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The purpose of surgical dermatology is to repair and/or improve the function of skin tissue. This includes focusing on the management of the skin, hair, nails and veins. Each procedure is individualized depending on the body location, patient’s age and any previous treatments to the area. Because of clinical advances and new technology, the majority of dermatologic surgeries are now minimally invasive and require only local or regional anesthesia. These advances provide patients with improved patient safety while reducing "downtime" recovery.
Some of the basic surgical dermatology procedures are explained below.
To perform a skin biopsy, your dermatologist first numbs the area with an injection. Once the area is numb, your provider removes some (or all) of the growth. This is sent to a lab, where a dermatopathologist or a board certified dermatologist will examine the specimen under a microscope. A dermatopathologist is a dermatologist who receives specialized training in examining skin samples. Many rashes that cannot be diagnosed with the naked eye can be better investigated with a biopsy. The only way to know for certain whether a growth is skin cancer is to examine it this way under a microscope.
This treatment destroys visible lesions by freezing them. The treated skin often blisters and peels off within a few days to a few weeks. This is a very common treatment. When the skin heals, you may see a small white mark is left behind. Discomfort is minimal and the procedure is quick.
Electrodessication and Curettage
Electrodessication and curettage involves rubbing the tumor with a sharp metal loop then destroying the affected tissue with an electrocautery device. Many times the diseased tissue can be differentiated from the normal tissue by the texture felt while scraping. This process is repeated several times to ensure complete removal of the tumor. This procedure is useful for small tumors less than 6 mm because it tends to leave only a small scar.
This procedure involves surgical excision of the lesion including a margin of normal skin. This method is preferred for larger lesions (>2cm) on the cheek, forehead, trunk, and extremities. The advantage of this treatment is that it provides a better cure rate then simple destruction with curettage.
Photodynamic therapy (PDT)
This treatment is used most commonly to selectively target cancerous and pre-cancerous tissue of the skin. A solution is first applied to the skin to make abnormal tissue more sensitive to light. After this solution is left on the skin for 1-2 hours, the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and selectively destroys the pre-cancerous tissue. As the skin heals, new healthy skin appears. This treatment modality has also been found to be effective for treating acne vulgaris in some patients.
Based on the severity of the skin cancer, if a skin cancer is found in an area of the skin that makes surgery difficult, or if a patient isn’t fit for surgery, radiation therapy may be required. It may be used alone or in combination with other treatment options and is performed by a radiation oncologist, who works in tandem with your dermatologist for treatment planning. Although radiation therapy is not used as often as surgery, it remains an important treatment option for suitable patients. Learn more about radiation therapy.