Dermatologic Surgery

  • Murad Alam

Key Features

  • Shave or punch skin biopsies can be accomplished with minimal trauma and scarring.

  • Excisional surgery is appropriate for removal of benign and malignant cutaneous lesions, including cysts, lipomas, atypical nevi, and some melanoma and nonmelanoma skin cancers.

  • Mohs micrographic surgery is the gold standard for removal of nonmelanoma skin cancers at sites requiring tissue sparing, such as the head and neck, genitalia, and hands and feet. Mohs is also appropriate when cancers are aggressive or high-risk, and these categories include recurrent tumors, tumors larger than 2 cm in diameter, histologically aggressive tumors, tumors associated with ionizing radiation, tumors in immunosuppressed patients, and tumors penetrating below muscular fascia. Mohs is used by some for treatment of melanomas, particularly of in situ melanoma.

  • Melanoma is treated by wide local excision, with depth to muscle and peripheral margin contingent on the Breslow depth of the melanoma. Peripheral margins may vary from 0.5 cm for in situ lesions (these can also be treated by Mohs) to 2–3 cm or greater for deeply invasive lesions.

  • Sentinel lymph node biopsy is becoming a standard of care prognostic procedure for melanoma of depth greater than 1 mm.

  • Bilayered repairs reduce the risk of dehiscence and provide improved cosmesis postoperatively.

  • Local anesthesia, commonly lidocaine with epinephrine, is sufficient for most dermatologic procedures.

  • Topical anesthetics and nerve blocks may be appropriate adjuvant anesthetics in special situations.

  • Surgery in children, such as removal of congenital nevi, may require general ane sthesia.


Sentinel Lymph Node Biopsy Nerve Block Merkel Cell Carcinoma Wide Local Excision Topical Anesthesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Further Reading

  1. 1.
    Alam M, Dover JS, Arndt KA (2003) Energy delivery devices for cutaneous remodeling: lasers, lights, and radio waves. Arch Dermatol 139:1351–1360PubMedCrossRefGoogle Scholar
  2. 2.
    Alam M, Ratner D (2001) Cutaneous squamous-cell carcinoma. N Engl J Med 344:975–983PubMedCrossRefGoogle Scholar
  3. 3.
    Anwar J, Wrone DA, Kimyai-Asadi A, Alam M (2004) The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes. Clin Dermatol 22:189–196PubMedCrossRefGoogle Scholar
  4. 4.
    Baker S (2007) Local flaps in facial reconstruction, 2nd edn. Mosby, New YorkGoogle Scholar
  5. 5.
    Brodland DG, Zitelli JA (1992) Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol 27:241–248PubMedCrossRefGoogle Scholar
  6. 6.
    Cook J, Zitelli JA (1998) Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol 39:698–703PubMedCrossRefGoogle Scholar
  7. 7.
    Goldberg LH, Alam M (2004) Elliptical excisions: variations and the eccentric parallelogram. Arch Dermatol 140:176–180PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg LH, Alam M (2003) Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip. J Am Acad Dermatol 49:685–689PubMedCrossRefGoogle Scholar
  9. 9.
    Kimmel Z, Ratner D, Kim JY, Wayne JD, Rademaker AW, Alam M (2007) Peripheral excision margins for dermatofib-rosarcoma protuberans: a meta-analysis of spatial data. Ann Surg Oncol 14:2113–2120. Epub 2007 Apr 28PubMedCrossRefGoogle Scholar
  10. 10.
    Lee KK, Swanson NA, Lee HN (2008) Color atlas of cutaneous excisions and repairs. Cambridge University Press, London, EnglandCrossRefGoogle Scholar
  11. 11.
    Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. J Am Acad Dermatol 53:458–463PubMedCrossRefGoogle Scholar
  12. 12.
    Leibovitch I, Huilgol SC, Selva D, Lun K, Richards S, Paver R (2005) Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol 52:295–300PubMedCrossRefGoogle Scholar
  13. 13.
    Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 53:452–457PubMedCrossRefGoogle Scholar
  14. 14.
    Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R (2005) Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol 53:253–260PubMedCrossRefGoogle Scholar
  15. 15.
    Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R (2005) Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. J Am Acad Dermatol 53:261–266PubMedCrossRefGoogle Scholar
  16. 16.
    Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, Cheney RT, Glass F, Grekin RC, Grichnik JM, Kessinger A, Lee NY, Lessin S, Lydiatt DD, Margolis LW, Michalski J, Nehal KS, Nghiem P, Oseroff AR, Rosenberg EW, Shaha AR, Siegle RJ, Urist MM; National Comprehensive Cancer Network (2007) Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw 5:506–529PubMedGoogle Scholar
  17. 17.
    Rohrer TE, Cook JL, Nguyen TH (2008) Flaps and grafts in dermatologic surgery, 1st edn. Saunders, Philadelphia, PAGoogle Scholar
  18. 18.
    Rubin AI, Chen EH, Ratner D (2005) Basal-cell carcinoma. N Engl J Med 353:2262–2269PubMedCrossRefGoogle Scholar
  19. 19.
    Walling HW, Scupham RK, Bean AK, Ceilley RI (2007) Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol 57:659–664PubMedCrossRefGoogle Scholar
  20. 20.
    Zitelli JA (2004) Surgical margins for lentigo maligna. Arch Dermatol 140:607–608PubMedCrossRefGoogle Scholar
  21. 21.
    Zitelli JA, Brown C, Hanusa BH (1997) Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol 37:236–245PubMedCrossRefGoogle Scholar
  22. 22.
    Zitelli JA (1989) The bilobed flap for nasal reconstruction. Arch Dermatol 125:957–959PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Northwestern University DermatologyClinical Trials UnitChicagoUSA

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