Key Features
-
Shave or punch skin biopsies can be accomplished with minimal trauma and scarring.
-
Excisional surgery is appropriate for removal of benign and malignant cutaneous lesions, including cysts, lipomas, atypical nevi, and some melanoma and nonmelanoma skin cancers.
-
Mohs micrographic surgery is the gold standard for removal of nonmelanoma skin cancers at sites requiring tissue sparing, such as the head and neck, genitalia, and hands and feet. Mohs is also appropriate when cancers are aggressive or high-risk, and these categories include recurrent tumors, tumors larger than 2 cm in diameter, histologically aggressive tumors, tumors associated with ionizing radiation, tumors in immunosuppressed patients, and tumors penetrating below muscular fascia. Mohs is used by some for treatment of melanomas, particularly of in situ melanoma.
-
Melanoma is treated by wide local excision, with depth to muscle and peripheral margin contingent on the Breslow depth of the melanoma. Peripheral margins may vary from 0.5 cm for in situ lesions (these can also be treated by Mohs) to 2–3 cm or greater for deeply invasive lesions.
-
Sentinel lymph node biopsy is becoming a standard of care prognostic procedure for melanoma of depth greater than 1 mm.
-
Bilayered repairs reduce the risk of dehiscence and provide improved cosmesis postoperatively.
-
Local anesthesia, commonly lidocaine with epinephrine, is sufficient for most dermatologic procedures.
-
Topical anesthetics and nerve blocks may be appropriate adjuvant anesthetics in special situations.
-
Surgery in children, such as removal of congenital nevi, may require general ane sthesia.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Further Reading
Alam M, Dover JS, Arndt KA (2003) Energy delivery devices for cutaneous remodeling: lasers, lights, and radio waves. Arch Dermatol 139:1351–1360
Alam M, Ratner D (2001) Cutaneous squamous-cell carcinoma. N Engl J Med 344:975–983
Anwar J, Wrone DA, Kimyai-Asadi A, Alam M (2004) The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes. Clin Dermatol 22:189–196
Baker S (2007) Local flaps in facial reconstruction, 2nd edn. Mosby, New York
Brodland DG, Zitelli JA (1992) Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol 27:241–248
Cook J, Zitelli JA (1998) Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol 39:698–703
Goldberg LH, Alam M (2004) Elliptical excisions: variations and the eccentric parallelogram. Arch Dermatol 140:176–180
Goldberg LH, Alam M (2003) Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip. J Am Acad Dermatol 49:685–689
Kimmel Z, Ratner D, Kim JY, Wayne JD, Rademaker AW, Alam M (2007) Peripheral excision margins for dermatofib-rosarcoma protuberans: a meta-analysis of spatial data. Ann Surg Oncol 14:2113–2120. Epub 2007 Apr 28
Lee KK, Swanson NA, Lee HN (2008) Color atlas of cutaneous excisions and repairs. Cambridge University Press, London, England
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. J Am Acad Dermatol 53:458–463
Leibovitch I, Huilgol SC, Selva D, Lun K, Richards S, Paver R (2005) Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol 52:295–300
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 53:452–457
Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R (2005) Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol 53:253–260
Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R (2005) Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. J Am Acad Dermatol 53:261–266
Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, Cheney RT, Glass F, Grekin RC, Grichnik JM, Kessinger A, Lee NY, Lessin S, Lydiatt DD, Margolis LW, Michalski J, Nehal KS, Nghiem P, Oseroff AR, Rosenberg EW, Shaha AR, Siegle RJ, Urist MM; National Comprehensive Cancer Network (2007) Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw 5:506–529
Rohrer TE, Cook JL, Nguyen TH (2008) Flaps and grafts in dermatologic surgery, 1st edn. Saunders, Philadelphia, PA
Rubin AI, Chen EH, Ratner D (2005) Basal-cell carcinoma. N Engl J Med 353:2262–2269
Walling HW, Scupham RK, Bean AK, Ceilley RI (2007) Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol 57:659–664
Zitelli JA (2004) Surgical margins for lentigo maligna. Arch Dermatol 140:607–608
Zitelli JA, Brown C, Hanusa BH (1997) Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol 37:236–245
Zitelli JA (1989) The bilobed flap for nasal reconstruction. Arch Dermatol 125:957–959
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Alam, M. (2010). Dermatologic Surgery. In: Krieg, T., Bickers, D.R., Miyachi, Y. (eds) Therapy of Skin Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-78814-0_12
Download citation
DOI: https://doi.org/10.1007/978-3-540-78814-0_12
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-78813-3
Online ISBN: 978-3-540-78814-0
eBook Packages: MedicineMedicine (R0)