icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή
icon-return-arrow Επιστροφή

DERMATOLOGIC SURGERY

Dermatologic surgery is an integral part of Dermatology. As Dermatologists, we specialize not only in studying skin diseases but also in providing solutions and treating our patients from these conditions. Often, these solutions are not achieved through the use of topical or systemic treatments alone. The immediacy and accessibility of the skin have led to the development of a plethora of surgical procedures for this purpose. Apart from the use of cryotherapy, cryosurgery, chemical peels, and lasers for treating our patients, we frequently employ dermatologic surgery under local anesthesia in our clinic. The identification and management of skin cancer, which is the most common cancer and a frequent problem we encounter in our clinics, is a characteristic example.

Our specialization allows us to better recognize a lesion as suspicious, while also giving us the confidence to classify a benign lesion as non-suspicious, which to non-specialized eyes might require removal. Thus, we have the highest rates of sensitivity and specificity in diagnosis.

Furthermore, our clinical diagnosis allows us to define with the best possible accuracy the margins with which the lesion should be excised. We follow internationally recognized protocols for various types of cancers, depending on the location and size, and we avoid the unnecessary removal of healthy skin in cases where malignancy is not suspected. We also choose whether to perform a complete and thorough excision of a lesion, proceeding with suturing, or if we can perform a tangential excision, which does not require sutures, in cases where the diagnosis does not concern us diagnostically, achieving better wound healing.

In some special cases, we can also use alternatives to surgery, such as in an elderly patient with mobility difficulties or dementia, using targeted oral medications and special immunomodulatory creams. Of course, these methods also have possible side effects, while surgical excision and histological identification and assessment of margins are the gold standard.

Finally, as Dermatologists, we have a deep understanding of the process of skin epithelialization, wound healing after injury, and collagen remodeling processes that follow. This helps us achieve the best possible aesthetic restoration after surgery, which can also be aided by the use of specialized laser applications.

How is surgical excision performed in the clinic?

In our clinic, we use local anesthesia similar to that used by dentists. It almost always contains a small amount of adrenaline, both because it reduces the toxicity of lidocaine, which is the anesthetic substance, allowing us to administer higher doses, and because it causes vasoconstriction, allowing us to have a clearer field with minimal micro-bleeding. Local anesthesia always allows us to have completely painless surgeries where only the initial pricks are felt. In cases of large lesions, we may use tumescent anesthesia to limit the effect of lidocaine.

The area is prepped and then the excision is planned with a special surgical marker. The excision is performed with small scalpels and instruments specialized for the area and size of the incision. We almost always choose to perform layer closure from deeper to more superficial layers using special size sutures with appropriate needle design. This necessitates the use of special absorbable internal sutures to shift the tension to deeper layers and avoid atrophy or hypertrophy after healing from tension during closure. Different materials are used on the body where we want absorption to be delayed and on the face where we want to avoid foreign body reactions. Finally, different suture materials are used for non-absorbable sutures placed externally so that the superficial edges of the incision oppose precisely for the best aesthetic result. Any minor bleeding is treated with vessel cauterization or compression, and at the end, a somewhat compressive dressing is applied to protect and absorb fluids from the incision for the next 48 hours. The sutures are removed at the appropriate time depending on the location of the excision and in consultation with the patient.

How is surgical excision performed in the clinic?

In our clinic, we use local anesthesia similar to that used by dentists. It almost always contains a small amount of adrenaline, both because it reduces the toxicity of lidocaine, which is the anesthetic substance, allowing us to administer higher doses, and because it causes vasoconstriction, allowing us to have a clearer field with minimal micro-bleeding. Local anesthesia always allows us to have completely painless surgeries where only the initial pricks are felt. In cases of large lesions, we may use tumescent anesthesia to limit the effect of lidocaine.

The area is prepped and then the excision is planned with a special surgical marker. The excision is performed with small scalpels and instruments specialized for the area and size of the incision. We almost always choose to perform layer closure from deeper to more superficial layers using special size sutures with appropriate needle design. This necessitates the use of special absorbable internal sutures to shift the tension to deeper layers and avoid atrophy or hypertrophy after healing from tension during closure. Different materials are used on the body where we want absorption to be delayed and on the face where we want to avoid foreign body reactions. Finally, different suture materials are used for non-absorbable sutures placed externally so that the superficial edges of the incision oppose precisely for the best aesthetic result. Any minor bleeding is treated with vessel cauterization or compression, and at the end, a somewhat compressive dressing is applied to protect and absorb fluids from the incision for the next 48 hours. The sutures are removed at the appropriate time depending on the location of the excision and in consultation with the patient.

What do we deal with surgically in our clinic?

In our clinic, we deal with all possible benign and malignant skin diagnoses. More frequently, we remove skin cancers, moles (nevi), cysts, and lipomas. Whatever is removed will always be sent for histological examination because even if there is no clinical suspicion of malignancy, identification of the lesion at a cellular level is necessary to confirm the diagnosis. Additionally, a determination is made whether complete removal is necessary. Finally, in rare cases, usually in large lesions, two entities may coexist, with one being hidden within the larger one and surrounding it.

In every case involving the removal of malignancies for medical reasons, the main goal is complete removal, followed by the best possible aesthetic restoration.

In larger lesions or areas where there is no skin mobility, we have extensive experience and specialized training abroad in the use of flaps, moving skin from surrounding areas, or grafts, where we take skin from another area to cover the defect. However, before complex restorations are performed, it is important to have a definitive answer regarding the complete removal of the malignant lesion; otherwise, a possible residue may be covered, leading to recurrence later on. For this reason, the simplest option is always chosen first, as it also provides good aesthetic results.
In cases where we know the lesion is benign, we may opt for optimal aesthetic restoration instead of complete excision, always in consultation with the patient, as even the small possibility of recurrence may bother them.

It is worth noting that in our clinic, we do not use laser to cauterize moles with melanocytes, although we have a plethora of specialized machines. It is a question that concerns researchers whether burning and burying melanocytes with laser can potentially lead to their mutation through intense inflammation, and many believe it is safe; however, in our clinical practice, we do not negotiate this.

For patients receiving anticoagulant therapy, it is important to emphasize that based on the guidelines of the International Dermatologic Surgery Society, we do not stop their medication when it is therapeutically (and not solely prophylactically) for the removal of a malignant lesion. In fact, it is almost never necessary to discontinue anticoagulant therapy for a dermatological procedure.

What is the cost of a surgical removal of a skin lesion?

The cost of each procedure varies depending on the type of lesion, which can determine the limits and depth of removal, its location, and size. When we have multiple removals on a patient, we try to offer a better overall price, but understandably, there is a limit to this. In our clinic, we do not have additional or hidden charges for wound care or suture removal, as we prefer to have control over the patient's progress. Written instructions are always provided for the next care steps, and some patients who live far away only come back for suture removal. Also, we have several patients from rural areas or abroad who have their sutures removed when they return home. The cost of a procedure in our clinic is naturally much lower than the cost of a procedure in a hospital, and each of our patients has the mobile phone number of their surgeon for clarification.

Once we have the results of the histological examination, your doctor will notify you personally, or they will be sent to your email, or you can come and pick them up. The time for results varies depending on the possible diagnostic difficulty and the use of special additional stains. Excisions of malignancies are naturally marked as urgent and usually results are available within a few days.