DERMATOSURGERY

When a new lesion or formation appears on the skin, the patient should first consult a dermatologist. Dermatology encompasses a significant branch called dermato-oncology, which is a field of medicine that studies new skin formations and tumor development pathologies, a highly relevant issue today.

Dermatology and dermato-oncology involve surgical methods in addition to therapeutic treatments. This gave rise to a new field called dermatosurgery. Dermatosurgery is a dynamically developing discipline with a wide range of tasks: new formations, skin injuries, burns, inflammatory-purulent diseases of the skin and subcutaneous fatty tissue, various skin defects including scars, and their correction.

Particular attention is given to benign and malignant formations, such as melanoma, basal cell carcinoma, and squamous cell carcinoma. Clearly, when dealing with skin tumors, it is essential for a dermatosurgeon to have a dermato-oncologist’s evaluation, which is based on clinical and optical digital dermatoscopic research. One of the most notable and common problems in dermatosurgery is skin cancer, as its incidence is significantly increasing, making it one of the most frequent types of tumors.

Skin cancer involves the uncontrolled proliferation of any type of skin cell, whereas under normal conditions, skin regeneration occurs through controlled cell replication. Each type of skin cancer has unique characteristics.

Skin tumors are also classified based on the patient’s age, which helps in the quick differentiation of tumors characteristic of various age categories. This classification includes viral warts, as it is often necessary to distinguish them from skin tumors.

• Skin tumors in children: Viral warts, intradermal nevi, molluscum contagiosum, hemangiomas, pyogenic granulomas, xanthogranulomas.
• Skin tumors in adults: Viral warts, plantar warts, nevi, cysts, soft fibromas, skin papillomas, sebaceous gland hyperplasia, histiocytomas, keloids, lipomas, pyogenic granulomas.
• Skin tumors in the elderly: Seborrheic keratoses, actinic keratoses, capillary hemangiomas, basal cell carcinoma, leukoplakia.

Generally, new skin formations do not require any treatment. In cases deemed suspicious by dermatoscopic examination, surgical excision followed by histological analysis is indicated. Most dermato-oncologists prefer surgical excision because the risk of recurrence is minimal, and the procedure removes not only the entire tumor but also an apparently healthy margin of skin, the size of which is determined individually based on the type and clinic of the formation.

Malignant skin tumors diagnosed at an early stage have a high cure rate. Excision within the healthy tissue margin is the standard treatment, whereas treating advanced cases of malignant skin tumors (Stages II-IV) is much more complex. This often requires extensive, “mutilating” surgical excision and, in cases of metastasis, prolonged treatment.

Surgical removal of skin tumors has several advantages over other alternative methods:

• The treatment and recovery period is relatively short.
• It avoids the negative effects of radiation therapy, such as burns to the bone and cartilage tissue, particularly around the nose, ears, cheeks, and fingers, which can lead to scarring.
• Some long-standing skin tumors are resistant to radiation therapy.

Preparing for a dermatologic surgical operation begins with preparing the patient, who should be informed about the purpose of the surgical intervention and the potential risks. It is also necessary to inform them about existing alternative therapeutic or non-invasive surgical treatments, such as radiation therapy, cryodestruction, and electrocoagulation, and explain their positive and negative aspects.

An important factor in dermatologic surgeries is anesthesia—the choice of anesthetic and its application method, which depends on the surgeon and the patient’s condition. Consideration must be given not only to the technical aspects and the scope of the operation but also to the patient’s age and emotional state. Notably, better results and fewer complications are achieved with local or regional anesthesia, as this allows the surgeon to communicate with the patient during the operation, which is very important for the procedure.

The diagnosis of new skin formations is made using optical dermatoscopy and by identifying characteristics typical of tumors. The diagnosis can be confirmed and validated through postoperative histomorphological examination. Histomorphological examination is a method of microscopic analysis of biological tissues and involves studying the individual structures that make up cells and their collective organization.

Immunohistochemistry is considered an advanced form of histomorphological examination. It is not typically used initially but is conducted when routine histological testing is insufficient for establishing a diagnosis.