Dermatologic SurgeryWhether you are requesting removal of a harmless lesion for cosmetic reasons or having treatment for skin cancer, our Dermatologists are highly trained in this area and will give you the best advice tailored to your needs.
These procedures and generally performed under local anaesthetic either in our fully-equipped operating theatres at Inner Sydney Dermatology, or in the Day Surgery Centre at Westmead Skin and Cancer Foundation. Skin cancer surgery in particular may require more advanced techniques such as flaps and grafts to obtain the best result. Most operations require a separate booking time, which will be arranged at the time of your consultation. If your Dermatologist feels that your condition requires urgent treatment, every effort will be made to perform your surgery as soon as possible.
Standard excisionThe skin lesion is carefully removed using an elliptical (or eye-shaped) excision. Blood vessels are gently sealed and the skin edges sutured together, usually with a combination of deeper dissolving and surface non-dissolving sutures. The surface sutures need to be removed 5-14 days following the surgery depending of the site.
Flap and graft plastic surgery techniquesWhen the skin lesion being removed is large, or in an area where there is limited skin laxity (such as the nose) it is not always possible to safely bring the skin together in the standard side-to-side fashion. In this situation, the wound may be closed using either a flap (whereby skin nearby is repositioned into the area) or a skin graft (where skin is taken from elsewhere and placed neatly into the wound).
Shave excisionSome raised skin lesions such as fleshy moles, skin tags or seborrhoeic keratoses are best removed by shave excision. This is a relatively quick and simple procedure whereby the area is numbed using local anaesthetic, and the lesion precisely shaved flush with the skin surface. Blood vessels are generally sealed using a liquid chemical or pressure, rather than heat, to minimize scarring. The process generally leaves a small area which heals up much like a graze would. Good wound care is extremely important to ensure a good cosmetic outcome.
Electrodessication or diathermyThis technique uses a gentle electric current to 'zap' away tiny skin lesions such as skin tags or small seborrhoeic keratoses. The area is numbed using a local anaesthetic injection (or anaesthetic cream for larger areas) before the lesions are treated. Afterwards a small crust froms which generally heals over the next 1-2 weeks.
CurettageSome skin lesions such as warty seborrhoeic keratoses can be removed using this technique. The area is numbed using a local anaesthetic and then the lesion is gently and precisely scraped flush with the skin surface. Blood vessels are generally sealed using a liquid chemical or pressure, rather than heat to minimize scarring. Good wound care is extremely important to ensure a good cosmetic outcome. This technique is also used in combination with electrodessication or diathermy for the treatments of some superficial skin cancers.
Mohs' surgery is a specialised type of skin cancer surgery pioneered by Dr Frederick Mohs, an American Dermatologist and Surgeon. Cure rates are much higher than with other forms of surgery, with five-year cure rates exceeding 99 percent for new cancers, and 95 percent for recurrent cancers. Dr Michelle Hunt is one of a small number of fully trained and accredited Mohs’ surgeons in NSW, all of whom are Dermatologists who have undertaken extra training in surgery, pathology and skin reconstruction. She has been performing this type of surgery at the Skin and Cancer Foundation, Westmead, for the past 17 years.
The procedureSometimes a skin cancer can be deceiving with more tumor cells growing beneath the skin than above, like roots of a tree. These 'roots' are not visible with the naked eye, but can be seen and traced using a microscope and special stains. In standard surgery, the lesion is removed and small sections are later examined by a pathologist. Some 'roots' may have been left behind and have the potential to grow again. With Mohs' surgery the entire under surface and sides of the specimen (rather than just a small portion of it) are examined during surgery to ensure that the skin cancer is completely removed at the time.
Mohs’ surgery is a day procedure performed under local anasthetic. If the margins of the skin cancer are difficult to see with the naked eye, the tumour is initially scraped away (debulked) to reveal these margins as best as possible. A thin layer of tissue is then taken around and under the tumour, and the edges marked with different colored dyes, forming a ‘map’ of the specimen. The tissue sample is then processed in the on-site laboratory so that any 'roots' of the cancer can be identified. If cancer cells are seen, an additional fine tissue layer is removed only in areas where the cancer remains, preserving as much healthy skin as possible.
The process is repeated until all cancerous cells are removed and the wound is repaired, which may require plastic surgery techniques such as flaps or skin grafts. A dressing is applied and patients are given complete home care instructions. The average time spent at the clinic is half a day, but there is obviously individual variation.
As Mohs' surgery is a more time consuming and labour-intensive treatment than conventional surgery, it is more expensive, but much of the cost is usually covered by private health insurance.
For more information visit www.skincancermohssurgery.org