Surgical Therapies are therapies whereby an instrument is in direct contact with the skin causing direct damage (wound). These therapies include all variants of surgery as well as those specific for skin surgery: Curettage, Electrodesiccation , Laser Surgery and Cryosurgery, among others.
Microscopically Controlled Surgery
(Microscopically Controlled Surgery/Micrographic Surgery/ MOH´s Surgery)
Most skin tumors are removed surgically. The first step of surgical removal involves anesthesia administered locally. In only a few other cases is general anesthesia needed. Once complete numbness of the treatment area is achieved, the affected tumor tissue is resected. Very small segments of healthy tissue, measured in millimeters, that surround the affected tumor tissue are also resected to ensure all tumor cells are removed. This healthy tissue will be examined with a microscope during the operation. If cancer cells are found in this healthy tissue, tissue will be resected around the tumor again in an area of larger radius. This procedure is repeated until all cancer cells from the area are removed. Only then will the operation be completed and the wound closed.
Depending on the size and depth of the original lesion, skin transplantation from another area on the patient may be necessary to ensure proper regrowth of healthy skin tissue.
In some cases, plastic reconstruction of the extracted tissue is required to correct the consequences of the operation.
Curettage is the use of a curette (French, meaning scoop) to remove gradually superficial tumors by scraping or scooping the affected skin tissue while under local anesthesia. This procedure is most often used on tumors that have not reached deeper levels of the skin. This technique helps ensure that nearby healthy tissue remains protected as much as possible. Unfortunately, due to the fact that the removed tissue was scratched off, it is usually unsuitable for microscopic examination.
Curettage may be performed on thicker tumors before treatment is conducted using Rhenium-SCT, so that the beta-radiation of the Rhenium is more effective.
Electrodessication is a procedure whereby the affected skin is strongly heated (cauterized=burned) by electrodes under high currents, destroying the tumor tissue. This process is also called Electrocautery. Local anesthesia is first applied to the tumor area before the electrodes begin cauterizing the lesion. This procedure is used only for smaller and superficial tumors. Since the tissue is destroyed completely in this procedure, microscopic studies cannot be done.
Laser surgery is an operation involving a laser applied to the skin. Like other skin surgeries, local anesthesia is first applied to the skin tumor area. The applied laser destroys the tumor cells via heat (laser coagulation), manifested by the high energy light from the laser. This procedure can only be used on superficial tumors. Like with the electrodessication therapy, the tissue is destroyed completely, and therefore, microscopic studies cannot be done.
In dermatology, cryosurgery is sometimes used for the removal of diseased tissue. The procedure involves a cooling medium, often liquid nitrogen (-70 – 196 C), that is applied directly on the affected tissue in the form of a spray. The tumor is destroyed through the formation of ice crystals inside the cells. As the tissue is destroyed completely in this procedure, microscopic studies cannot be done.
In most cases, cryosurgery is used with older patients and for superficial breast, stomach, or back basaliomas or with actinic keratoses. The procedure can be repeated. The resulting damage, however, often takes longer to heal that with other procedures, and scarring can occur.
Important Note about Surgical Therapies
In cases where curettage, electrodessication, laser surgery and cryosurgery are performed, macroscopic studies of tissue are not possible. As previously mentioned, this is because of the complete destruction of the treated tissue. To the human eye, it may appear that the tumor has been completely removed; however, it cannot be entirely assured whether or not tumor cells still remain in the treated area. Thus, these procedures cannot fully with 100% accuracy remove all localized tumor cells. This leaves the risk that a tumor may regrow (relapse). Therefore, these procedures are not typically used for non-melanoma skin cancers.
Only with microscopically controlled surgery (micrographic surgery/ MOH´s Surgery) can a conclusive statement about the removal of all tumor cells be ascertained. The risk of a relapse is lowest with this microscopically controlled surgery. This is thus the first choice surgical procedure for non-melanoma skin cancer
Wound healing and scarring
With all surgical therapies, a wound will form. Depending on the size of the wound, a suture may be required to allow for proper tissue healing. In cases where a particularly big wound forms, skin transplantation with or without reconstruction may be necessary. However in other cases, the skin may heal and regrow without suturing.
In principle, a wound has to be kept clean and dry to avoid infection. To protect against infection, your doctor will choose a suitable bandage for you.
To ensure an undisturbed healing process, sports activities or frequent movements in the wound area should be avoided.
How long a scar may remain in the wound area depends on many different factors.
If the wound becomes inflamed or healing problems appear, bigger and thicker scars often form.
Wounds in body regions that are frequently moved (elbows, shoulders, hips, knees, feet) can often become bigger and thicker.
Generally, wounds heal slower for elderly people than for younger individuals. The positive outcome associated with this fact is that the wounds of younger people heal faster, but due to this fact, bigger and thicker scars can form.
Also, genetic factors play an important role. Those of African or Asian origin tend to develop bigger scar formations. If your family members show strong scar formation, your risk of developing strong scar formations could be higher.