The removal of skin lesions is performed either for diagnosis, and cure from skin cancer, or for cosmetic reasons.When excising a benign, soft tissue mass, it is the goal to remove the lesion with the thinnest, shortest scar, and the most favorable orientation possible. Also when the tissue is removed, it will be sent to the Dermpathoplogy laboratory for histopathologic (analysis of the tissue under the microscope) assessment and final diagnosis.
If a malignant skin lesion has been diagnosed by the biopsy procedure, surgical excision of the skin cancer is usually warranted. In the early stages this is usually a small, simple procedure. If the skin cancer has progressed, and depending on the anatomical location and the stage of the skin cancer, curative treatment may be more involved. With excision, (and histopathological confirmation that the skin cancer has been removed completely), reconstructive plastic surgical procedures may be beneficial to restoring your normal appearance.
Basal cell carcinoma, squameous cell carcinoma and malignant melanoma are the most common types of skin cancers.
Basal cell carcinoma is a skin cancer that usually rises in sun-exposed areas and tends to grow in one location (that is it does not readily spread to other areas of the body). Basal cell carcinoma, however, in certain locations, has the tendency to grow deep in former embryological fusion zones, especially in the face. It is critical to be aware and knowledgeable about those zones, so as to modify removal techniques to eradicate these skin cancers completely and forever. There are different histologic types of basal cell carcinomas which show different growth and expansion patterns, that affect surgical treatment plans, recurrence rate and surveillance check-ups. As previously said, basal cell carcinoma usually does not metastasize (spread) to other parts of the body, but it can be locally destructive, particularly if there is a prolonged wait before seeking curative treatment. So it is best to address its removal at an early stage, completely and comprehensively, in order to avoid more involved surgery with more complex reconstruction and often visible scarring.
Squamous Cell Carcinoma of the skin is a skin cancer, that has a higher (10%) chance of spreading to other parts of the body. Like basal cell carcinomas it usually develops in sun exposed areas of the body, but it is more aggressive than basal cell carcinoma. Surgical excision with histopathological analysis is typically required to treat this form of skin cancer optimally. A common precursor (premalignant) of squamous cell carcinoma is actinic keratosis, which affects only the very superficial layers of the skin. Actinic keratosis presents usually as a scaly, red patch which, if left untreated may progress into squamous cell carcinoma. Actinic keratosis does not require surgery; instead it can be treated locally with different topical anti cancer creams, and shielding from excessive sun exposure.
Once a patient had been diagnosed with any type of malignant skin cancer, it is important to assess the body for similar additional lesions and to undergo regular skin surveillance examinations.
The incidence of malignant melanoma has multiplied within the past years, and the prevalence rates continue to increase. Most commonly melanoma affects fair skinned people with a history of sun exposure or a positive family history of malignant melanoma. Malignant melanoma is responsible for about 4% of all skin cancers, and has a wide range of risk to the affected indivuidual’s health from simple to serious consequences. Early treatment of melanoma provides the best opportunity for cure.
Any suspicious lesion should be assessed using the ABCDE analysis:
Suspicious skin lesions should be either biopsied or excised for further histopathological evaluation. If the diagnosis returned is malignant melanoma, the depth of the skin level is an important indicator of outcome, as is the involvement of the lymph nodes, and other organs of the body.
Simple excision alone can be performed in premalignant lesions. If true melanoma is proven by biopsy usually a wider excision is warranted. If the level of melanoma is deeper, an additional “SENTINEL NODE” biopsy is indicated for staging purposes to determine further treatment plans. Understanding and treating melanoma is especially important for achieving a cure form this form of skin cancer.Malignant melanoma treatment is clearly more involved than most other skin cancers. The Yale Melanoma Center was part of Dr Bianca Knoll’s plastic surgery training at Yale, which was dedicated to clinical and basic research for curing melanoma. This expertise has contributed to the establishment of an internationally recognized, and highly effective, strategies for the diagnosis and treatment of malignant melanoma.
The decision making process for optimal treatment is based on, first, the correct diagnosis, then an individualized surgical treatment plan with associated reconstructive measures, ending with the appropriate follow up care. This requires knowledge and expertise and a thorough understanding of oncologic management principles. Therefore, Dr Knoll has opted to work together with an internationally recognized pathology laboratory that is specialized in dermatopathology, and is therefore able to diagnose even the most challenging of cases with the most currently available techniques. This means more appropriate, and specific treatment for you, enhancing the potential for both cure and normal appearance.
The treatment of skin cancer can entail different stages ranging from biopsy to removal, to reconstruction, and medical oncological treatments. It is quiet difficult to provide any estimated costs without having examined and talked to the patient. It is easy to understand that the costs of the surgery will vary depending on the complexity, length of the procedure, hospital stay, and the details involved. Usually there are 4 different costs associated with a surgery; the surgeon’s fee, hospital fee, dermpathology fee, and anesthesia fee. Most skin cancer cases are fully or partially covered by your health insurance. Costs related to excision of benign skin lesion removal for cosmetic reasons, is not covered by health care insurances.During your office consultation with Dr. Knoll you will be thoroughly examined, allowing us to provide you with information pertaining to surgery, post operative expectations and cost associated with your individual surgery plan. For these reasons a consultation in our Frankfurt office is strongly encouraged. We understand that it can be impractical for some of our out of town / or international patients to travel to Frankfurt for an initial consultation. For this reason, Dr. Knoll offers online consultations. By submitting a series of photographs, information abut your desired outcome, and a little about yourself, we can start to determine if you are a good candidate. Though a virtual consultation starts the consultation conversation, it does have it’s limitations and does not replace the need to be seen in person for a traditional consultation to finalize plans for a procedure.
During your consultation Dr Knoll will carefully listen to your concerns, examine you and thoroughly analyze your case. She will then discuss the assessment, explain your case with you, and your available treatment options. In some cases additional radiographic imaging and a team of consulting services will be required. If you have already a histological diagnosis, a referral of another physician, or results of any diagnostic imaging, please bring a copy with you to your consultation. Old operative reports are also very helpful. Some patients prefer to send those medical documents to us, prior to their consultation appointment. The more information Dr Knoll has about your case, the more conclusive your consultation will be. Medical photographs will be performed during your consultation. You will also receive further information about any type of preoperative testing required and additional information about the procedure.Choosing an experienced plastic surgeon who has performed reconstuctive surgeries of the nose, rhinoplasties and craniofacial surgeries, using modern and advanced techniques is important. If you wish to have additional information or would like to schedule a consultation please contact the office of Dr. Bianca Knoll, we will be happy to assist you.