The dermo-surgery arises in dermatology help to solve some problems of the skin that can not find resolution with other therapies, but always with a consideration of the aesthetic results. It deals with the clinical diagnosis, therapy and surgical pathologic diagnosis of tumors of the skin problems that arise from the aesthetic point of view and / or oncology.
The skin lesions are divided mainly into three broad categories:
Premalignant and malignant lesions pose an obligation dell’exeresi surgery, while benign lesions are often removed for purely aesthetic reasons. Assuming that the safety diagnosis is obtained only with the final histological examination, all tumors must be removed with a surgical margin to ensure the correct dell’exeresi radicalism. The incision lines are still carried out at the “Langer lines” (areas of least skin tension) so as to ensure a inconspicuous and maskable healing in skin folds physiological. Some specific skin lesions can still be removed by other methods: diathermy, treatment with laser therapy, cryotherapy or excision with removal with shaving.
The majority of outpatient surgery is performed and includes removal of the lesion and reconstruction can be immediate, by closing “first intention” with the use of techniques of reconstructive plastic surgery, or “secondary intention” with the principals of advanced medications.
Among the most common skin diseases can be considered:
MOLES or NEVI
The moles (or nevi) are small groups of dark (in color from brown to black), flat or raised, in the skin of all persons, their number varies from a few up to several hundred. As a rule, are small: less than 6 mm in diameter. Sometimes a mole may develop into melanoma, a malignant tumor that appears almost exclusively on the skin. It ‘then must learn to know your moles and keep them under control because this is the best form of prevention. In addition, you should know that about half of melanomas appear directly on healthy skin (ie not derived from the processing of a mole) and that the cause is often made up of excessive exposure to sunlight. Melanoma is a cancer very dangerous: it is therefore important to monitor regularly the prevenedo evetuali serious problems. It ‘good to remember: every time you look at a mole with a diameter larger than 6 millimeters, or when an old neo changes its usual form, the second as noted above, you should contact your doctor.
Do not forget that early surgical excision of a suspicious lesion you can save your life.
BASAL CELL AND SQUAMOUS CELL EPITHELIOMA
The epitheliomas are tumors of the skin, histologically classified as malignant tumors, in fact absolutely clinically benign. Why this difference between “histology” and “clinical”? The answer lies in the fact that these tumors, but in every way just like those of the deadly cancers that affect internal organs, are not capable of producing metastases, and therefore their malignancy is expressed only locally, with the progressive erosion skin. In fact the ability of metastasis is not fully anything, but in very rare case of squamous cell epitheliomas, and even in the exceptional case of basal cell ones. This “kindness” clinic but must not make that one can underestimate the importance of these skin lesions, as the ability to destroy the skin around the lesion is sometimes very intense and fast, especially on the face, where among ‘dell’epitelioma another frequency is very high, the diagnosis and removal should be early, to avoid debilitating aesthetic results. There are two histological types of epithelioma, basal cell and the squamous ones. The latter are more aggressive than the first, and then expand more quickly and sometimes, albeit rarely, can reproduce in the lymph nodes near the lesion.
Actinic keratoses are known in dermatology with the terms of solar keratosis and senile keratosis. They are considered pre-cancerous skin due to excessive sensitivity to sunlight and UV rays in general. From a histological point of view of the actinic keratoses are intra-epidermal carcinomas, with possible changes in spinalioma (squamous cell carcinoma) or basal (BCC). They appear as rough, crusty patches that appear in chronically sun-damaged areas are also known as actinic keratoses keratosis solari.Le usually measured between 2 and 10 mm in diameter and can EESS the normal color of skin, erythematous, pink or white with an adherent crust sopra.possono be flat or detected. In addition to the roughness actinic keratosis can sometimes show a burning sensation or even pain when traumatized even superficially. With the specialist visit, the dermatologist has the ability to distinguish between actinic keratoses and other skin diseases program the most suitable course of treatment to the patient. The most common treatment is simple and with cryotherapy with liquid nitrogen, but can be treated with curettage, CO2 laser, or by local retinoids.
Among the most common benign lesions, we can identify the seborrheic keratoses, sebaceous cysts and sebaceous adenomas.
The seborrheic keratosis is a benign lesion very frequent in ‘middle age and advanced, with preference when the face and trunk above the top, but can appear in almost every part of the body. Because of their shape, sometimes give the impression of being glued to pelle.Talvolta their growth is stimulated by factors such as pregnancy or hormone therapy or simple irritation. Their growth in locations such as the face and if very numerous on the trunk can also be aesthetically relevant. The treatment of seborrheic keratoses is quite simple and allows good results in both aesthetic and functional.
The sebaceous cyst is an excrescence under the skin that looks like a lump under the skin that can reach sizes of 5 or 6 cm. Causes of sebaceous cysts may be different. This is very annoying skin diseases that can become infected and painful. Sebaceous cysts are not dangerous and can be treated with simple remedies: application, skin ointments, drugs by mouth. If you are in the presence of a small inflamed cyst, your doctor may use a drug or steroid medication with antibiotics that reduce the swelling. If the cyst swells in size and becomes annoying for the aesthetic and even harder tissue, you may want to perform minor surgery. Careful to maintain a good lifestyle: the causes of sebaceous cysts may also be: stress, smoking, alcohol and cosmetics.
The sebaceous adenoma is a fairly common lesion that is observed in middle age (50-60 years) and beyond. Preferentially localized to the face (forehead, cheeks, nose) may be present with one or more elements, white, or yellow skin color. It has dimensions of between 2 and 9 mm. and is characterized by the presence of a groove in the middle (ombelicatura). E ‘benign, it is not contagious and does not lead to subjective complaints (eg itching, pain, etc.).. We do not know that it may be. Ultraviolet rays, aging and a state of immunosuppression may be factors or cofactors for development. The diagnosis is usually easy with simple observation. In doubtful cases, dermoscopy can be useful. Since benign lesions do not require any treatment unless it is required its removal for cosmetic reasons exclusive. In this case, can be used the diathermy, cryotherapy with liquid nitrogen, laser therapy, photodynamic therapy. Sometimes, however, may recur.
The lipoma is a benign tumor derived from adipose tissue. The lipoma is usually equipped with a capsule that surrounds them and makes it easy to surgical excision (not encapsulated forms are more rare, for example in multiple symmetric lipomatosis). Lipomas appear as subcutaneous nodules, slow-growing, mostly localized to the armpits, shoulders, buttocks, trunk and thighs, more rarely occur in the connective tissue or retroperitoneal fat in the capsule of the kidney. Lipomas are traditionally treated by excision which removes them in their entirety.
Among the small but annoying skin diseases are warts. Warts are benign skin lesions caused by a virus (HPV) and are as tough and fleshy growths. We distinguish different types of warts, which differed in their appearance and location. These epidermal lesions are very common among young people, have a very long incubation period (on average 3-4 months) and is mostly in areas most subject to cuts and scrapes, like arms, legs, hands and feet. The methods to eliminate them are different and vary depending on the type of wart. Among the treatments that are eligible include: curettage, cryotherapy, pulsed CO2 lasers are optimal for each type of lesion by HPV.