Plastic Surgery Indianapolis
 
 
David Sterling Slatton, MD
Indianapolis Plastic Surgeon
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Mole Removal and Skin Cancer Treatments Indianapolis, IN

Mole Removal and Skin Cancer Treatment in Indianapolis, Indiana

Mole, Birthmark, and Age Spot Treatments

Treatment of unsightly moles is surgical excision and skin closure.  Better cosmetic results are obtained when the mole is removed and the resulting skin defect is closed with sutures.  Using relaxed skin tension lines, a better scar is obtained and fading usually occurs within a year or sooner.   Enlargement, itching, bleeding, and color change are common reasons for mole removal.    Types of moles that require excision are:

Dysplastic nevus

Junctional nevus

Benign nevus

Melanoma in situ

The diagnosis of the type of mole that is removed is made by examination of the excised mole by a pathologist. 

The Dysplastic nevus syndrome requires close follow up and photographic documentation at yearly intervals.  Family or personal history of melanoma will require close and frequent follow up and should lower the bar for removal of moles. 

Birthmarks can also be unsightly, and even a health risk.  Some may degenerate into malignant melanoma.  Surgical excision is the gold standard for treatment of birthmarks.  Large birthmarks may require serial excision over a period of months or years, skin grafting, and possibly the use of tissue expansion to create enough skin for closure of the resulting defect from excision of the birthmark.

Age spots can vary from melasma to seborrheic keratosis.  Brown spots that are not raised can be treated with creams that contain hydroquinone.  Raised or “stuck on” appearing brown spots may be seborreic keratosis and these can be treated by excision.  Scraping a seborrheic keratosis is a temporary treatment as the lesion will eventually return.

Skin Cancer Surgery

Skin cancer can be treated with excision or occasionally the use of a skin chemotherapeutic agent such as Effudex. 

The optimal and most conclusive treatment for skin cancer is excision.  This allows for the tumor to be removed and for diagnosis of the cancer to be made by microscopic examination by a pathologist.  The resulting defect can be closed directly, with a local skin flap, or a skin graft (either full thickness or partial thickness) 

Types of Skin Cancer -

Basal Cell Carcinoma  Sun damage causes this cancer… it is the most common type of skin cancer, and the most curable.   Excision and closure are the most common treatments.  Occasionally, topical chemotherapeutic agents may be of benefit for superficial spreading basal cell carcinoma.  Radiation therapy may be necessary in some instances.

Squamous Cell Carcinoma-the second most common type of skin cancer…sun damage and malignant degeneration of actinic keratosis are common risk factors.  These cancers are best treated by excision and closure of the resulting defect.  Depending on the size and location, local flaps or skin grafts may be required to close resultant defects.

Melanoma – malignant melanoma can be a fatal disease.  It is treated with careful and deliberate planning and surgical excision.   Depending on the microscopic thickness and level of invasion, treatment may require removal of lymph nodes that are in proximity to the location of the melanoma.  Melanoma in situ is treated by surgical removal alone.   Even with the complete surgical removal of melanoma, close and consistent follow up is recommended for everyone who has had melanoma

Skin Cancer Removal

Excision (surgical removal) is the definitive treatment for skin cancer.  This is usually done under local anesthesia in the office setting.    The skin cancer is submitted to the pathologist for proper examination.  Clear margins (normal tissue surrounding cancerous tissue) is the goal of the procedure.   Many times, the defect resulting from the skin cancer excision is closed in a single line along relaxed tension lines of the skin (Primary Closure).

MOHS Surgery – this surgery is really a very slow and prolonged method of surgically removing skin cancer.  It involves removing very tiny slivers of skin and pathologically examining every sample.  The idea is to spare normal tissue and more accurately remove all tumor that exists microscopically.  However, the skin cancer removal results of Mohs excision are no better than having the skin cancer removed with an anticipated margin of normal tissue and simultaneously closing the resultant defect with a local tissue flap or skin graft. Often Mohs surgery is done by a dermatologist who then leaves the patient with an open wound which is not closed until the patient is seen by a plastic surgeon and treated with definitive closure. This means having an open wound on the face or body until an appointment can be made for definitive surgical closure.  Therefore, for an overwhelming majority of skin cancers, Mohs Surgery is entirely unnecessary.

Reconstruction after Skin Cancer Removal

Primary closure -  People seek a plastic surgeon when they have a skin cancer is for a nice and imperceptible closure and resultant linear scar.  While this is achievable in many instances, there are times where more complex procedures need to be performed.

Local flaps—certain defects require the rotation of normal adjacent tissue to fill a void in soft tissue for best cosmetic results.  Local flaps are of similar color and thickness; features which provide an asethetic advantage.

Skin Grafting

Split thickness skin grafts   These skin grafts are referred to as “split thickness” because the dermis is divided along the undersurface of the skin.  Split Thickness Skin grafts can be a temporary or permanent closure for large areas of soft tissue loss.   The skin is removed from one area of the body and applied to the area of soft tissue loss.  Skin grafts work well to cover areas where soft tissue loss occurs from injury or burns.

Full Thickness skin grafts- These grafts are best for defects of soft tissue in the facial region as well as the hands and extremities. The full thickness of the dermis is used for this type of skin graft.  This allows for a better color match in many instances. 

Tissue Expansion – Larger defects of soft tissue resulting from skin cancer removal may require coverage of full thickness skin, subcutaneous fat, and fascia both for improved cosmetic and functional result.  A tissue expander placed beneath the skin and deep tissue will enlarge the area so that it can be rotated into the adjacent area of soft tissue defect.

Nasal Reconstruction-  when the nose or significant areas of the nose are destroyed by cancer or trauma, reconstruction of the nose may be required

Skin Cancer Surgery Results- After skin cancers are removed and closure of the resultant soft tissue defect is completed, healing takes place over the ensuing months.   It is important to follow your plastic surgeon’s recommendations for care of the operated area for best cosmetic/aesthetic appearance.   It is best to follow up with post operative appointments as well as long term follow up depending on the type of skin cancer.

Skin Cancer Surgery Benefits- Most skin cancers are easily curable with early intervention and close follow up after removal.  The longer someone waits for skin cancer diagnosis and treatment, the more problematic and dangerous the skin cancer can become.