Skin tumour/mole removal

Cutaneous tumours (or lesions) are marks or skin excrescences which may take various shapes, sizes and colours. There are many types of tumours from the simple mole (naevi) to the rare and hard to diagnose tumour. They may be present on the body from birth or appear later. Most of the time, they are diagnosed by your attending physician or your dermatologist, who send you to a plastic surgeon for the operation (surgical resection).

Soft tissues englobe all the tissues of the body except bones and organs: muscles, fat, fibrous tissues, blood vessels. Tumours can develop on the tissues and must be surgically removed.

There are two types of tumours:

• Benign tumours (minor):

They can be removed (resection) when they may become malignant (a preventive removal is carried out). Benign tumours can also be removed if they are disturbing (causing rubbing and irritation because of their emplacement) or unsightly.

Here are some of the usual benign tumours:

Naevi (or moles) are melanocytic pigmented benign tumours which develop from the basal layer of the epidermis. Under the effect of different elements (repeated sun exposure, genetic reasons, mechanical irritations), they may become cancerous melanomas.

Cysts are glands with secretions which accumulate in a pocket.

Lipomas are very common fatty tumours. Despite their insensitivity, they may be disturbing because of their emplacement or their size.

• Malignant tumours:

These tumours imply skin cancer. In most cases they need to be surgically removed using an excisional method. A "safety margin" will be applied around the tumour in order to avoid recurrence. They can be epithelioma, melanoma or sarcoma.

Because of their wide variety and their rare nature, soft tissues sarcomas cancers are difficult to identify. Unlike sarcomas, benign tumours usually are superficial and small (less than 5 cm). Sarcoma can be diagnosed by the apparition of a mass on a soft tissue, more often on the members than in the trunk, neck or head areas.

The procedure

A resection is a surgery consisting in removing a harmful element for the organism (tumour, organ or foreign body).

Concerning benign tumours, a surgical resection allows cutaneous lesions removal for cosmetic purposes or because of a functional discomfort. When the resection is carried out for cosmetic purposes only, it is important to discuss the potential scars with the surgeon.

Tumour removal, even benign ones, requires extreme precision: the resection need to be carried out with a sufficient margin around the tumour to avoid recurrence.

For simple resections, the procedure ends with sutures. If the lesion needs a deeper resection, the loss of substance needs to be reconstructed (flap technique, epidermal graft).

The operation lasts between 20 minutes and 1 hour, depending on the type of the cutaneous lesion.

It is usually carried out in an ambulatory facility, under local anaesthesia.

After the operation, a piece of skin is removed and sent in a laboratory to be analysed. This aims at confirming the resection is sufficient and the margins are situated in healthy tissues.

After the procedure

The follow-up is generally simple even if unusual manifestations need to be watched (swelling with redness, abnormal sensitivity, beginning of purulent discharge).

After the surgery, histologic analysis will confirm the resection is complete and benign.

A strict clinical follow-up is necessary to control healing and potential recurrences. The cutaneous follow-up by the medical consultant or the dermatologist is useful to identify the first signs of tumours.

Itching is common during the first days of healing.

As long as the scar is dark, prolonged sun exposure is advised against, or a total protection solar cream needs to be applied.

The final aspect will be appreciated after several months (even one or two years).