SKIN LESION TREATMENTS
The vast majority of facial skin cancers can be cured if diagnosed and treated early.Initial evaluation includes a comprehensive health history and clinical examination. An initial biopsy may be required. A biopsy involves numbing the skin with a local anesthetic and removing a small part of the lesion. This is then sent for examination under the microscope. Results usually take at least five working days as the tissue has to have dyes added to it (sort of like pickling an onion) before the tissue can be examined under the microscope. A diagnosis can be given.
Further treatment, if required, will depend on the place and size of the lesion, the age of the patient, cosmetic considerations, and the patient’s preferences.
Lesions on facial skin are removed under local anaesthetic or general anaesthesia.
An antiseptic solution is used to clean the area. The amount of time that the removal takes obviously varies depending on the size of the area involved. The lesion is removed and sent for examination under the microscope. This to ensure that lesion is completely removed. Results usually take at least five working days.
Removal of the lesion leaves a defect in the skin. This hole can be repaired in a number of ways:
- If the defect is small and If the surrounding skin is loose, the wound can be closed by bringing the edges together (direct or primary closure).
- If the defect is large and the skin is not elastic, then the edges cannot be joined. Pulling the edges together may pull and deform important facial features such as the eyelids, nose, lips etc. In such cases the wound is repaired by borrowing a piece of skin from another part of the body either as a local flap or a skin graft. The area from where the skin is borrowed is called the donor site.
- In a skin graft, the skin is completely detached from its donor site. Skin grafts are often taken from behind the ear or just above the collarbone. These sites are chosen because they already have an excess of skin. The graft is then laid over the hole where the facial lesion has been removed and stitched into place. A dressing is stitched over the graft for around 5 days.
- With a local flap, the borrowed skin is still attached at the donor area. Local flaps differ from skin grafts in that they bring their own blood supply. The skin in a local flap is from an area that is very close to the wound e.g. a wound on the side of the nose may be repaired with skin from the cheek. Local flaps usually work better and give a superior appearance. Regional flaps are a variant of a local flap in that the skin used is not next to the wound but is from the same area of the body e.g. a wound on the tip of the nose might be repaired with skin from the forehead. . Regional flaps are often a bigger procedure and may involve more than one operation, and are usually carried out under general anaesthesia.
Stitches are removed 5 to 7 days later. You are reviewed in clinic two weeks after the surgery with the results.
The common risks and complications with this type of surgery are bleeding, infection and lumpy scars. If you have a skin graft or a skin flap there can be similar complications at the donor site. Sometimes the graft may not take fully or flap may not survive. Further surgery may then be required. The scar remains quite noticeable for the first 3 to 6 months and then starts getting flatter and paler. Massaging the scar with a moisturising cream two or three times a day for the first few months helps in this process. The scar should be protected from direct exposure to sun during this early period. Sometimes the scar may take up to a year to fade.