Basic Principles of Dermatosurgery: Survey of Surgical Techniques

Abstract

The decision whether to perform surgery depends on the general condition of the patient [242,243,396]. If, for example, there are substantial internal contraindications, another method of treatment will be preferred or, in the case of cosmetic corrections [405], treatment will be refused [244]. On the other hand, the after effects of other therapeutic measures, e.g., especially radiation [266,455,496], are frequently a reason for operating. Late radiation injuries [radiation combination injuries, cf. 287,379] are treated relatively frequently by the dermatologist [480]. Therapy for these injuries is always surgical [288,355,401,572], especially if cancer is suspected [26,178,336,374, 415]. Conservative local therapy ensures that the area for surgery [500,509] is properly prepared. Minor operations are performed under local anesthesia. If more extensive plastic surgery is necessary, a physical examination must ascertain whether the patient is healthy enough for full anesthesia and an operation. The anesthesiologist is consulted on whether to use local or general anesthesia. In addition to its aesthetic improvements, surgical treatment of tumors is recommended [125,134] for the following:

• 1. To prevent malignant neogeneses in the case of skin lesions, e.g., solar keratosis, leukoplakia, lentigo maligns; lupus vulgaris, and late radiation injury [170,323,368,424].

• 2. In the presence of neoplasms near bones or cartilage (nasal tip, auricle, larynx, temple regions, scalp, hands, feet, phalanges, etc.) to obviate the danger of cartilage or bone necrosis resulting from x-ray therapy applied to the neoplasms [19,93,344]. Additionally, the sluggish reaction of the veins in the temporal and parietal region [325,326], for example, negatively influences radiation treatment in this area [27], and when there are neogeneses on the scalp, there is the frequently unavoidable danger of radiogenic epilation.

• 3. For special tumors such as morphea-like basal cell carcinoma or highly differentiated squamous cell carcinoma, which respond only slightly to radiation [159,160]. As a general rule, any suspicious lesion which has not responded after 1–2 months of conservative treatment should be excised [107,332] and examined histologically [214]. In this manner a possible neoplasm is verified, its continued growth prevented, and the danger of recurrence reduced [32,349].

[See 24,189,406].