Surgical removal of new growths (neoplasms, tumors)

Skin is a physical barrier to the environmental influence and is very much susceptible to negative ecological and workplace related factors. No wonder that among global incidence of cancer diseases, skin cancer is the most prevalent form of human cancer in most countries (or most common in humans in most countries). Human skin is a complex organ that includes cells of different tissues and every normal cell can undergo a transformation during which it grows and multiplies without normal control. It explains a large variety of tumors that occur in skin.

Skin irritation can be a significant problem when there is exposure to mechanical, physical, chemical and biological agents such as friction, excessive heat, wind and cold, sunlight, dust, metals, organic and inorganic chemicals, detergents, soaps, irritating plant and food materials. The damage to the skin can result in conditions ranging from dryness to severe irritant or allergic contact dermatitis.

Skin tumors (neoplasms, newgrowths) is the most common reason for consultations in dermatological practice. 

Neoplasms (tumous) are subdivided into the following groups:
- benign.
- malignant.

Institute VIRTUS uses the following stages for skin growths diagnostics^

1. Initial dermatology consultation – at the initial consultation patients are inspected to find out the details related to the nature and development of the skin growths.
2. Dermatoscopy - A noninvasive diagnostic technique for the early diagnosis of skin neoplasms (tumors) by means of special device called dermatoscope (HEINE, Germany) (pic.1) This method allows tumor structure high magnification and visualization as well as determining its possible risk (dermatoscopic index – DI) and treatment approach.

3. UltraSound skin testing (U/S of skin) (pic.2, pic.3) presents an innovative technology, which allows non-invasively (without incisions) determine the depth of the examined intradermal tumor, and consequently choose the best way to remove it by means of laser or via surgical removal. (pic.4)

Pic.2 skin testing U/S device

Pic.3 U/S new growth skin

4. Oncologist appointment is scheduled to verify if the examined neoplasm (tumor) is cancerous or otherwise poses danger and then to chose the best treatment option.

5.Plastic surgeon consultation – is necessary in cases when surgical invasion to remove the neoplasm (tumor) is combined with simultaneous plastic procedure of the treated area. For instance removal may be combined with skin rejuvenation (pic. 5 a, b)

Skin new growths removal techniques.
Laser surgery, is typically performed by a dermatologic surgeon, plastic surgeon, or other surgical specialist. To treat this type of skin lesions we use the advantage of Er:YAG laser MSL dermadlate (Asclepion, Germany) as minimally invasive and selective approach with low postoperative risk of scarring. The procedure is done under local anesthesia.
This approach is used to treat the following skin new growths:
- dermal, epidermal and verrucous nevi;
- skin growths caused by human papillomavirus (warts, papillomas, condylomas);
- verrucas planae;
- actinic lentigo, keratomas, seborrheic keratosis, actinic keratosis, cutaneous horn.

Surgical removal of neoplasm (tumor, abnormal growth) is performed by plastic surgeons, or oncologists in case of cancerous nature of the growth.

The procedure may be performed in the following cases:
- if the abnormal growth is widespread on the skin surface and in deep skin layers thus limiting laser treatment and requiring one stage plastic surgery procedure (Pic. 6 a, b, с);

-before
-after the surgical removal of nevus and one stage flap plastic surgery.
-nevus residual tissue laser vaporization

- If the new growth removal is combined with another surgery (facial aesthetic surgery, intimate plastic surgery);
- If it is a malignant growth that requires special removal approach used in oncology and is normally taken care of by means of plastic surgery. The following new growths require surgical removal:

- Basalioma (basal cell carcinoma) Pic 7 a, b, c, d;
– Dermatofibroma – lipoma, atheroma.

Pic.7 Residual basal cell carcinoma, radiation skin injury. 
a - before,                                                                                                                                                   b – preoperative marking with the emphasis on the skin flap (singlng out) (glabellar, two-petalled flap) to disguise the existing deformity;                                                                                                                                        с – 6 months after the surgery.