Treating Skin Lesions

Dermatosurgery is the treatment of skin lesions and subcutaneous tissue.

The most frequent lesions are:

Benign skin lesions

NAEVUS (or beauty spot) is a benign lesion or mole that can sometimes degenerate into a melanoma. It can be excised for purely aesthetic reasons or as a preventive measure. If in doubt, it is important to consult your dermatologist who will give you guidance. In fact the frontier between the two types of lesion is sometimes hard to assess, even by a specialist, so all the more so for yourself. Beware of very dark or irregular moles.

FIBROMAS (FIBROIDS), MOLLUSCUM (WATER WARTS) are much less worrying.

ANGIOMAS, these are benign but may sometimes be rather large, and would benefit from laser treatment.

XANTHELASMA (XANTHELASMA), deposits of cholesterol on the eyelids, justifying removal but recurrence is frequent.

Malignant skin lesions

EPITHELIOMAS (baso- or spino-cellular) are to be suspected if the lesion is red and bleeding or forms a crust but does not heal. These are promoted by exposure to the sun (generally since childhood) and need to be excised so they can be analysed. They often begin with a pre-cancerous KERATOSIS lesion which can be burned off by a dermatologist, using liquid nitrogen.

MALIGNANT MELANOMA is much more serious and requires extensive exeresis (greater or smaller depending on their thickness). This should be suspected if the lesion is very dark and irregular but these lesions can take other, more deceptive, forms.

Subcutaneous lesions

LIPOMAS, these are fatty lumps in a healthy skin. They may be isolated (sometimes very large and deep) or multiple, and they could be scattered in dozens all over the body in the case of lipomatosis.

SEBACIOUS CYSTS, they are equivalent to very large blackheads adhering to the skin that can become infected. They should be operated on when they are not inflamed, otherwise they are very likely to reoccur. They generally appear on greasy skin and are rarely single.

WARTS, these are the equivalent of a sebaceous cyst but at the hairline and are often multiple.

Hundreds of other skin an subcutaneous lesions exist and justify a consultation with a dermatologist.

The operation

• Anaesthesia is usually local and does not require hospitalisation (day surgery), neuroleptic analgesia is give if the lesion is large, so that injections will not be felt, but this will require hospitalisation for half a day (day surgery). General anaesthetic is rarely justified.
• The operation consists in removing the lesion cutting beyond it depending on the gravity. In the case of epitheliomas, analysis is performed during the operation by the pathology laboratory (extemporaneously) to be certain of having remove it all to attempt to prevent an early recurrence.
• If the skin is quite supple, the wound will simply be sutured making it possible to obtain as little scarring as possible. Sometimes, especially in the case of a malignant lesion, it may be necessary to perform a skin graft (the skin is taken from another part of the body and grafted over the area that contained the tumour) or by a flap of skin (the skin is removed from an area next to the area of exeresis but remains connected to its blood vessels) and the scar will be more visible.
• The wound will heal in four days to a fortnight depending on the part of the body affected. The larger the lesion, the greater the tendency for the scar to expand.