC occurs when DNA damage from ultraviolet radiation exposure or other damaging agents trigger abnormal changes in the squamous cells.
Squamous Cell Carcinoma starts out as a small nodule that grows relatively quickly presenting color changes, telangiectasia and as it spreads, it becomes necrotic with central ulceration. The lesion may be asymptomatic, unless you have one of the following alarming symptoms:
The main causes of squamous cell carcinomas are the following:
Malignant Melanoma is the most dangerous and aggressive form of skin cancer. Early diagnosis and treatment are of utmost importance for the patient. If not detected at an early stage, melanoma can metastasize and the treatment becomes more difficult and less predictable. Malignant melanoma is not as usual as the aforementioned skin cancers. However, it is more unpredictable and urgent to treat.
Most of the melanomas are tan or dark brown coloured, without however excluding the presentation of red, pink or even white naevi (amelanotic melanomas).
Predisposing factors include hereditary predisposition, UV exposure, skin type (lighter skin tone patients have higher predisposition for developing melanoma) and previous melanoma in the past.
Clinically, there is the rule of ABCDE (Asymmetry, Boarder, Colour, Diameter, Evolution) in order to self-evaluate any suspected lesion. However, if the patient has any doubts, he should visit an expert Plastic Surgeon or Dermatologist for examination.
Preoperative evaluation is performed based on your past medical history in combination with the preoperative assessment if general anaesthesia is required. At the same time, a detailed assessment of the pathology of the disease is performed, as well as detailed data regarding possible therapeutic approaches and indicated treatment, depending on your case.
Preoperative check includes mainly blood tests, chest X-ray, ECG or even more specialized tests, depending on the case, in order to ensure the safest treatment for you. Finally, preoperative check is completed following MDT (Multi-Disciplinary Team) meeting if necessary, discussing with an Oncologist and a radiotherapist the proper treatment plan. The decisions are always taken based on international guidelines. Surgical excision with histologically negative margins is the recommended and first-line treatment for primary cutaneous melanoma of any thickness, as well as for melanoma in situ. Surgical margins should be based on tumor thickness. Depth of excision is recommended to (but not including) the fascia. Adjuvant therapy is determined by the Oncologist while functional and aesthetic reconstruction is a primary goal, if possible.
Methods such as radiation, cryoablation, diathermy and photodynamic therapy (PDT) have been recommended and are useful for specific malignancies to specific patients. However, surgical removal remains the gold standard in treating a malignant skin tumor- Dr Karmiris’ option in most of the cases. The extent of the excision depends on the type of the tumor, the size and the area of the body where the tumor is located. Minor lesions are treated under local anaesthesia with wide excision and direct closure or by using a skin graft or adjacent tissues (local flaps) for reconstruction. Bigger lesions, may need general anaesthesia and more composite flaps for reconstruction. All skin lesions are removed and sent for histological examination in order for the patient to be informed of the definite diagnosis, as well as for histologically negative margins. Patient’s stay in hospital depends on the extent of the surgery and his past medical history.
Dr Karmiris will explain you in detail all the surgical options, will answer your questions and will recommend you the most appropriate solution, for an optimal result.
The patient after the end of the surgical procedure, in case of local anaesthesia will be discharged on the same day. He will have a silicone dressing depending on the removal area while Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op, what medication you should take and when you will be seen for a follow up. Sutures are removed depending on the operated area, that is at 7 days in face area and 14 days in torso. In case of general anaesthesia, the patient might spend 1-2 days in the Hospital, depending on the extent of the operation.
Complications can happen and depend on the extent of surgery and patient’s condition. Postoperative bleeding (formation of haematoma) and inflammation may occur in a general percentage of 1-2%, while there is also possibility of seroma, incomplete excision and need for revision. Dr Karmiris will answer all your questions regarding the risk of your skin lesion and the protocol that needs to be followed based on international bibliography.
The doctor will answer all the questions and will help you to find the most appropriate therapy, depending on your case.