ONCOSURGERY

Oncologic surgery for skin and soft tissues covers a wide range:

• Benign formations: Nevi (moles), seborrheic keratoses, fibromas, cysts.
• Cancer-causing tumors: Actinic keratoses, cutaneous horns, arsenical keratoses, leukoplakia.
• Skin tumors in the elderly: Seborrheic keratoses, actinic keratoses, capillary hemangiomas, basal cell carcinoma, leukoplakia.
• Various skin defects, including scar correction.
• Inflammatory and purulent diseases of the skin and subcutaneous fatty tissue.
• Malignant formations: Basal cell carcinoma, squamous cell carcinoma, melanoma.

When consulting with a dermato-oncologist or dermatologist, a thorough examination of the entire skin surface and visible mucous membranes is essential. Additionally, determining the patient’s phototype—skin, hair, and eye color, and the presence of freckles—is necessary. All skin formations on the patient’s body should be carefully examined, not just the ones the patient points out. Detailed medical history (anamnesis) should also be collected.

Additionally, a detailed medical history (anamnesis) should be collected, including:

• • Changes in appearance: How and when the appearance of the formation changed.
  • Development background: Whether the new formation developed on a pre-existing element (such as a congenital pigmented nevus) or on previously unchanged skin.
  • Injury history: Any history of trauma to the pigmented nevus or other skin formation (mechanical, thermal, or chemical).
  • Subjective sensations: The presence of sensations such as itching, burning, peeling, or bleeding.
  • Personal or family history of skin cancer: The presence of skin cancer in personal and/or family medical history.
  • Sunburn episodes: The number of sunburn episodes, particularly during childhood.
  • Occupational hazards: Exposure to professional hazards, such as contact with carcinogens or chronic ultraviolet radiation exposure.

When it comes to skin cancers, it is crucial for the oncosurgeon to have a dermatologist’s report based on clinical and digital, optical dermatoscopic examination. This is a simple and non-invasive method that allows for a more accurate assessment of new skin formations than the naked eye. Using a digital dermatoscope, the oncodermatologist can see the dermatoscopic image of the new formation in real-time on a monitor and save the corresponding digital image, enabling easy monitoring of the new formation. Comparing dermatoscopic images of the same element taken at different intervals allows for the diagnosis of small, almost imperceptible skin cancers based on the changes observed. This also reduces the number of biopsies, which is particularly important for patients with multiple moles. Another advantage of digital dermatoscopy is the involvement of the patient in the examination process. With traditional dermatoscopy, the patient cannot see the image, but digital dermatoscopy allows the patient to observe the examination object along with the doctor. Numerous studies have shown that patient involvement in the examination process positively impacts their attitude and attentiveness.

The frequency of monitoring intervals (every 3, 6, or 12 months) is determined individually for each patient, considering the initially described new formation, skin phototype, personal and family medical history, and other factors. The vast majority of dermatologists agree that regular skin examinations are crucial for the prevention and early diagnosis of skin cancer.

In modern medical practice, nevuses that pose a risk should be completely excised. If the patient is an adult, they should be informed about the risks, the technical details of the surgery, and the expected cosmetic outcome in each specific case, as the clinical picture, size, depth, localization, and associated aesthetic issues often require individual consideration.

If clinical and dermatoscopic examination of a skin formation reveals suspicious signs, a biopsy and histomorphological examination of the material are necessary. For elements clinically and dermatoscopically suspicious for melanoma, surgical excision should be performed with a 2-3 mm margin of healthy tissue and sent for histomorphological analysis. Partial biopsy of the formation is not recommended to allow the histomorphologist to fully examine the damaged tissue; however, this may be acceptable for large tumors.

Histomorphological examination may sometimes be complex and insufficient, necessitating immunohistochemical studies. Based on the obtained results, the staging of the cancer is determined, and the tactics for treatment and follow-up are developed.

The removal of moles occurs under two conditions: if they present an oncological indication or a cosmetic problem. In both cases, the decision is made by a dermatologic oncologist and never by a cosmetologist. As for the method of removal, the choice is made by the patient after consultation with the doctor.

It is noteworthy that patients are becoming increasingly demanding not only regarding the quality of diagnosis and treatment but also the cosmetic outcomes. Therefore, both preoperative and postoperative objective analysis is performed, based on dermatoscopic examination, necessary monitoring, pathomorphology, and the latest technologies used in dermatocosmetology and aesthetics.

In skin and soft tissue surgeries, one of the important factors is anesthesia – the choice of anesthetic and its application method. It is important to note that better results and fewer complications are achieved with local or regional anesthesia during surgery, as this allows the surgeon to interact with the patient, which is crucial during the operation.

Attention!!!

• If you notice an unusual-shaped new growth
• If it has grown unevenly and the contour is irregular
• If the color has changed – either lost or significantly increased pigmentation
• If a border has appeared on the periphery; it has started peeling; the surface has become uneven with nodules
• If there are cracks, fissures, and bleeding

Then it is time to raise the alarm, as the new growth on your body is undergoing changes.