Is conventional surgery the most appropriate treatment to solve my skin problem?
Te han diagnosticado cáncer de piel y quizá has oído hablar de varias modalidades de cirugía, seguramente te preguntarás: ¿en qué consiste la técnica? y ¿sería la técnica más adecuada para resolver mi problema?
You have been diagnosed with a skin cancer and you have heard about several surgical modalities, being conventional surgery one of them. You might have some related questions: what does the technique consists of? and would it be an appropriate treatment for me?
I will help you to clear up any doubt and then you’ll know if mohs surgery is indicated to treat your skin lesion
I am dr.
Throughout my professional career, I have been accumulated 20 years of experience in treating either benign or malignant lesions with conventional surgery,
Find out what conventional surgery consists of for different skin lesions
The conventional surgery is one the most practiced surgical processes in dermatology and it is done for the excision of benign and malignant skin lesions.
It consists of the removal of both the tumor and a variable peripheral surrounding margin of supposedly “healthy” tissue to ensure the complete removal of the tumor.
Removing these additional margins means that the size of the surgical defect and the resulting scar may be visibly larger than the initial tumor.
Although CC presents differences with respect to Mohs surgery, it represents a valid option (and sometimes it is the best alternative) in the case of the removal of tumors located in the trunk and extremities (also sometimes on the face) and in certain tumor types.
What are the 4 steps to follow during conventional surgery?
Surgery is a process that begins at the pre-surgery visit and ends when the scar is already fully formed.
In most cases, CC is performed in an outpatient basis under local anesthesia, without the need for hospital admission; however, in certain cases, such as complex tumors, or at the request of the patient, general anesthesia will be required.
what steps are we going to follow?
The surgical process begins in the visit prior to the surgery
where it is very important to take down all the relevant data about the patients’ medical history, inform them about the type of surgery that is going to take place, the need for postoperative care and also introduce the management of expectations of short and long term results.
The fact of having and providing the appropriate information will allow us to minimize and anticipate the possible complications that may arise and build a relationship of trust between doctor and patient that will undoubtedly make the entire process easier.
On the day of the surgery
it is recommended that you do not come driving in your own car and you come accompanied by a family member or friend.
If it is an intervention under local anesthesia, you can eat a light meal at least two hours before the intervention and be fasting if you must undergo general anesthesia or sedation.
I will notify you about the steps that we are going to follow next, whether it is information related to local anesthesia or the surgery itself, a fact that will allow you to maintain regular communication with us and also give you peace of mind and security.
Sometimes, within the CC, “perioperative or intraoperative biopsies” of the surgical margins are performed, which consist of performing the histological study during the surgical intervention, and has the objective of guiding the surgeon on the existence or not of tumor persistence. However, in this modality, neither the entire piece nor the margins are analyzed, but only a small part of the sample.
Once the surgery has been completed
it is recommended that the surgeon informs you about the postoperative duration of anesthesia applied during the intervention, the treatment of possible posterior pain, the probable complications that could appear and clear instructions on wound healing.
The first postoperative visit
is usually done within the first two weeks after the surgery, requiring in many occasions and in function of the type of surgery that was performed, a closer monitoring, being able to indicate a first check up in the first 3 postoperative days to check the condition of the wound.
1. Margins of healthy skin:, CC is performed taking a “fixed” and standardized length of margins of visibly healthy skin around the tumor.
2. Processing of the removed tumor: In Mohs surgery, the entire excised sample is examined in situ, while in CC only a small percentage of the specimen is analyzed (generally at the level of the margins of the specimen) and delayed.
3.Duration of intervention: The fact that Mohs surgery allows, in most cases, the processing and analysis of the tissue simples excised at the same time of the intervention, makes the duration of this technique longer than the CC, since in the latter, the excised piece is sent for analysis by the pathological anatomy after the surgery.
The length of the peripheral margins of healthy skin to be removed in cases of malignant tumors varies depending on the type, size and location of the tumor, but, as a general rule, it usually ranges from 4mm to several cm
The excised piece will be examined later and deferred (after surgery) by a specialist in pathological anatomy, who will determine if the tumor has been completely excised with free margins (clean of tumor) or if, on the contrary, the margins are affected and there is tumor persistence
In general, it is not recommended to discontinue antithrombotic therapy before dermatological surgery because the potentially higher risk of serious thrombotic complications would outweigh the less significant risk of bleeding.
However, it would be convenient to individualize the decision-making regarding the management of antithrombotic treatment before the surgery, based on the medical situation of each patient, taking into account the type and number of antithrombotic drugs that they take, associated comorbidities, tumor size and the type of surgical reconstruction planned.
Mohs surgery is associated with a low complication rate, which is usually less than 5%. The complications that can occur on certain occasions are:
- Wound infection:.
- Flap/graft necrosis
- Intense and/or prolonged postoperative pain, which may or may not be associated with the previously mentioned complications.
PLEASE CONSULT IN THE EVENT OF ANY POST-SURGICAL COMPLICATION IS SUSPECTED, LIKE BLEEDING, INTENSE PAIN AT THE LEVEL OF THE WOUND AND FEVER
The pain that patients experiment after the dermatologic surgery is usually a mild one and generally is controlled by common pain relievers.
Between the factors that have been associated with this postoperative pain exists the presence of anticipatory anxiety or the fear of the patient’s own pain and the factor of having removed more than one tumor injury.
Paracetamol can be used to manage this pain, reserving other drugs such as metamizole, opiates and NSAIDs for specific situations that require it