Removal of Skin Tumors and Other Skin Lesions on the Face
The skin is not a uniform surface and it may show changes such as areas of increased or decreased pigmentation or lesions that are raised above or sunken below the level of the surrounding skin. Most skin changes are benign and do not require removal, except in cases where they are aesthetically unsatisfactory. A smaller number of skin changes are skin tumors. The most common ones are basal cell and squamous cell carcinomas. Rare but dangerous and often pigmented tumors are melanomas. An experienced dermatologist or surgeon can usually make a reliable diagnosis through clinical examination, but only a pathologist, after removal and histopathological (PHD) analysis of the lesion, can definitively determine its nature.
Regardless of the type of condition, every facial surgery is an aesthetic procedure. Likewise, every surgical procedure leaves a scar on the face. Both the patient and the surgeon must keep these two facts in mind. A successful facial surgery is considered to be one in which the scar is placed in a way that makes it as inconspicuous as possible.
What facial lesions are possible and which should be removed?
There are many different types of lesions that can appear on or within the skin of the face. For any skin change on the face it is best to consult your doctor who will provide professional advice. Listed here are only the most common lesions or those that definitely require treatment.
Every face has moles, usually they are darkly pigmented lesions that are raised above the skin surface. These are benign changes that slowly grow over a lifetime. The reason for their removal may be cosmetic or due to their location, which can cause inconvenience in daily life (shaving, combing, shirt collar, etc.). Some moles have the potential to turn malignant, i.e. melanoma. It is best to seek medical advice in such cases. The only way to determine the true nature of a mole is through pathological examination after its removal. Moles are most often removed elliptically and the scar depends on the size of the lesion.
Solar keratoses are lesions that develop on the facial skin as a result of prolonged sun exposure. These are benign changes, but they can sometimes resemble melanoma or may contain underlying skin cancer. They can be removed in various ways, but surgical removal is recommended as it provides tissue for the pathologist to make a definitive diagnosis.
Basal cell carcinoma is the most common malignant tumor of the face. It almost never metastasizes, but it spreads locally and if it is not completely removed can recur. It appears in various forms, which is why any new skin lesion on the face that you haven't noticed before and that is slowly but steadily growing should be evaluated by a doctor. If the tumor is removed in its early stage the procedure can be performed on an outpatient basis under local anesthesia. After removal the tumor must be sent to a pathologist to determine whether there are clear and healthy tissue margins around it. If the tumor is excised with healthy margins it will not return. Patients who have had surgery for this tumor are more likely to develop the same or another type of skin tumor later on, so follow-up checkups are recommended at least twice a year.
Squamous cell carcinoma is the second most common malignant skin tumor. It often appears as a non-healing sore. In addition to the skin of the face, it can also develop on the vermilion border of the lip. Unlike basal cell carcinoma this tumor can spread both locally and to nearby lymph nodes in the head and neck. Small tumors can be treated on an outpatient basis, while larger ones may require defect reconstruction after removal. After excision the tumor must be sent to a pathologist for analysis to confirm the presence of healthy margins around the tumor. Regular follow-up is essential after surgery as metastases can appear more than two years after tumor removal. Periodic checkups are also recommended beyond two years post-surgery, as patients may develop the same or another type of skin tumor.
Melanoma is the most commonly dark-pigmented malignant skin tumor. It can develop from a pre-existing mole or appear on previously unaffected skin. Any mole that changes in color or size, bleeds occasionally or has changes in the surrounding skin should be examined by a doctor. It is recommended to remove such a mole with a healthy margin of 2–3 mm (excisional biopsy) and send the tissue to a pathologist for analysis. The pathologist’s role is to confirm or rule out the diagnosis, and if it is melanoma to determine the depth of its invasion into the skin. Treatment of melanoma depends on the pathologist's findings. Superficial melanomas rarely metastasize and are usually treated by widening the excision margins around the former mole. For tumors that have penetrated deeper into the skin, in addition to a wider excision, it is also necessary to remove the associated lymph nodes in the head and neck (neck dissection). The prognosis for early-stage melanoma is excellent, while advanced cases with metastases to the neck or other organs require additional medical therapy. Early detection is crucial for successful treatment so regular self-examination and prompt consultation with a doctor is extremely important.
When is surgery needed?
To treat a skin lesion on the face it is usually sufficient to remove it, i.e. to perform an excision. In a small number of cases after removal and a definitive pathological diagnosis additional procedures may be necessary. This could include a wider excision and reconstruction, removal of the salivary gland in front of the ear (parotidectomy) or surgery on the neck, i.e. a neck dissection.
Facial skin lesions can be removed by a
dermatologist, plastic surgeon, or otorhinolaryngologist.
Why entrust the removal of a skin lesion to a specialist in head and neck plastic surgery?
The education of a specialist in head and neck plastic and reconstructive surgery combines the principles of oncologic and plastic surgery of the head and neck, enabling them to both begin and complete your treatment.
Once you have chosen a qualified surgeon you trust they will assess not only the skin lesion but also your skin type during the consultation and recommend the most suitable surgical approach for you. You should discuss with your doctor the possible pathological diagnosis and any additional procedures that may be necessary following the final pathology report, the risks of the procedure and any conditions that may affect the surgery such as blood pressure, medications that might impact blood clotting, allergies, smoking, tendency to scar and so on. For a successful outcome and for making an informed decision about the procedure it is crucial to realistically assess with your surgeon the necessity of the surgery and the expected results.
Understanding the surgery
The way the lesion on your face will be removed depends on its size and location. Most often, the lesion is removed in an elliptical shape (elliptical excision) and the edges of the resulting defect are sutured in layers (primary closure). The direction of the long axis of the elliptical excision must follow the natural lines and folds of the facial skin in order for the scar to be less noticeable. In cases where the lesion is of such a size or located in a way that primary closure would result in a poor aesthetic outcome the defect is closed using a local or regional flap. Most commonly a local flap is used, meaning tissue from the surrounding area is repositioned in a way that preserves the anatomical structures of the face.
What after the surgery?
Most procedures are performed under local anesthesia and the patient can leave the hospital the same day. In cases where the procedure is performed under general anesthesia the patient is advised to stay overnight in the hospital. Once the anesthesia wears off the patient may experience minimal pain and the doctor will advise on which medications can be taken. If a bandage is applied after the procedure it can be removed the day after surgery. The patient is advised to rest with the head elevated and to apply a cold dry compress to the wound to reduce postoperative swelling. For the same reason intense physical activity should be avoided. For wound cleaning, saline is recommended followed by a thin layer of antibiotic ointment. Sutures are typically removed between the fifth and seventh day. Recovery takes approximately 10 to 14 days. There are various creams on the market that can help improve scar healing, but their use should be discussed with the physician. The appearance of the scar is not assessed immediately after suture removal, but rather after 6 months post-operation for a final evaluation.
Do you have any questions regarding the removal and reconstruction of skin tumors and other skin lesions on the face? Feel free to contact our Center for Plastic, Reconstructive and Aesthetic Surgery at +385 1 2867 400 or by email at info@stcatherine.hr.
