Plastic & Reconstructive Surgery - Skin

 
Skin Cancer

Scar Management

Complex Wounds

Benign Skin Lesions
Plastic Reconstructive Surgery Skin Hampshire

Skin Cancer

What causes skin cancer?

By far the biggest cause of skin cancer is sun exposure. There is a significant genetic component also. The commonest skin cancer is Basal Cell Carcinoma (BCC or 'rodent ulcer'). This is a relatively well behaved cancer as although it can grow quite large if left alone, it does not spread to other parts of the body and can be removed easily if caught early. The next commonest skin cancer is Squamous Cell Carcinoma (SCC). This cancer behaves in a variable fashion and, although it has the potential to spread around the body, this is very unlikely if it is caught early.

The final kind of skin cancer, for the purposes of this information page, is malignant melanoma. This behaves the worst of all skin cancers and the incidence of melanoma is increasing year on year. Again, if caught early enough, surgery can be curative, so close surveillance of your skin, particularly if you have lots of moles, is essential.
Skin Cancer Images Hampshire   
  BCC                                        SCC                                        Melanoma

What are the treatment options?

Skin cancer can be treated by surgery, radiotherapy, or topical creams

At your initial consultation, I will closely examine the area of concern and decide upon a treatment plan. If I suspect a small and shallow BCC, then a special cream may be all that is required. Thicker BCC, SCC and melanoma are more likely to require excision.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.

The excised lesion is sent off to the lab to be looked at under a microscope to be absolutely sure what the diagnosis is and to make sure the whole thing has been removed.

Sometimes it is not possible to simply suture the excision wound closed. For example, the tumour may be too large or it might be in an area that does not have very much loose skin. In these cases, I would need to use plastic surgery techniques to close the wound to allow healing. This usually involves moving the local skin around in such a way as to allow closure and may require borrowing skin from somewhere else on the body (skin graft).

Following surgery, we would meet again in the clinic with the lab results. Based on these, we would make a further plan if necessary. For more information, please visit this website.
 
Scar Management

What is scar management?

Unfortunately, modern science has not yet come up with a way of avoiding scars. It is a misconception that plastic surgery is 'scar-free' surgery. Any cut to the skin will make scar tissue, it's just that plastic surgeons use techniques that make the scars as invisible as possible who can benefit from scar management?


Scarring can cause problems for some people:

    1) It can be unsightly
    2) It can form across a joint leading to tightness
    3) It can itch or be painful    

How is it done?

We have several methods at our disposal for improving scars. Wide scars can be made narrower. Lumpy scars can be revised by excision or injections of steroid. Contracted scars, or scars that run in a direction that is cosmetically unfavourable can be improved by techniques such as 'Z-plasty'.

At your initial consultation, I will examine your general health and we will then discuss in detail exactly which scar or scars are causing concern and how best to deal with them.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent.

What are the risks?

There are very few risks associated with scar management. Bleeding, infection, and continuing scarring are the most common.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is usually performed under a local anaesthetic (with you awake), but may be a general anaesthetic (with you asleep) if the scarring is extensive.

After the Surgery

Scar management is usually a day case procedure. You will be fine to leave the hospital on the day of your surgery.

One or two  weeks after your surgery you will visit the dressing clinic to have the dressings changed and any sutures removed.

Returning to work and play

As a general rule, scar management should not have any effect on your day to day life except to make it easier.

It is important to understand that scarring takes up to 2 years to fully mature, so although the scar revision may look pink and raised to start with, it is likely to soften and settle over the coming months.


 
Complex Wounds

What are Complex Wounds?

Some wounds take a long time to heal and can present an ongoing problem to the sufferer. Months and months of dressings can be distressing and debilitating.

There are many reasons as to why wounds do not heal. Smokers heal less efficiently for instance. In addition, the presence of dead (necrotic) tissue inside a wound, the presence of foreign material, infection, or a poor blood supply will all contribute to delayed wound healing.

What can be done?

There are now various novel techniques available to plastic surgeons for the management of complex wounds. Adequate debridement of unhealthy tissue can be achieved both surgically and through the appropriate use of dressing materials.

Even medicinal maggots placed on a wound can have a dramatic effect on wound health!
More modern techniques include skin substitutes and negative pressure therapy. It may be necessary to excise the wound completely back to healthy tissue and either rearrange the local tissues to allow closure, or use a skin graft.

Follow up

While you are undergoing complex wound management, you will be closely followed up by the specialist nursing staff in the dressing clinic and also by myself on a regular basis to check that things are progressing satisfactorily

Benign Skin Lesions

What are Benign Sin Lesions?

Benign skin lesions are all the ‘lumps and bumps’ that can be found in or under the skin that are not cancers. This would include moles, warts, cysts, lipomas (benign fatty lumps under the skin).
 
Benign Skin Lesions Hampshire

Why have them removed?

There are a number of reasons as to why you might want a benign lump removed. For example:
    
1)    It is unsightly
2)    It is painful or itchy
3)    It gets in the way or catches on things
4)    It interferes with some function or other
5)    It has become infected or discharged

The surgery

The nature of the surgery very much depends on the size and site of the lesion to be removed. The majority of lesions may simply be excised and the wound sutured closed in such a way as to make it as inconspicuous as possible. Smaller lesions can be scraped off or treated by electrocautery.
In rare cases, more advanced plastic surgery techniques such as flaps and grafts may need to be used, but this would be fully discussed with you at our initial consultation.

The risks of surgery

All surgery carries some degree of risk and uncertainty. Benign lesion removal is considered minor surgery and is performed under local anaesthetic (with you awake) as a day case procedure. Even so, it is possible for there to be wound healing problems, particularly if an infection takes hold and occasionally this requires antibiotics. Even when a lesion is entirely removed, there is a risk of recurrence.

Remember that we will be swapping the benign lesion for a scar, so it is important that your reasons for going ahead with the surgery are clear and that we work together to achieve those goals.
 
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