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Reconstructive Procedures: Facial Plastic Surgery

Reconstructive Procedures: Facial Plastic Surgery

Reconstructive Procedures: Facial Plastic Surgery

Facial Skin Lesions, Skin Cancers And Their Management

Facial Plastic Surgery_3
There are many causes of lumps and bumps on the face. These can arise from any of the tissue of the face, and can be benign or malignant (cancerous). The aim of treatment of these skin conditions is complete excision with minimal distortion of facial appearance, whilst minimizing recurrence. With a deep understanding of facial lumps and bumps as well as extensive experience in facial anatomy and delicate soft tissue management, plastic surgeons are best placed to help achieve these aims.

Benign skin lesions

Common benign skin lesions of the face include skin inclusion cysts, lipomas, seborrheic keratosis, warts, and xanthelasma around the eyes (especially in patients with abnormally high cholesterol). While they can be left alone with no long-term harm, benign skin lumps can be unsightly and grow slowly to cause functional problems such as obstruction of vision, with some having the potential to turn cancerous. It is for these reasons that excision is recommended, with the lump being sent for testing to ensure that it is not more harmful than expected. Visual inspection of a skin lump by an experienced dermatologist or plastic surgeon can also help in determining the nature of the lump.

Malignant skin cancer

There are many types of skin cancer, with basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM) being the most commonly mentioned. Whilst chronic sun exposure is one of the main risk factors for skin cancer formation, other pre-disposing conditions include genetic preponderance as well as exposure to radiation and certain chemicals. BCC is the most common type of skin cancer, and along with SCC, is much less likely to spread to other parts of the body. However, they can be locally destructive and should be dealt with early to prevent the need for major surgery at a later stage. BCC commonly presents as a raised skin lesion with rolled borders, while SCC presents with ulceration and bleeding.
MM is the most feared form of skin cancer as it has a high risk of spread to the lymph nodes and other organs in the body. Whilst there are many subtypes of melanoma, it commonly presents as a black spot with irregular borders, forming and growing over weeks rather than months. MM should be excised with appropriate margins which are dependent on the depth of skin invasion of the cancer. Adjuvant treatments such as chemotherapy may be required depending on the extent of the MM.

Whilst there are some medical treatments available skin cancers, surgical excision is the mainstay of treatment. An incisional or excisional biopsy can help to determine whether a skin lesion is malignant. A clinical assessment of the lymph node basins may also be involved, and further investigations such as blood tests or X-rays and scans may be ordered.

Plastic surgery and the management of benign and malignant skin lesions

Plastic surgeons are involved in the entire spectrum of skin lesion management, from diagnosis all the way through to excision and reconstruction. If the resultant wound is small enough, it can be closed along relaxed skin tension lines to minimize scarring, while bigger wounds may require grafts or flaps to repair. With this entire armamentarium at their disposal, the plastic surgeon can discuss with you to select the most appropriate treatment modality. After surgery, your plastic surgeon can also coordinate other treatments that are required with dermatologists or oncologists.

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