What is a skin tumor
Tumor = new tissue growth, benign or malignant
A skin tumor is a skin lesion or new tissue growth on the skin that can be either benign or malignant. Skin tumors are often noticeable due to changes in skin color and texture. Patches with irregular borders and raised areas of skin, redness, scaly or crusty changes, bleeding skin lesions, or non-healing, chronic wounds are always cause for concern and should be evaluated through a tissue sample (histology).
To the benign Skin changes include
Naevus (so-called mole, birthmark)
Seborrheic Keratosis (so-called senile wart)
Atheroma/Epithelial cyst (so-called groat sac)
Lipomas (proliferation of fatty tissue cells in the subcutaneous fatty tissue)
Verruca (wart, virus-related skin change)
Xanthelasma (fat and cholesterol deposits, especially around the eyes)
Nevus flammeus (port-wine stain, dilation of small blood vessels)
Hemangioma (blood sponge)
Fibroma (connective tissue tumor, e.g. in Recklinghausen's disease)
To the malignant Skin changes include
Basal cell carcinoma (white skin cancer)
Squamous cell carcinoma (spinalioma, white skin cancer)
Malignant melanoma (black skin cancer)
Basal cell carcinoma grows aggressively locally but extremely rarely forms secondary tumors (so-called metastases). Squamous cell carcinoma can form secondary tumors, for example, in lymph nodes, the lungs, or the liver. Malignant melanoma can spread not only to the lymph nodes, lungs, and liver, but also to the bones and brain. In these cases, special tests must be performed so that we can determine the stage of your disease and which additional treatments (radiation therapy, chemotherapy, etc.) may be appropriate for you.
In such cases, follow-up therapy would be carried out by oncology colleagues (internists who specialize in cancer) with whom we work closely.
The decisive factor in the case of malignant skin changes is complete, radical surgical removal!
Information on the operation
You should not have any open wounds or scratches in the operating area before the operation, as this increases the risk of infection.
Small, circumscribed skin changes are removed and the skin is closed with single button threads or a thread running through the skin (intracutaneous thread).
In the case of an unclear, large-area skin lesion, a small tissue sample is usually first taken using a pen-shaped Hautstanzzylinder (1–4 mm in size) and examined histologically (a so-called “test biopsy”).
If the sample biopsy shows benign findings and there are no symptoms, no further surgery is required.
In the case of malignant findings or disturbing skin findings, the procedure is as follows:
Either:
Tumor removal and wound closure
In the case of a malignant finding or a smaller skin tumor, this is
is removed with a certain safety distance to the healthy skin and the wound is then closed.
Or:
Tumor removal without immediate final wound closure
Once the tumor has reached a certain size, the surrounding skin can no longer be closed by a skin suture after its removal.
In these cases, a fat gauze is placed on the wound or an artificial skin (epigard) is sutured into the soft tissue defect and the final tissue examination by the pathologist (histology) is awaited.
When we receive the tissue examination, we know whether the tumor has been removed from the healthy tissue or not. What can you expect next?
Either:
The tumor was not removed when healthy
If the tumor extends to the incision site, the edge of the tissue should be re-resected. In these cases, the skin defect is covered again with fatty gauze or artificial skin (Epigard), as described above, and the tissue examination is again awaited.
Or:
The tumor was removed in a healthy state
Once the tumor has been removed from the healthy tissue, the so-called "defect coverage" is performed.
There are several options here:
- Local tissue flaps (local displacement, pivot, or rotational flaps) or tissue flaps pedicled on a blood vessel (e.g., subcutaneous fat flaps from the forehead for larger nasal defects = forehead flaps)
- Vollhaut-Transplantat: An area of skin the size of the tissue defect is harvested—for example, from the back of the ear, the neck, the inner upper arm, or the groin, among other sites—and sutured into the defect.
- Spalthaut-Transplantat: Using a so-called skin knife, known as a “dermatome,” a superficial layer of skin of a specific size and thickness (0.2–0.6 mm) is harvested from the thigh, trunk, or head and sutured into the defect.
Often, a skin graft is pressed against the wound bed using a pressure or so-called bolus dressing with special sutures to ensure that the skin heals properly. This dressing is not removed until after approximately 5–7 days. When a skin graft is used, the outcome is good for superficial defects; however, for deep defects, a trough-like depression may remain.
Local tissue displacement (flap surgery) often has a better aesthetic result in the long term.
We will discuss with you in detail before the operation which type of defect coverage is suitable for you.
Hospital stay and anesthesia
The surgery can be performed under local anesthesia or general anesthesia. A hospital stay is generally not required for skin tumor removal.