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Excision of skin: surgery is indicated to remove skin tumors

Excision of skin: surgery is indicated to remove skin tumors

Excision is a surgical procedure to remove an injury by cutting the skin around the lesion, allowing removal. It is used both for the removal of benign and malignant lesions. In cases of skin cancer, in addition to the injury, a piece of normal skin around the lesion, called the safety margin, is removed. The width of this margin of normal skin removed depends on factors such as skin cancer type, tumor size and depth. Surgical excision is the gold standard treatment for skin cancer, that is, it is always the first option for removal of the tumor, and can then be combined with other treatments, such as radiotherapy or immunomodulatory ointments.

Indications

Simple surgical excision is indicated to remove skin cancer that has well delimited margins. Poorly delimited lesions may require more sophisticated surgical procedures, such as Mohs surgery.

Who can not do

Contraindications for surgical excision of a skin cancer are the same as for any other surgical procedure of the same size. For small lesions, surgery is usually performed under local anesthesia in an outpatient setting, and contraindications would be severe coagulation disorders, use of anticoagulants, and allergy to local anesthetics. Cases of severe systemic diseases, use of pacemaker and advanced age should be evaluated individually. Depending on the case, the doctor may indicate another form of treatment such as the use of creams or ointments with chemotherapy and antitumor effect, or use of light on a special ointment, such as in photodynamic therapy

Which doctor performs the surgery? A dermatologist can perform the surgical excision of a skin cancer as long as he is skilled and familiar with the procedure.

Exams Needed for Surgery

For simple cases and small lesions, preoperative exams are expendable. In the case of larger procedures, the doctor will probably order a series of preoperative tests, including cardiac evaluation, electrocardiogram, and chest x-ray.

Preparing for surgery

Your surgeon can make some pre-surgery recommendations :

Stop taking certain medicines: let your surgeon know of any medications or supplements you are taking, including blood thinners, such as warfarin or acetylsalicylic acid

  • Some dietary supplements (such as garlic capsules, gingko biloba) and vitamins (such as vitamin E) may also interfere with clotting after surgery, so make sure your surgeon knows about these as well
  • Continue to take any prescription medications (especially for diabetes and high blood pressure) as directed, unless your doctor tells you otherwise
  • Wear comfortable clothing: it is advisable to wear clothes that are not too tight tight and easy to wear, so you do not have to bother.
  • Types of anesthesia

The type of anesthesia used for surgery depends on the size, location, and type of skin cancer. Removal of carcinomas (basocellular or squamous cell) is usually calmer than removal of a melanoma, which is the most aggressive type of skin cancer and requires excision with a higher safety margin. Surgery in small, easily reached cancers may require only a local anesthetic, whereas surgery for larger tumors may require general anesthesia.

How it is performed

Surgical excision - Photo: Getty Images

The vast majority of cases of excision of skin tumors can be done outpatient, under local anesthesia. In these cases, you probably will not need to change your clothes, but depending on the location of the cancer the doctor or nurse may request the exchange for a surgical apron. Before skin excision, the nurse or doctor cleans the area to be operated, delimiting it with a special pen. A local anesthetic is applied to the skin so that you feel nothing during the procedure.

Before the incision, a curettage of the area can be done, that is, scraping the skin. This may facilitate the removal of larger tumors.

A cut is made on the skin with a scalpel around the visible skin cancer lesion, along with a margin of apparently healthy tissue. In general, a margin of 1 cm for carcinomas and up to 2 cm for melanomas is used in all directions.

After the cancerous area is removed, the incision is closed with stitches or, for less severe cases, the wound can be left open to heal on its own. If the incision is large, sometimes a skin graft is needed or the skin is moved from a nearby area to cover the wound. Reconstructive surgery may be necessary if excision creates an unaesthetic scar.

The removed tissue should be examined histologically, allowing assessment of the lateral and deep margins, and the certification that all cancer cells have been removed. It is extremely important that all skin cancer has been removed to reduce the risk of recurrence.

Procedure duration

The duration of the surgery depends largely on the size of the tumor that will be removed and the possibility of having some complication. The doctor will be able to tell you more about the length of surgery for your case.

Care after surgery

Excisions generally have a smooth, trouble-free healing. You will follow up with your surgeon or doctor to monitor your recovery and make sure that the wound is healing properly. Although excision has a high cure rate for skin cancer, you will always have a small risk of recurrence or otherwise develop skin cancer elsewhere. Therefore, it is important to maintain regular follow-up with the dermatologist to detect any new skin cancer.

Possible Complications / Risks

Risks of using excision to remove skin cancer include:

The wound infects, bleeds and pain

  • Scars
  • The skin graft may not heal
  • Not all cancer cells have been removed, requiring further surgery or another procedure.
  • How is patient recovery

A Skin cancer surgery recovery varies depending on the location of withdrawal, how much skin is removed and the general health of the patient. The cosmetic results are good, in a general way.

Pregnant can do?

Yes. Skin excision can be performed during pregnancy, but in these cases the risks and benefits of the procedure are evaluated. In some cases, it may be more prudent to wait until the end of gestation.

Cost of surgery

Costs vary greatly depending on the size of the procedure to be performed and the type of anesthesia used. Small, outpatient and local anesthesia procedures cost from R $ 400,00 - while larger surgeries, with grafts or flaps, under general anesthesia in a hospital environment can cost more than R $ 30,000.

Regulation

The surgery is approved by the Federal Council of Medicine

References:

Tatiana Jerez, dermatologist and member of the Brazilian Society of Dermatology

Paulo Issa, dermatologist coordinator of the skin cancer alert campaign of the Brazilian Society of Regional Dermatology Rio de January (SBD-RJ)

Selma Cernea, dermatologist at the Israelita Hospital Albert Einstein


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