Removal of skin tumours

Changes in the skin or the subcutaneous tissue can be benign or malignant in nature. Benign skin tumours are removed if they disturb a patient functionally or cosmetically. The removal of malignant skin tumours is always indicated and medically necessary.

Switzerland has one of the highest rates of skin cancer worldwide with 15,000 cases per year. The diagnosis of skin cancer and the determination of the appropriate therapy belong in the hands of experienced dermatologists. The surgical removal of the tumour and the reconstruction of the resulting tissue defect are ideally performed by a plastic surgeon.

Dr. Inja Allemann combines both: she is the only doctor in Switzerland with a double board certification in dermatology and plastic surgery. Accordingly, Dr. Allemann is uniquely positioned not only to make the right diagnosis for you as a dermatologist and to find the appropriate form of therapy, but also to assist you professionally, competently and actively as a surgeon during surgery and follow-up.

With Dr. Allemann, Rivr sets new standards in offering competent medical care under one roof. You save time and avoid the loss of information that can occur again and again in the event of referrals to other doctors and locations. From the first step of the diagnosis up to the follow-up, we go all steps together. From the diagnosis to the scar treatment the same team is at your side.

 

The three most common types of skin cancer are:

• Melanoma (black skin cancer)
• Squamous cell carcinoma/spindle cell carcinoma (white skin cancer/ non melanoma skin cancer)
• Basal cell carcinoma (white skin cancer/ non melanoma skin cancer)

Melanoma

Melanoma is the most dangerous and aggressive of all skin cancers. The malignant cells multiply and in advanced cases develop metastases in various organs. Patients in Switzerland are particularly affected: Every year roughly 2500 people get diagnosed with a malignant melanoma. Almost one third of the patients are under the age of 50 at the time of diagnosis.
With the help of regular preventive examinations and skin checks, melanoma can be diagnosed early, which has a lasting positive effect on the prognosis and chances of recovery.

In women, melanoma occurs primarily on the lower legs, in men on the back. Causes for melanoma are multifactorial. The most common cause is strong UV exposure, with repetitive sunburns, especially in childhood – the skin does not forget a ray of sunlight. But a genetic predisposition can also be one of the reasons.
Since every third melanoma develops from a birthmark, a regular examination of moles is particularly important. The principle here is: the more birthmarks you have, the higher the risk of melanoma.

There are different types of melanoma that can differ greatly in their appearance. If you notice the following change(s), you should consult a dermatologist:

• Change in the colour of the birthmark, in particular darker colours or an irregular pattern
• Growth of the birthmark (>5 mm)
• Different appearance in contrast to other moles (ugly duckling sign)
• Spontaneous bleeding or itching of the birthmark

If there is a clinical suspicion of a melanoma, it is surgically removed and the tissue is examined microscopically and with special staining by a specialist. If the diagnosis of melanoma is confirmed, further therapy follows the Swiss guidelines for the treatment of melanoma. Melanoma patients are often treated in an interdisciplinary manner by a team of specialized doctors consisting of dermatologists, oncologists, radiologists, radiooncologists and surgeons, and therapy decisions are made jointly within the framework of a tumour board. Dr. Allemann and her double board certification in dermatology and plastic surgery combine two important milestones on the way to your recovery.

Non-melanoma skin cancer

Non-melanoma skin cancer is the most common skin cancer and includes spindle cell carcinoma and basal cell carcinoma. Both types typically occur at an advanced age, after the skin has been damaged by UV radiation for many years. According to this, in most cases areas affected are those particularly exposed to the sun, such as the face, ears, bald scalp, but also the back of the hands and forearms. Non-melanoma skin cancer also frequently occurs on the nose. The tumours can look very different, but new, growing skin changes or bleeding wounds without trauma are always suspicious and should be shown to the dermatologist.

Spindle cell carcinoma

Squamous cell carcinoma is a malignant tumour that grows destructively and can also metastasize. It usually occurs at an average age of 70 years and in sun-damaged skin. Men are affected twice as often as women and 90% of tumours occur in the head area, such as on the bald scalp, forehead or lower lip.

Basal cell carcinoma

Basal cell carcinoma also occurs at an advanced age on sun-damaged skin. Typically from the age of 60 and up to 80% in the head and neck area. Of all skin cancers, basal cell carcinoma is the least dangerous because it usually grows slowly and rarely metastasizes.

In the treatment of skin tumours, the type of tumour as well as its extent and size are decisive. The early stages of many skin tumours, as well as certain small tumours, can be treated with non-surgical procedures, such as cryotherapy directly in consultation. However, the gold standard of tumour treatment is complete surgical removal with histopathologic examination of the tissue.

Depending on the type, size and location of the tumour, various surgical techniques are used, such as micrographically controlled surgery and special processing techniques such as “Slow Mohs”.

Depending on the type of skin cancer, some tumours must be excised with defined safety margins in order to reduce the risk of recurrence to an absolute minimum. This means that certain tissue defects can be closed directly, while others require plastic surgical reconstruction with various flap techniques. Since the majority of these tumours are located in the face, a particularly high level of plastic surgery expertise is of utmost importance.

In the case of certain tumours with particularly unpredictable growth patterns, or in sensitive areas such as the eyelids, we operate in “two-stages”: We first remove the tumour with a clear margin of normal looking tissue and sent to the laboratory to confirm the diagnosis. The defect is closed with a temporary bandage. Only after the result of the tissue examination (usually after 3-5 days) is available and confirms that the tumour has been completely removed with the required safety margin is the defect closed by reconstruction. This provides us the utmost security and the possibility to remove any residual tumor without destroying a definitive reconstruction.

The complexity of the tumor treatment described above – from diagnosis and therapy to surgical reconstruction – emphasizes that sound basic knowledge and experience are the prerequisites for the appropriate treatment of a patient from A to Z. The treatment of tumors is based on the following principles: Dermatologists normally make the diagnosis and then assign the patients to a plastic surgeon for the surgical procedure. But it works better from a single source: Dr. Inja Allemann has performed more than 1000 operations in this field at the University Hospital of Zurich in over 3 years. Her additional training in Mohs surgery in the USA also makes Dr. Allemann a proven specialist in this field as a plastic surgeon and dermatologist.

Since the majority of cases involve tumours in the facial area, a plastic surgical reconstruction of the resulting tissue defect is of central importance in order to achieve a functional but also aesthetic result.

The treatment of skin tumours is covered by the health insurance companies.

If you notice a new or changing or skin lesion, we recommend a visit to our office. Together we will take a close look at your skin and find the next suitable steps in each case.

The first step is the clinical evaluation of the suspicious skin lesion, with one of the most important aids of the dermatologists: the dermatoscope (epiluminescence microscopy). This special examination allows us to assess the skin change exactly with several magnifications and strong light and to make a diagnosis according to clear criteria of color and pigment-network.

Depending on the clinical diagnosis, a decision is made as to which therapy should be used to treat the tumour. If necessary, the therapy can take place directly in the consultation hour. If surgical intervention is necessary, it will be discussed with you in detail and planned in our certified operating theatre within the next few days.

The surgical removal as well as the reconstruction of the tissue defect always take place in our certified operating theatre and can usually be performed on an outpatient basis. In certain cases, e.g. in elderly patients with blood thinners, a hospital stay of 1-3 days may be necessary.

A simple excision usually does not take longer than 30 minutes. If the tissue defect has to be closed with a reconstructive procedure, it usually takes 60-90 depending on the size and complexity. In most cases, the procedures are performed under local anaesthesia. As soon as you have recovered from the operation, you can go home again. We recommend that you be picked up by an accompanying person.

The surgical site is protected with a bandage, which you should wear for a few days. After 5-7 days, we will be happy to perform the first dressing change in order to assess the wound and the healing progress. At this time you will also be informed of the results of the tissue examination. In the area of the face, the stitches are removed after 5-7 days, in the area of the body after 10-14 days.

As with any surgical procedure, you will feel slight pain in the first few days. For this you will receive adequate painkillers and we will be there for you in case of any questions. We will accompany you from the first presentation at our clinic until the wound has healed and the scar matured. But we would also like to see you again afterwards. Since follow-up of skin cancer is of central importance, we recommend 6 to 12-month clinical check-ups, depending on the diagnosis.

Every operation involves surgical and anesthesia-related risks. There is an increased risk of surgical complications, especially for patients who smoke or suffer from obesity or diabetes.

Risks associated with any surgical procedure:

• Bleeding
• Haematoma
• Wound infection
• Unfavourable or excessive scarring
• Poor wound healing
• Thrombosis

Risks of surgical removal of skin tumors:

• Incomplete removal of the tumor (requiring repeated excision)
• Poor healing of the skin graft (if used)
• (Partial) necrosis of the reconstructive flap

Make an appointment today to have your skin professionally examined.

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