Skin Lesions and Skin Cancers

Benign Skin Lesions: Moles, Cysts and Other Growths:

Skin lesions are very common. Virtually every one of us will have had or will develop at least one skin lesion during the course of our lives and most of us will develop more than one. Fortunately the vast majority are and will remain entirely benign.

Causation:

Our skin is subjected to considerable wear and tear from an early age. Sun exposure is a major skin irritant. However it takes years for such irritants to manifest in the form of a skin lesion. Therefore the resulting skin lesions tend to occur in adults and in middle age / elderly. The cause of skin lesions, particularly moles, in children and young adults is not clear. Longstanding sun exposure is probably not a factor in this age group.

Moles and Pigmentation:

Moles are very common. They may be flat or elevated. Sometimes they grow hairs. The most important feature however is pigmentation – a brown discolouration of the overlying skin.

When should you be suspicious of a mole ?

  1. Recent appearance of pigmentation
  2. Pigmentation that becomes darker
  3. Itching or irritation
  4. Bleeding
  5. Growth in size especially a growth spurt
  6. A mole which was once flat becoming raised.

If you are concerned about the above or any other changes you should consult with your General Practitioner / Doctor.

Cysts:

This is a swelling that appears under the skin. The overlying skin is usually normal, occasionally discoloured due to thinning of the skin. The size of the swelling may range from that of a pea to a small marble but occasionally it can be larger. Cysts are invariably benign. Excision is advised.

Vascular Lesions:

These appear as small bright red spots. They are benign. Larger vascular lesions appear in childhood and young adults, these are often congenital. The latter may require special investigation and treatment. Small vascular lesions are relatively easy to remove.

Fatty Swellings / Lipomas:

There are fatty swellings that appear under the skin. They are benign and relatively common. They are often soft to the touch, the overlying skin is always normal. Sometimes they are multiple. Excision / biopsy is usually advised.

Skin Tags:

These occur commonly in the armpits and in the neck. They are often multiple. They tend to grow where the skin is moist due to perspiration. They are usually excised for cosmetic reasons.

Degenerative Lesions:

Degenerative lesions such as Seborrhoeic keratosis are commonly seen in middle age and in the elderly. These lesions may be pigmented and can appear worryingly similar to certain skin cancers. If there is any concern about these lesions they are best excised.

Skin Cancers:

  • Cancerous growths on the skin are common.
  • Fortunately the majority are slow-growing and they do not spread.
  • Furthermore being on the skin surface they are usually diagnosed at an early stage.
  •  Sun exposure over the years plays a significant role in the growth of skin cancers. The role of sun exposure also explains why the majority occur on the exposed skin – the face / neck, the upper chest and on the back of the hand. The majority of solar related skin lesions occur in middle age and in the elderly. However it takes many years for the effects of the ultraviolet light of the sun to manifest on the skin for this reason.
  • Malignant melanoma is the exception – it is a potentially very malignant tumour with a tendency to spread. Most melanomas arise in a pre-existing pigmented mole. Therefore any mole which changes or displays suspicious features should be assessed by your Doctor and removed.

Treatment of Skin Lesions / Skin Cancers:

  • The majority of skin lesions can be treated in a relatively simple manner. This entails surgical excision under local anaesthesia. Therefore the assessment and excision can frequently be performed at the initial consultation. If a skin cancer is suspected a diagnostic biopsy may have to be performed at the initial consultation. The treatment is completed as soon as the report is available.
  • If the lesion has a completely benign appearance there is no need to request laboratory analysis.
  • Therefore apart from skin cancers the treatment can frequently be completed on a single visit.
  • Some simple skin excisions do not require sutures. In other cases dissolving sutures may be used. In either case there is no need to return to The Clinic for removal of the sutures.
  • Dressings are usually of a simple nature and they can frequently be removed at the appropriate time by the patient.
  • A follow-up consultation is advised should there be any worries or concerns.
  •  Healing of these simple wounds usually takes no longer than one to two weeks.
  •  Post-operative pain and discomfort is usually mild. Simple pain relief medication usually suffices.

Scarring:

The excision of skin lesions including skin cancers by a Plastic Surgeon should leave imperceptible or at the very least very acceptable scars in the majority of cases.

In the minority of cases where an unsatisfactory scar may be anticipated this is discussed with the patient at the outset. In many cases moles and other skin lesions are excised primarily for cosmetic reasons. Therefore we must always assess the potential cosmetic benefit of mole removal against the potential risk of an unsightly scar – will the resulting scar constitute a lesser blemish than the mole ? In most cases it is possible to excise a skin lesion and leave an acceptable or indeed imperceptible scar. Patients are advised regarding aftercare of the scars including special creams and massage.
 

Examples of Skin Lesion Surgery:

Case 1:

This fifty three year old man had a simple skin cyst removed from his right eye. He was reviewed and photographed three months post operatively.

Although a relatively ‘minor’ operation my initial anxiousness re the procedure was quickly dispelled by Mr Small’s and teams reassuring and authoritative demeanour.  The whole process from initial consultation, surgery and follow up was a thoroughly professional one.

Most importantly I am more than pleased with the result and would have no hesitation in recommending such an operation when conducted by such a skilled unit.

S.C.