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Wound care 

Any procedure results in a scar. 

There are various methods for minimizing scarring  following a procedure.

These include:

  • Vitamin C 2000mg for up to 3 weeks pre and post procedure. 

  • Zinc 2 tablets for up to 6 weeks. 

  • Vitamin E supplements if you have lax scars or a history of Ehlers Danlos syndrome. 

  • Topical silicon based gels or silicon tapes for up to 3 months. 

  • Although slightly less effective an alternative to silicon is an oil based moisturizer, applied several times a day. The wound should be kept moist, no scab should be allowed to form. 

  • No fish oil for 3 weeks before or after the operation. 

  • Avoiding activities which cause excessive sweating for the first week following the procedure. 

  • Avoiding heavy lifting for 6 weeks where there has been sutures in the back, chest, arms or legs. 

  • Avoiding bending over when there have been excisions on the face, neck or scalp. 

Biopsy 

A definitive diagnosis of skin cancers needs a biopsy for a pathologist's opinion. 

It depends on what pathology the doctor suspects as to what sort of biopsy the doctor will perform.

In all biopsies Local anaesthetic is injected under the skin prior to the procedure.

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Shave biopsy 

A superficial sample of cells is taken, similar to having a graze to the skin. 

This technique is commonly used when a superficial skin cancer is suspected. 

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Punch biopsy 

This is when a small round sample of skin is removed, its useful for assessing the depth of lesions and for large lesions obtaining a diagnosis prior to a full excision. 

It is also used for diagnosis some types of non-malignant skin conditions. 

This procedure is not recommended if melanoma is suspected.

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Incision biopsy 

Part of the lesion is taken usually in the form of a ellipse. 

It is useful for the diagnosis of lesions prior to a larger excision.

Its also used in the diagnosis of non-malignant skin lesions where there is involvement of the subcuticular fat. 

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Excision biopsy 

Removal of the entire lesion, plus a margin around. 

This is generally recommended for suspected SCCs and melanoma's.

Curettage and cautery

May be an add on to the shave biopsy. 

Alternatively the abnormal skin cells may be scooped out and sent to the pathologist.

The base is treated with electrocautery and  the process is repeated.

This allows both diagnosis and treatment of superficial skin cancers. 

Ellipse excision

The entire skin cancer as well as a small margin of normal tissue is excised and the wound closed as a linear line.

This is the optimal treatment if sufficient skin is available. 

Excision with healing by Secondary Intention

The skin cancer is excised. A suture may be placed around the edge of the wound to prevent expansion. 

The wound is packed and left to heal slowly.

This is a time consuming process but for the person willing to be patient it has a great long term result in regards to matching skin. Most commonly used on the nose. 

ALA photo therapy  may be added to this procedure to decrease chances of tumor reoccurence. 

Skin flap

A skin flap is used when there is either insufficient skin to close the wound directly or a direct closure would result in unacceptable distortion of the surrounding structures. In essence skin is borrowed from close by to close an area where their is minimal skin available. 

Skin graft

In areas where there is insufficient skin to close the defect.

There are two types of skin grafts, the type will usually depend on size of the lesion and location. 

The full thickness skin graft is when full thickness graft of the skin is taken. Common donor sites are behind the ear, the upper arm and thigh. 

Split thickness skin grafts are generally used when a defect is too large to graft or as a secondary salvage method to speed up healing when the initial reconstruction has failed. 

Mohs Surgery 

Moh's surgery is offered by specialist dermatologists. It is generally offered in an area where the skin is very tight and minimizing tissue loss will improve reconstruction. In Australia this is commonly only done for BCCs.

In essence the cancer is taken out and the edges are examined under a microscope. If there is residual a further amount of tissue is removed and this continues until there is normal tissue on examination.  

A variation of this procedure know as a slow moh's may be done in a skin cancer clinic where the sample is taken and sent to the pathologist for urgent processing and the patient returns for a further excision or reconstruction on a subsequent day with the wound packed in the mean time. 

Sentinal Lymph node biopsy

This is a procedure undertake after a diagnosis of invasive melanoma has been made. Usually it takes place in conjunction with a wide local excision and possibly a skin flap or graft. 

It involves the injection of contrast media into the site of the skin cancer the lymph nodes nearest the cancer are then biopsied to determine if there is any spread. 

This procedure does not determine you likelihood of survival but is usually needed if you are going to undertake any chemotherapy/immunotherapy for your cancer. 

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