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Introduction
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A lesion is a lump, bump, crack or other mark on the skin that is not normally present. Consultant maxillofacial surgeons deal with the surgical removal and diagnosis of numerous different types of skin lesions, from the common to the rare. These may include skin cancers.
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Why do we need to remove these lesions?
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- To establish a diagnosis - tell us and you what the lesion is.
- In order to treat the lesion - that is the surgical removal.
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What types of lesions are seen on the skin?
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The types of lesion can be divided into:
- Benign Lesions:
These lesions may be unsightly or may be traumatised repeatedly, for example during shaving.
- Malignant (cancerous) lesions:
The majority of these lesions spread slowly over years but some may spread more rapidly to involve lymph glands in the local area or more distant areas. All will cause great damage if neglected.
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Some common benign skin lesions
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- Haemtoma or naevi:
These are known as moles and are often pigmented.
- Squamous cell papilloma:
A number of different lesions are seen:
(a) Epithelial naevus or strawberry marks - present at birth
(b) Common wart - caused by viral infection
(c) Seborrhoeic keratosis or senile keratosis - these are usually seen in the more senior patient.
- Fibroma:
Seen in association with chronic trauma
- Keratoacanthoma:
This innocent, but rapidly growing lesion, can mimic a malignant ulcer.
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Some malignant tumours of the skin
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- Basal-cell carcinoma:
Often known as a rodent ulcer, because of its gradual gnawing away of the skin.The lesion gets larger with time 85% of these cancers will be on the face, head or neck). A result of sun damage, these lesions grow slowly but do not spread to other parts of the body.
- Squamous-cell carcinoma:
This tumour can arise in sun damaged skin, normal skin, or in Bowen's disease. Again, it is usually associated with prolonged skin exposure, and although many tend to be low grade malignancy, some may spread to local lymph nodes.
- Melanoma:
Although this a rarer tumour, it has increased in incidence as a result of increased exposure of the skin to sun. Melanoma can arise:
(a) in normal skin;
(b) in a pre-existing naevus or mole
Danger signs include:
- recent increase in size
- ulceration, bleeding
- change in colour
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Types of melanoma
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- Lentigo maligna melanoma:
Mainly seen in more senior patients with about 90% occurring on the head and neck.
- Superficial spreading melanoma:
Makes up about 50% of all melanomas seen. Commonly found on the calf of a woman or the back of a man.
- Nodular melanoma:
Can be raised blue to black nodule, most commonly found on the trunk of the body.
- Lentigo maligna:
Not a melanoma but an enlarging pigmented area on the face which carries a significant risk of turning into a melanoma. Removal is often recommended because of this risk and also because of the continued increase in size.
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Removal of these lesions
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After the diagnosis is established (which may require a biopsy), the lesions are excised or removed under a local or general anaesthetic.The mark left by removal can be repaired by:
- Primarily joining the edges of the skin together.
- By transferring or rotating tissue adjacent to the defect - this is called a flap.
- Using skin from a distant site - called a skin graft.
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Skin grafts
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A cotton wool pack is placed over the skin graft to ensure healing is undisturbed.
Antibiotics are given in the form of tablets and cream, to prevent infection.The pack is removed between ten and fourteen days.
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Wound care and sutures
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Dressings are rarely used except for skin grafts and the patient is encouraged and expected to clean their wound and apply antibiotic cream 3 to 4 times daily. This makes suture removal, generally at your first follow-up at 5 - 7 days, much easier.
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Healing
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The lesion which has been removed will leave a scar. The excision and the flaps are planned so as to minimise the effect by placing the scars in the natural creases of the face whenever possible.
The healing of the scar takes time and there are various phases. It is important to remember that scars generally look worse before they get better.
- Red phase - can last up to three months. Itching can occur at this phase with the wound feeling tight and often appearing to be red and raised.
- Pink phase - can last several months. Massage and moisturising cream can be used to soften the scar and aid healing.
- White phase - this fading phase is complete at a year from surgery and represents full maturation of the scar giving the final result of a pale flat and soft scar.
AFTER CARE *REMEMBER*
- SliP - Slip on a shirt
- SLAP - Slap on a hat
- SLOP - Slop on some sun cream
If you have any questions or concerns, please get in touch with your Maxillofacial surgeons.
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