EXCISION OF MALIGN LESIONS
Skin cancer is the most common cancer in the world. The mostly seen three types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM).
Unlike other cancers, it does not involve lymph nodes and metastasize, but progresses where it is. In general, their prognosis is good. Malignant melanoma progresses rapidly and metastasizes. The prognosis is poor. Early diagnosis is very important.
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European and Turkish Board Certified Plastic Surgeons
Turkish Plastic, Reconstructive and Aesthetic Surgery Association Certificate of Competence
Before Excision of Malign Lesions
Skin cancers are the most common cancer in the world, particularly the BCC, the most common type, is not discussed very often because of its non-metastasis and low mortality rates. However, skin cancer is an important health problem, particularly in light skinned people and those who are exposed to frequent or severe sunlight.
As with all cancers, “early diagnosis saves lives”. With an annual dermatological examination, it is possible to diagnose cancer before it progresses. During their check-ups, the patients should pay attention to newly formed lesions or changes in old lesions and consult a physician.
Even in malignant melanoma with a very poor prognosis compared to BCC and SCC, recovery can be achieved with early diagnosis and current treatments. Asymmetrical formations, irregularities, color changes, growths and swellings in colored skin lesions bring melanoma into the mind. While bleeding is a late symptom for many skin cancers, itching may be an early symptom.
In patients with suspected or pathologically diagnosed skin cancer, systemic examination should not be skipped. Particularly for lymph node involvement, the relevant region should be examined. If systemic metastasis is suspected, radiological examinations should be requested.
During Excision of Malign Lesions
The definitive diagnosis of skin cancer is made by pathological examination. If the lesion is small, it may be completely excised and submitted for pathological examination. Particularly if the surgical margin is sufficient in BCC, the treatment is completed and the patient is followed up.
In larger lesions, a sample is taken beforehand for definitive diagnosis and submitted for pathological examination. If the pathology is reported as malignant, the entire tumorous area should be excised with clean margins. Since lymph node involvement may also be present in SCC and malignant melanoma, if there is no palpable lymph node in the examination, nuclear-marked sentinel lymph nodes are also excised.
If the symptoms of disease are detected in these lymph nodes, or if a palpable lymph node is found in the examination, the relevant lymphatic region should also be completely excised. During the surgery, a sample is submitted to the pathology to ensure that the area is completely cleaned.
The formed defect (old tissue area) can be closed with various reconstructive surgeries in the same session depending on the nature and region of the tumor, or the wound closure can be performed with a second surgery after the definitive pathology report is issued.
After Excision of Malign Lesions
For early stage BCC and SCC, complete surgery with clear margins is an adequate treatment. In advanced stage BCC and SCC, post-surgical treatment continues with radiotherapy.
In advanced malignant melanoma, options such as chemotherapy and immunotherapy are available and the treatment is arranged accordingly. Metastatic malignant melanoma has a poor prognosis in general and survival expectancy is very low. After the treatment of skin cancer, monthly and then annual follow up should never be postponed.
Various tests are requested from time to time. We frequently exposed to UV rays, in other words, the sun in the etiology of skin cancer,. For this reason, it is frequently reminded by plastic surgeons and dermatologists to be protected from the sun, to use creams containing at least 30 SPF, and to spend the most effective hours of the sun indoors.