Skin tumors

(Tumor = new tissue formation, benign or malignant)

What is a skin tumor

A skin tumor is a skin change or new tissue formation on the skin that can be either benign or malignant. Skin tumors are often noticeable due to a change in skin color and texture. Blurred spots and skin lesions, reddening of the skin, scaly or scabby changes, bleeding skin lesions or non-healing, chronic wounds are always suspicious and should be clarified by taking 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 forms metastases extremely rarely. Squamous cell carcinoma can form metastases, e.g. in the lymph nodes, lungs or liver. In addition to the lymph nodes, lungs and liver, malignant melanoma can also spread to the bones and brain. Special examinations must be carried out here so that we know what stage of the disease you are at and what additional therapy (radiotherapy, chemotherapy, etc.) may be suitable 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 change, a small tissue sample is usually first taken through a pin-shaped skin punch cylinder (1-4 mm in size) and examined tissue-wise (so-called "sample 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 cut surface, the edge of the tissue should be recut. In these cases, the skin defect is closed again with fatty gauze or an artificial skin (Epigard), as described above, and the tissue examination is awaited again.

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 displacements (local displacement/swivel, rotation flaps) or tissue displacement stanched on a vessel (e.g. skin-fat flap from the forehead in the case of larger nasal defects = forehead flap)
• Full-thickness skin graft: An area of skin the size of the tissue defect is removed from the back of the ear, neck, inner side of the upper arm or groin, for example, and sewn into the defect.
• Split-thickness skin graft: With a so-called skin knife,
  Called a "dermatome", a superficial area of skin of a certain size and thickness (0.2-0.6 mm) is removed from the thigh, trunk or head and sutured into the defect.

A skin graft is often pressed against the wound bed with a pressure or so-called bolus dressing with special sutures so that the skin heals well. This dressing is only removed after approx. 5-7 days. If a skin graft is used, the result is good for superficial defects, but a trough-shaped depression may remain in deep defects.

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 operation can be performed under local anesthesia or general anesthesia. A stay in hospital is not usually necessary for skin tumor removal.