Outcomes of Skin Surgery

A Concise Visual Aid

Graham Colver

• Publisher: CRC Press
• Year: 2008
• eBook ISBN: 9781000612103
• Topic: Medicine
• Subtopic: Dermatology

There is a great need for a visual resource to document, with clarity, the possible outcomes of surgery, including side effects and complications, and how these outcomes vary from individual to individual. Using a straightforward approach, Outcomes of Skin Surgery: A Concise Visual Aid is an easy-to-consult and highly illustrated reference for surg

1

No treatment

No treatment might be best – harmless lesions

Doctors are frequently asked if anything needs to be done about a skin lesion or blemish. Often they are harmless and natural and many patients, especially if they are slightly guarded about intervention, willingly take the advice to ‘do nothing’.

Offering the ‘no treatment option’ should always be part of the consultation for benign lesions. Despite the contents of the referral letter from the general practitioner and even the initial expressed wish of the patient it is quite common to discover some misunderstanding about the exact nature of the lesion and its surgical treatment.

• Some people convince themselves that they have a malignant lesion but are reluctant to admit it

• Others have misunderstood the discussion with their primary care doctor and believe that the lesion should be removed. In these circumstances strong reassurance combined with an explanation of the natural history of the lesion may be sufficient

• Some people decide against treatment when they are informed about the technique and risk of scarring

There are some situations in which it may be reasonable to remove a benign lesion:

• Simply because it is very large or unsightly

• It is on a prominent site such as the tip of the nose

• Fleshy moles may catch on clothing

• Skin tags can be unsightly and uncomfortable

• Some lesions, e.g. cysts can become infected and painful

Benign mole on chin

Dermatofibroma with characteristic pigment in a circle around it

Seborrhoeic keratosis

Multiple seborrhoeic keratoses

Minor sun damage

No treatment might be best – low-risk lesions

If an elderly and frail individual develops a low-grade premalignant lesion such as a solar keratosis, Bowen’s disease or lentigo maligna, it is sometimes the right decision to wait and see – unless it is causing symptoms or problems such as catching on clothing.

The risks of doing nothing

• Each solar keratosis has a 1:1000 chance of malignant change per annum

• Patches of Bowen’s disease have 5–20% life-time risk of malignant change

• Lentigo maligna has 10% life-time risk of malignant change

• It is possible for any of the lesions to grow more quickly (see next section)

Healing problems which might occur in elderly people include:

• Slow healing or ulceration of wounds on the lower leg

• Swelling or bruising after use of liquid nitrogen or topical creams

Even when dealing with low-grade malignancy in low-risk sites, there may be an argument to wait and see, particularly in people suffering from other serious illnesses. When dealing with more aggressive lesions it would be unusual not to intervene.

Low-risk solar keratosis

Larger solar keratosis

Patches of Bowen’s disease

Superficial scaly basal cell carcinoma

Small nodular basal cell carcinoma (low-ri...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Introduction
• 1 No treatment
• 2 Curettage, cautery, snip, shave, trichloroacetic acid
• 3 Cryosurgery
• 4 Radiotherapy
• 5 Biopsies and excisions
• 6 Flaps
• 7 Skin grafts
• 8 Special sites – the ear
• 9 Special sites – the nose
• 10 Special sites – the lips
• 11 Special sites – the eye
• 12 Special sites – the nails
• 13 Open wound healing, partial closure and lattice closure
• 14 Wound dressings
• 15 Topical therapy
• Index