Dermatologic surgery in Tunisia

Skin tumors types?

Benign and malignant tumors

The "soft tissue" category includes all body tissues other than bones and organs: muscles, fat, fibrous tissues, blood vessels. Tumors can develop on his tissues and must be treated by surgical excision.

There are three types of skin tumors:

Benign tumors

They may be excised when they are likely to progress to malignancy (the excision is then performed as a preventive measure). Benign lesions can also be excised if they are troublesome (causing friction and irritation due to their location) or because they are unsightly.

There are several common forms of benign tumors:

Naevi (or moles) are benign pigmented tumors of melanocyte origin that develop from the basal layer of the epidermis. Under the effect of several factors (repeated sun exposure, genetic factors, mechanical irritation), naevi are likely to carcinize in the form of melanoma.

Cysts are glands whose secretions accumulate in a pocket.

Lipomas are very common fatty tumors. Despite their insensitivity, they are sometimes perceived as embarrassing because of their situation or their volume.

Basal cell carcinomas are frequent lesions that account for about 60% of all skin cancers. Although they never give rise to metastases, it is important not to let this type of lesion evolve to avoid ulceration.

Doubtful tumors

In a visual examination, it is not always possible to diagnose the benign or malignant nature of a lesion. In this case, they are subjected to microscopic examination after surgical removal to confirm the diagnosis. The benign tumors described above may be considered "dubious" as long as their appearance is unusual.

Any doubtful tumors or skin lesions must be examined by a doctor who can examine them histologically (examination of tissues). Only a doctor can diagnose if a tumor is benign or malignant and advise you on the proper treatments. If you notice a size or lesion, it is important to consult a doctor as soon as the prognosis depends on the early diagnosis and treatment.

Malignant tumors – Skin cancer

These tumors correspond to skin cancers and must be surgically removed by excision in the majority of cases. Exeresis will be performed with a "safety margin" around the tumor to limit the risk of recurrence. These may be epitheliomas, melanomas or sarcomas.

Soft tissue sarcomas are types of cancer whose diagnosis is made difficult by their great variety and scarcity. Unlike sarcomas, benign tumors are usually superficial and small in size (less than 5 cm). Sarcoma can be diagnosed by the appearance of a mass that develops on soft tissue, more often in the limbs than in the trunk, neck or head.

Skin tumors excision

An excision is a reconstructive surgery procedure that involves removing a harmful element to the body (tumor, organ or foreign body).

In the case of benign tumors, surgical excision removes skin lesions for aesthetic reasons or because of functional discomfort. When the excision is performed for strictly aesthetic reasons, it is important to discuss with the surgeon the possible scarring ransom of the procedure. 

The removal of a tumor, even benign, requires a very high precision insofar as the excision should be performed with a sufficient margin around the tumor to avoid any risk of recurrence. The sufficient margin around the tumor varies according to the lesion treated, hence the importance of preoperative diagnosis.

In the case of simple resections, the procedures end with the placement of stitches. In the case of lesions requiring deeper resection, repair of the loss of substance is necessary (flap techniques, epidermal grafting).

The procedure lasts between 20 minutes and two hours depending on the type of skin lesion treated.

The procedure is generally performed under local anesthesia and outpatient.

Following this  plastic surgery procedure, a piece of skin removed is sent to a laboratory for examination to confirm that the excision is sufficient and that the margins of resection are well located in healthy tissue.

Postoperative surgical excision of cutaneous tumors

The surgical follow-up of a benign cutaneous tumor resection is generally simple even if one must be vigilant in case of unusual manifestations (swelling with redness, abnormal sensitivity, beginning of purulent flow).

Postoperative histological analysis confirms that the excision is complete and benign.

A strict medical follow-up is necessary to control the cicatrization and the possible recurrences. The development of cutaneous tumors at another location may be encountered, particularly in cases of basal cell carcinoma. Skin monitoring performed by the referring physician or a dermatologist can detect early forms of tumors.

Itching is quite common during the first days of the healing phase.

As long as the scar is still dark, avoid prolonged sun exposure or use "full screen" protection. 

A delay of several months (or even a year or two) is necessary to assess the final appearance of the scar. Scar removal surgery can be planned after 12 or 18 months.

An excision is a surgical procedure that presents the risks inherent to anesthesia as well as the surgical procedure. 

Smoking increases the risk of surgical complications of any surgery. Stopping smoking 6-8 weeks before the procedure eliminates this additional risk.