SKIN LESIONS


Benign (non-cancerous) skin lesions 

Examples of benign lesions that may need removal under local anaesthesia are:

A mole (especially if new) that is changing in any way, for example - growing, altering in shape or intensity of pigment (black or brown), bleeding or becoming itchy. They need to be assessed and if necessary removed for examination under the microscope to exclude anything sinister.

Naevi. These are colourless skin lesions - usually 5-8 mm & rounded, common on the face around the mouth & chin. They are innocent but are often cosmetically unpleasing. They can be removed by a "shaving" technique, which does not necessitate the use of sutures (stitches) & normally heal without any scarring.

Sebaceous Cyst.  The Sebaceous gland in the skin produces the waxy material which coats the skin and gives it it’s texture. When the outlet of this gland gets blocked the waxy material accumulates due to a damming back effect & enlarges to form the cyst. Sooner or later these cysts get infected (forming an abscess) & for this reason they are best removed before this event. If the cyst gets infected, they are initially treated as for an abscess & when they have fully settled (usually 2 - 3 months) they are removed but a much larger area needs to be cut out resulting in a large scar. Prevention (i.e. removing the cyst before infection sets in) is always the best policy.

Lipoma. These are literally rounded lumps of fat that occur under the skin. They may be multiple & can grow anywhere. Sometimes they are painful. Although it is extremely rare for these to become malignant, they are best removed before they get too large, especially if they are painful as removal cures the pain.

Dermatofibroma. These are usually approximately 5-10 mm hard lumps in the skin (common on the legs & thighs) - which are probably sites of previous minor injury -including insect bites. They can often itch & cause discomfort - hence are better removed.

Skin tags & other small lesions. These can be removed if they are causing any inconvenience or are cosmetically displeasing. Like naevi they can be removed by the "shaving" technique which results in no scarring.

Seborrhoeic Keratosis (Basal Cell Papilloma).  These are crusty brown or black lesions, which normally appear as the skin ages.  Sometimes they need to be removed as they cause irritation and itching.  Shave or curette and gentle hyfrecation is used to remove them.

  

Pre-Malignant skin lesions

Conditions such as Actinic Keratosis (also known as Solar Keratosis) and Bowen’s disease of the skin often appear as pink, crusty patches, are potentially pre-malignant and need to be treated, either by removing them normally using the shave and hyfrecation method or application of special creams.



Malignant (cancerous) skin lesions

Part of the reason for removing skin lesions is to examine them under the microscope (histology) to ensure they are not cancerous. Ultra-violet radiation from the sun (or sun-beds) is extremely harmful to the skin - especially in fair-skinned or freckly individuals.  The effect is accumulative over the years and pre-disposing factor in producing cancerous change. The common skin cancers are:

Melanoma: This is a mole that has become malignant. If caught at an early stage, before they have become invasive, i.e. developed the ability to spread, removal will result in a cure - hence removing all moles that have changed in any way. If the melanoma is established then either more extensive surgery or surgery with other treatments are started.

Squamous cell cancer of the skin (Epithelioma).  Cancerous change in the top layer of the skin can produce a lump or an ulcer with elevated & rolled edges. Again, if fully removed at an early stage, a cure or a much better outlook is possible.

Basel Cell Cancer (BCC, Rodent ulcer). Although called a "cancer", this lesion does not spread but only grows locally. It is common on the face & other sun-exposed areas, e.g. forearm & hand. Removing it fully results in a cure. Sometimes, if it is situated in a place where removal is not appropriate, radiotherapy is used to treat it. There is a special variety of this cancer known as Superficial BCC, which can be treated with special creams rather than surgery, but a small biopsy is necessary prior to treatment to confirm the type of the lesion.