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Treatment and Reconstruction of Skin Lesions

Lesions on the skin such as moles, cysts, warts, skin tags, birthmarks and scars are mostly benign (non-cancerous) but if they are painful, unsightly appearance or restrict movement, you may want to consider to have them removed. Lesions that show any sign of turning cancerous, for example, a mole that has changed its shape or colour, surgery is strongly recommended.

Skin cancer can occur anywhere on your body, but it is most common in places that have been exposed to more sunlight, such as your face, neck, hands, and arms. Untreated or undiagnosed skin cancer can cause significant local destruction and may be potentially life threatening. The three most common cancers of the skin are basal cell carcinoma, squamous cell carcinoma and melanoma.
 
 
Basal cell carcinoma occurs in the basal cells. This is the most common type of skin cancer, usually localized growths caused by excessive cumulative exposure to the sun and do not tend to spread.
 
Squamous cell carcinoma occurs in the squamous cells that make up most of the skin’s upper layers (epidermis). Squamous cell carcinomas may occur on all areas of the body, most common in areas frequently exposed to the sun such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms and legs. These cancers are also considered extremely treatable.
 
Melanoma is the most serious form of skin cancer. It is a potentially fatal skin cancer that forms in melanocytes (skin cells that make pigment). If it is recognized early and treated aggressively, it is almost always curable. If it is not detected early, the melanoma can advance by spreading downwards into deeper skin layers, and to lymph nodes and to other parts of the body, where it becomes hard to treat and can cause death.
 
 
What does the surgery involve?
 
Skin lesions such as warts, skin tags or moles which are usually small, of no suspicious pathology can be removed by a laser. Lesions like cyst, birthmarks, scars, keloids, moles with a potential of becoming malignant and skin cancers – Basal cell carcinoma and Squamous cell carcinoma will be removed surgically and the tissue will be sent to a laboratory for biopsy where a pathologist will examine it under a microscope.
 
Treatment for melanoma depends on the extent of the disease, the patient's age and general health, other factors. Surgery is the usual treatment for melanoma. Dr Fok will recommend a wider excision which removes the tumour and some normal tissue around it. This procedure reduces the chance that cancer cells will be left in the area. The width and depth of surrounding skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin. Occasionally surgery in combination with a sentinel lymph node biopsy will be performed. A radioactive substance is injected near the melanoma. An imaging study called lymphoscintigraphy will be done at the same time to identify the sentinel node. A probe will be used to follow the movement of the radioactive substance so as to detect the lymph nodes. The first lymph node to take up the substance is called the sentinel lymph node. Dr Fok will then remove the sentinel node to check for cancer cells.
 
 
What happens on the day of surgery?
 
Surgery to remove a skin lesion is usually a quick and straightforward procedure that does not require to stay in hospital except for surgery for melanoma. Dr Fok performs most of the skin lesions excision at his office based outpatient ambulatory surgery centre accredited by Singapore Ministry of Health.
 
The surgery is usually done under a local anaesthesia. It can also be done under a twilight sedation combined with local anaesthesia which means that you will be asleep throughout the procedure and will feel no pain. The choice of anaesthesia will depend on the size, location of your lesion and the age of the patient.
 
After the lesion is being cut out entirely, the wound will be closed with stitches. The stitches will then be removed in 5 – 10 days.
 
 
What to expect during the recovery phase?
 
The patient should be able to resume to their daily activities almost immediately after surgery. An appointment will be given for stitches removal and review by Dr Fok about 5 – 10 day after the surgery. Patients are generally comfortable during the recovery phase with very minimal pain which most of the time does not even require any medications.
 
Most surgical operation sites simply need to be kept clean, patient are allow to wash and shower as usual. Patient is advised not to do any strenuous exercises such as swimming or jogging for about 2 weeks.
 
Medication in a form of cream or gel to help wound and scar healing will be prescribed by Dr Fok. Patient is also advised to use sunscreen with a sun protection factor (SPF) of 25 or higher every day.
 
Surgery is generally may not be effective in treating melanoma that has spread to other parts of the body. In such cases, chemotherapy may be required.
 
 
What are the risks?
 
Complications are unexpected problems that can occur during or after the surgery. Most people are not affected. The main possible complications of any surgery are excessive bleeding during or soon after the operation, developing an infection and an unexpected reaction to the anaesthetic.
 
Most people's scars heal normally but a small percentage of people have an inherited tendency to form keloids which are scars that are unusually red and raised.