Dermal Surgery

Procedures

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dermal

Dermal Surgery

MELANOMA EXCISION AND RECONSTRUCTION

Melanoma occurs when the pigment-producing cells that give colour to the skin become cancerous.

 Treatment:

Treatment for Melanoma depends on the size and stage of the cancer and the patient’s overall health and personal preferences.

 Treating early-stage melanomas:

  • A very thin melanoma may be removed entirely during the biopsy and require no further treatment.

 Treating melanomas that have spread beyond the skin:

  • Surgery to remove affected lymph nodes:
    • If melanoma has spread to nearby lymph nodes, the affected nodes will be removed.
    • Additional treatments before or after surgery also may be recommended.
  • Chemotherapy:
    • Chemotherapy uses drugs to destroy cancer cells.
    • Chemotherapy can be given intravenously (Intravenous therapy (IV) is a therapy that delivers fluids directly into a vein), or in pill form or both so that it travels throughout the body.
    • Chemotherapy can also be given in a vein in the arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don’t affect other parts of your body.
  • Radiation therapy:
    • This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells.
    • Radiation therapy may be recommended after surgery to remove the lymph nodes. It is sometimes used to help relieve symptoms of melanoma that have spread to another area of the body.
  • Biological therapy:
    • Biological therapy boosts the immune system to help the body fight cancer.
    • These treatments are made of substances produced by the body or similar substances produced in a laboratory.
    • Biological therapies used to treat melanoma include interferon and interleukin-2, ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda).
  • Targeted therapy:
    • Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells.
BASAL SKIN CANCER REMOVAL

Basal cells produce new skin cells as old ones die. Limiting sun exposure can help prevent these cells from becoming cancerous. This cancer typically appears as a white, waxy lump or a brown, scaly patch on sun-exposed areas, such as the face and neck.

Treatment:

Surgery:

Basal cell carcinoma is most often treated with surgery to remove all the cancer and some of the healthy tissue around it, surgery options include:

  • Surgical excision:
    • In this procedure, the doctor cuts out the cancerous lesion and a surrounding margin of healthy skin. The margin is examined under a microscope to ensure that there are no cancer cells.
    • Excision might be recommended for basal cell carcinomas that are less likely to recur, such as those that form on the chest, back, hands and feet.
  • Mohs surgery:
    • During Mohs surgery, the doctor removes the cancer layer by layer, examining each layer under the microscope until no abnormal cells remain.
    • This allows the surgeon to be certain the entire growth is removed and avoid taking an excessive amount of surrounding healthy skin.

 Non-surgical treatments:

  • Curettage and electrodessication (C and E):
    • C and E treatment involves removing the surface of the skin cancer with a scraping instrument (curet) and then searing the base of the cancer with an electric needle.
    • C and E might be an option for treating small basal cell carcinomas that are less likely to recur, such as those that form on the back, chest, hands and feet.
  • Radiation therapy:
    • Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells.
    • Radiation therapy is sometimes used after surgery when there is an increased risk that the cancer will return. It might also be used when surgery isn’t an option.
  • Freezing:
    • This treatment involves freezing cancer cells with liquid nitrogen (cryosurgery). It may be an option for treating superficial skin lesions.
    • Freezing might be done after using a scraping instrument (curet) to remove the surface of the skin cancer.
  • Topical treatments:
    • Prescription creams or ointments might be considered for treating small and thin basal cell carcinomas when surgery isn’t an option.
  • Photodynamic therapy:
    • Photodynamic therapy combines photosensitizing drugs and light to treat superficial skin cancers.
    • During photodynamic therapy, a liquid drug that makes the cancer cells sensitive to light is applied to the skin. Later, a light that destroys the skin cancer cells is shined on the area.

Treatment for cancer that spreads:

  • Targeted drug therapy:
    • Targeted drug treatments focus on specific weaknesses present within cancer cells, by blocking these weaknesses, targeted drug treatments can cause cancer cells to die.
    • Targeted therapy drugs for basal cell carcinoma block molecular signals that enable the cancers to continue growing. They might be considered after other treatments or when other treatments aren’t possible.
  • Chemotherapy:

Chemotherapy uses powerful drugs to kill cancer cells. It might be an option when other treatments haven’t helped.

SQUAMOUS CELL CANCER EXCISION AND RECONSTRUCTION

How are they Managed:

Generally, when a skin lesion that looks suspicious, a biopsy is performed, which is a small sample of the lesion and send to the laboratory for analysis. The results might take a week. A definitive plan can then be made with regards to modality of treatment required.

What are the causes?

  • Sun exposure
  • Sun tanning booths
  • Immunosuppression
  • Exposure to high levels of radiation
  • Chronic heat exposure to heat
  • Previously traumatized skin e.g previous burns
  • Exposure to chemicals e.g arsenic, soot, hydrocarbons

 What are the different modalities if treatment?

  • Medical treatment, usually employed for premalignant lesions or small low grade tumours
  • Alternative treatment: cryotherapy, coagulation and curettage, Laser etc. are also employed for the basal cell carcinoma, premalignant lesions and lesions located on cosmetically sensitive areas.

Surgical excision is done for Melanoma, high grade Squamous cell carcinomas and Basal cell carcinomas and recurring lesions.

MOLES & SKIN TAGS REMOVAL

What are moles and skin tags:

  • Moles:
    • Moles are skin growths made up of cells that produce colour (pigment). A mole can appear anywhere on the skin, alone or in groups. Most people get a few moles during their first 20 years of life. They are usually brown in colour but can be blue, black, or flesh-coloured. Most moles are harmless and don’t cause pain or other symptoms unless you rub them or they bump against something.
  • Skin tags:
    • Skin tags are small, soft pieces of skin that stick out on a thin stem. They most often appear on the neck, armpits, upper trunk, and body folds. The cause of skin tags is not known. They are harmless.

Why remove a mole or skin tag?

  • Most moles and skin tags don’t require treatment. But sometimes people want to remove them for cosmetic reasons or because they cause discomfort when they rub against clothing or get caught in jewelry.

How do doctors remove moles and skin tags (these procedures usually leave no scars or marks)?

  • Cutting it off:
    • Skin tags may be snipped off with a scalpel or surgical scissors, some moles can be “shaved” off flush with the skin.
    • Other moles may have cells that go underneath the skin, so your doctor might make a deeper cut to remove the entire mole and prevent it from growing back, this cut may require stitches.
  • Freezing with liquid nitrogen:
    • Your doctor will swab or spray a small amount of super-cold liquid nitrogen on the mole or skin tag.
    • You might have a small blister where the mole or skin tag was, but it will heal on its own.
  • Burning it off:
    • An electric current passes through a wire that becomes hot and is used to burn off the upper layers of the skin. You may need more than one treatment to remove a mole.

Skin tags are removed by burning through the narrow stem that attaches them to the skin, the heat helps prevent bleeding.

HAEMANGIOMA MANAGEMENT

What is a haemangioma of the skin?

A ‘haemangioma’ (Greek for blood-vessel-growth) of Infancy is a benign (not cancerous) overgrowth of blood vessel cells that is self-limiting (will stop growing without treatment).

What do haemangiomas of Infancy look like?

The majority affect the face, but any part of the skin or other organ can be involved. The appearance changes rapidly during early life. A small red mark or swelling may be visible at birth or develop during the first weeks of life. This may increase in size usually most quickly over the first 3 months. Further change is usually slower and gradual for up to twelve months. Usually the haemangioma subsequently shrinks in size for up to 10 years (‘regression’). However, some haemangiomas don’t grow much at all and some do not shrink.       

How is a haemangioma of infancy of the skin diagnosed?

The diagnosis can be made by the appearance of the haemangioma and the history of rapid growth followed by slow regression. Sometimes scans will be organised to help confirm the diagnosis or to get further information about the extent of the haemangioma. For deeper or less typical lesions, a biopsy (skin or tissue sample) may be required to confirm the diagnosis.

Treatment can consist of one or a combination of the following:

  • A topical solution or gel applied directly to the haemangioma
  • Medicines (orally by mouth or by injection)
  • Laser therapy
  • Surgery for haemangiomas that are still growing topical or oral treatments are most often used
  • Drugs called beta-blockers shrink blood vessels and can be used as a topical treatment or as an oral medicine:
    • Timolol can be applied as a solution or gel to the haemangioma. It has been proven to be safe and effective, especially for more superficial lesions
    • Propranolol given by mouth is now the first choice to treat haemangiomas at important anatomical sites such as around the eyes or mouth. Almost all haemangiomas respond to propranolol. Treatment usually lasts for 6 to 12 months.
    • An ulcerating haemangioma needs additional treatment with non-adherent dressings and pain relief. Laser therapy can be useful to treat ulcerated lesions. Antibiotic ointment or medicine may also be required to manage infection.
    • After the haemangioma has stopped shrinking, surgical removal of excess tissue or laser treatment of remaining redness can sometimes be useful. The Pulsed Dye Laser is most commonly used. It produces a beam of specially formed light that reacts with the red colour in blood and penetrates to about 1.2mm into the skin. In adults, usually no anaesthetic is required. 
  • Cover-up makeup can be useful to cover skin discolouration.
TATTOO REMOVAL

Tattoo removal is a procedure done to try to remove an unwanted tattoo. Tattoo ink is placed beneath the top layer of the skin. That makes tattoo removal more complicated — and expensive — than the original tattoo application.

Why its done:

  • You might consider tattoo removal if you regret a tattoo or you’re unhappy with the appearance of your tattoo.
  • Perhaps the tattoo has faded or blurred, or you decide that the tattoo doesn’t fit your current image.
  • Tattoo removal might also be important if you develop an allergic reaction to the tattoo or other complications, such as an infection.

Common techniques for tattoo removal:

  • Laser surgery:
    • Q-switched lasers — which release energy in a single, powerful pulse — are often the treatment of choice for tattoo removal. A special type of laser — called a Q-switched Nd:YAG — might be used on darker skin to avoid changing the skin’s pigment permanently.
    • Before laser treatment, the skin is numbed with an injection of a local anesthetic. Then a powerful pulse of energy is applied to the tattoo to heat and shatter the tattoo ink.
    • Multicolored tattoos might need treatment with various lasers and different wavelengths.
    • After the procedure, you might notice swelling and possibly blistering or bleeding. Antibacterial ointment can help promote healing. You’ll likely need repeated sessions to lighten the tattoo, and it might not be possible to completely erase the tattoo.
  • Surgical Removal
    • During surgical removal, the skin is numbed with an injection of a local anesthetic.
    • The tattoo is removed with a scalpel, and the edges of skin are stitched back together. After the procedure, antibacterial ointment helps promote healing.
    • Surgical tattoo removal is effective — but it leaves a scar and might be practical only for small tattoos.
  • Dermabrasion
    • During dermabrasion, the tattooed area is typically chilled until numb.
    • Then the tattooed skin is sanded down to deeper levels with a high-speed rotary device that has an abrasive wheel or brush, this allows the tattoo ink to leach out of the skin.
    • The affected area feels sore and raw for several days after the procedure.
    • Recovery can take up to two to three weeks. 

Results

Tattoos are meant to be permanent, and complete tattoo removal is difficult. Some degree of scarring or skin color variation is likely to remain, regardless of the specific method of tattoo removal

More Procedures

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Breasts

Body Contouring

Abdomen

Genital

Dermal Surgery

Hands

Patient Instruction Information

What you need to know before THE operation

INSTRUCTIONS

The pre-operative instructions are important in giving you insight on things that hamper your healing progress. Please read carefully. If you still have questions after reading this, call the rooms (011 485 4434), to have all your concerns addressed

TWO WEEKS BEFORE YOUR SURGERY

Medications:

• Do not take any aspirin-containing products (see the attached list), anti-inflammatories (e.g. ibuprofen, advil, Meloxicam), blood thinners (e.g. coumadin, warfarin, clexane), or vitamin E for 14 days before your operation. These medications thin the blood and increase the risk of bleeding. Paracetamol can be taken safely.

• Stop taking any supplements, herbal, natural, diet, or alternative drugs 14 days before your surgery (e.g. ginkgo biloba, ginseng, St. John’s wort).

• We recommend stopping birth control pills or estrogen replacement therapy 4-6 weeks before surgery, particularly for abdominoplasty (tummy tuck) or liposuction. These drugs increase the risk of blood clots in the leg.

• Only essential medications may be taken throughout the peri-operation. It’s important to inform the surgeon and the anesthesiologist are aware of any medications you take.

• Patients with heart disease, Diabetes Mellitus, Previous cerebrovascular accidents, and pacemakers should also highlight this to the surgeon and anesthesiologist.

 • Please notify our office before your surgery if you develop a cold or infection.

Smoking:

• Smoking should be stopped at least 2 weeks before your operation, and you should refrain from smoking at least 2 weeks after the operation as well. Smoking greatly increases the risk of poor wound healing and even skin loss.

NIGHT BEFORE & DAY OF SURGERY

• Arrange transport to fetch you after discharge and a person to look after you post-discharge.  

• You can take only essential medications (for example, cardiac or blood pressure pills) on the morning of surgery with a small sip of water (except those mentioned below).   

• Nothing to eat or drink after midnight the night before, and the morning of surgery. If you do eat or drink, your surgery will likely be cancelled.

• Remove all make-up and nail polish the night before surgery.

• If you are having a facelift or browlift surgery, wash your face with soap and shampoo your hair the night before surgery.

• If you are having breast surgery, make sure you have a post-operative or sports bra available and bring it into the operating room.

• Remove all jewellery and leave money and all valuables at home

• Do not shave 3 days before surgery. Shower before surgery.

• Wear comfortable, loose-fitting clothing that is easy to put on and take off (e.g. sweat pants, button or zipper shirt).

• Arrive at the hospital at least 2 hours before the scheduled operation time      

• Be prepared to take time off work. In general, at least 5-7 days (this varies quite a bit, depending on the procedure). Try to avoid strenuous work or exercise for 6 weeks post-surgery. It is recommended to have someone at your home who can assist you.

WE RECOMMEND THAT PATIENTS DISCONTINUE USE OF THE FOLLOWING AT LEAST TWO WEEKS PRIOR TO SURGERY:

Aspirin Containing Products and
Anti-Inflammatories
Herbs and Natural Products
ASA
Instantine
Ginkgo biloba
Actifed
Indomethacin
Garlic
Advil
Midol
Ginger
Aleve
Motrin
Ginseng
Alka Seltzer
Naprosyn
Feverfew
Anaprox
Nyquil
Clove
Ansaid
Nytol
Danshen
Aspirin
Oxycodone
Dong Quai
Bayer
Pamprin
European Mistletoe
Celebrex
Pepto Bismal
Fenugreek
Contact
Percodan
Focus-kelp, black tang
Coumadin (Warfarin)
Persantine
Goldenseal
Darvon
Phenylbutazone
Horse chestnut
Dristan
Propoxphene
Northern prickly ash
Duragesic
Robaxisal
Endodan
Sominex
Entrophen
Sudafed
Fiorinal
Talwin Compound
Flurbiprofen Sodium
Trandate
Heparin
Trental
Ibuprofen
Vitamin E

WHAT YOU NEED TO KNOW AFTER THE OPERATION

General Comfort

It is important for you to get up, move around the house, and take some deep breaths 4-6 times a day from day 1 after the operation. Plan to sleep on your back with your head elevated, if possible. Sleeping on your side will cause swelling on the side you are laying on. Making yourself a nest with pillows can be very helpful.

Some people experience a slight sore throat or mild cough for 2-3 days after surgery. This is a side effect of anaesthesia and should resolve in 48-72 hours.


Pain Management


The first night and day after surgery will be your most uncomfortable. The pain will then stabilize over the next 24-48 hours and then decrease day by day. Analgesia appropriate to the type of surgery will be prescribed for you. Report to the doctor if you have unbearable pain. You will heal faster if you are not tense and tired from pain.

Stool softener may be helpful for patients who develop constipation as result of opioid pain killers. You can progress to regular strength paracetamol as your pain subsides. Narcotics will interact with alcohol so do not drink at the same time you are taking them. Drains are used in 80% to 90% of our surgeries to prevent post-operative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital.

The initial drainage will be bloody, changing to clear red then to clear yellow over the next 3-5 days. If blood clots in the tube, it can be cleared by applying pressure and “milking” the tube toward the bulb. Be careful not to put tension on the tube where it enters the wound. If you have less than 30mls of drainage in 24 hours before your first post-op appointment
you may call the office to make an appointment to have them removed.

Wound Care

• There is no need to change a clean, dry dressing for the first 2-3 days after surgery.
• It is preferable to have your 1st dressing change at the doctor’s office.
• You may shower after the original dressings and drains have been removed. Your doctor will give any other wound care instructions to you at the time of your surgery.
• Keep your supportive Bra on consistently for the first 6 weeks.

Complications

Please call or come into the consulting room or the Emergency Department when the clinic is closed as soon as possible if you have:

Increasing swelling, redness, or pain in the breasts.
Pus drainage from the breasts.
Excessive bleeding post-op (i.e., bandages become soaked with blood).
Shortness of breath.
Fever greater than 38 degrees orally.
Activity Limitations After Surgery


There should be no reaching above your shoulders, twisting or lifting more than 5 pounds for three weeks. No heavy activity or exercise for three weeks. Any activity that makes your face flush or makes you sweat can make you swell. No soaking your incisions (bathing or hot tubs) until your Steri-Strips® are removed, your sutures have been removed, and all scabs are healed.

After three weeks, you may resume normal activities. Do not wear underwire bras for 4 to 6 weeks after surgery, and then it is a matter of personal choice.

Scar Care


• Scar development is a process that lasts up to a year or more after surgery.
• Apply Micropore tape scars for a period of up to 6 months if possible.
• Use silicone base gel to massage the scar.
• Use clothing and sunscreen to protect the scars.
• Report any scars that you find unacceptable.
• Need to ask a question, email doctor on nkhens@mweb.co.za . We are here to help.

Contact

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011 485 4434
066 006 6631

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