SKIN LESIONS

Examples of common benign (non-cancerous) skin lesions that may need removal under local anaesthesia are:

1. A mole that has changed in any way: for example - grown, altered in shape or intensity of pigment (black colour), bled or become itchy. They need to be removed for examination under the microscope to exclude anything sinister.
2. A sebaceous cyst - which forms when the outlet of this skin gland producing waxy material (to give our skin its texture) gets blocked. The waxy material then accumulates due to a damming back effect & enlarges to form the cyst. Sooner or later these cysts get infected (forming an abscess) & for this reason they are best removed before this event. If the cyst gets infected, they are initially treated as for an abscess & when they have fully settled (usually 2 - 3 months) they are removed but a much larger area needs to be cut out resulting in a large scar. Prevention (i.e. removing the cyst before infection sets in) is always the best policy.
3. Lipoma. Theses are literally rounded lumps of fat that occur under the skin. They may be multiple & can grow anywhere. Sometimes they are painful. Although it is extremely rare for these to become malignant, they are best removed before they get too large, especially if they are painful as removal cures the pain.
4. Dermatofibroma. These are usually approx. 5 mm hard lumps in the skin (common on the legs & thighs) - which are probably sites of previous minor injury -including insect bites. They can often itch & cause discomfort - hence are better removed.
5. Naevi. These are skin lesions -usually 5 mm & rounded, common on the face around the mouth & chin. They are innocent but are often cosmetically unpleasing. They can be removed by a "shaving" technique, which does not necessitate the use of sutures (stitches) & heal without any scarring.
6. Skin tags & other small lesions. These can be removed if they are causing any inconvenience or are cosmetically displeasing. Like naevi they can be removed by the "shaving" technique which results in no scarring.

Malignant (cancerous) skin lesions

Part of the reason for removing skin lesions is to examine then under the microscope (histology) to ensure they are not cancerous. Ultra-violet radiation from the sun (or sun-beds) is extremely harmful to the skin - especially in fair-skinned or freckly individuals pre-disposing to cancerous change. The common skin cancers are:

1. Melanoma: This is a mole that has become malignant. If caught at an early stage, before they have become invasive, i.e. developed the ability to spread, removal will result in a cure - hence removing all moles that have changed in any way. If the melanoma is established then either more extensive surgery or surgery with other treatments are started.
2. Epithelioma: (squamous cell cancer of the skin). Cancerous change in the top layer of the skin can produce a lump or an ulcer with elevated & rolled edges. Again, if fully removed at an early stage, a cure or a much better outlook is predictable.
3. Rodent ulcer (basal cell cancer - BCC), although called a "cancer", this lesion does not spread but only grows locally. It is common on the face & other sun-exposed areas, e.g. forearm & hand. Removing it fully results in a cure. Sometimes, if it is situated in a place where removal is not appropriate, for example near the eyes radiotherapy is used to treat this cancer.

NOTE ON SURGICAL TECHNIQUE TO REMOVE THESE SKIN LESIONS:

Local anaesthesia alone is use in all cases. Some lesions which are obviously benign (non-cancerous) can be removed by the "shaving" technique followed by a form of heat application called hyfrecation. The main advantage of this is that the resulting wound heals without any scarring - especially useful for lesions on the face.

If a conventional incision (cut) is necessary, as for example in removing lipoma or sebaceous cysts, the length of the cut is, obviously, kept to a minimum. More importantly, cuts are place along "crease lines" which result in much better & cosmetically superior scarring - often not visible after healing is complete. Sutures (stitches) used whenever possible are placed subcutaneously, i.e. the single suture is under the skin & does not cross the scar to give it the unsightly cross-line ladder appearance.

I prefer to use non-absorbable (not self-dissolving) sutures i.e. they need to be removed after 5 - 10 days but they do result in a better scar. The absorbable (self-dissolving) sutures tend to produce rougher scars.

If you do have a skin lesion that has changed in any way, has suddenly appeared or grown rapidly or if it is troubling you, either physically or is worrying you, it is best to have it checked out

You can do this by seeing your Family Doctor (G.P.), a specialist or attend the MOLE Clinic (www.themoleclinic.co.uk) where your skin lesion(s) can be checked with state of the art equipment

CARE OF YOUR SCAR

The appearance of your scar can go on improving for up to one year when it matures fully.

Most scars heal well & are often flat & hardly visible.

A few scars, depending on the site & genetic predisposition of the person thicken & may become very hard. To reduce the chance of this you can take some simple measures:

• Avoid exposing the operation site to the sun - for at least three (or preferably six) months after the operation. If you wish you can cover the scar with skin coloured micropore adhesive tape (available from chemists) to protect it from the sun. This will also apply pressure to the scar, which seems to help improve the cosmetic effect.

• After the wound has healed to make a secure scar, (about 3-4 weeks), gently massage the scar, by moving it over the underlying structures, rather than rubbing the scar itself, for up to 5 minutes many times a day, if at all possible.

• Moisturise the scar by applying a moisturising cream, (any good preparation used for daily skin care) to the area. Alternatives are pure white soft paraffin BP or Vaseline, - both available from Chemists. You can start this after the sutures are removed and for a good 6 months if at all possible

• Apply silicone, in the form of a gel or patches to the scar. These can be purchased from large chemists, e.g. Boots which makes their own brand labelled Scar Reduction Pad. Other brands are Elastoplast Scar Reduction Patches and Cica-Care made by Smith and Nephew. They have a website which provides information regarding care of scars - www.scarinfo.org. Dermatix is a gel which is easy to apply and dries to simulate a patch. The longer the patch stays in contact with the scar the better the result. Please read the instructions on the packets carefully before use.

SHAVE EXCISION AND HYFRECATION

Your skin lesion can be removed by a technique called shaving, and application of heat energy to the area using a special machine called a Hyfrecator. This leaves a superficial burn which may swell and look unsightly. Don't worry as this is its transient natural progression, and will settle. A scab may form - don't disturb it as healing is progressing underneath it. If a scab has formed, it will fall off after a week or so. Please keep the area dry for about 36 hours following the procedure. After this, you can gently wash the area, to keep it clean, and moisturising it, which helps it to heal the shaved area with minimal or no scarring. You can do this by applying a moisturising cream, (any good preparation used for daily skin care) to the area. Alternatives are pure white soft paraffin BP or Vaseline, - both available from Chemists. You should continue moisturising the area for a good 6 months if at all possible.

After the area has healed (normally 1-3 weeks), instead of using a moisturising cream, you could apply Silicone, in the form of a gel or patches to the area. These can be purchased from large chemists, e.g. Boots which makes their own brand labelled Scar Reduction Pad. Other brands are Elastoplast Scar reduction Patches and Cica-Care made by Smith and Nephew. Dermatix is a gel which is easy to apply and dries to simulate a patch. The longer the patch stays in contact with the shaved area the better the result. Please read the instructions on the packets.

Another important measure is to avoid exposing the area to the sun - for at least three (or preferably six) months after the operation. If you wish you can cover the "scar" with skin coloured micropore adhesive tape (available from chemists) to protect it from the sun.

Usually the area heals without visible scarring, but sometimes it may discolour a little. It may take up to a month or six weeks to heal properly. You can't judge the final cosmetic result until a whole year has passed.