SINGAPORE ASSOCIATION OF PLASTIC SURGEONS

Skin Tumours

SKIN TUMOURS

Author: Dr Adrian Ooi
Skin tumours encompass growths of the skin and subcutaneous tissue on any part of the body. They include benign conditions such as skin cysts and seborrheic keratosis, as well as malignant conditions such as squamous cell carcinoma, basal cell carcinoma and melanoma.

The majority of skin tumours are slow growing and only cause concern when they become an aesthetic or functional nuisance. Malignant skin tumours are more worrying as they are faster growing, can invade surrounding structures, and spread to the lymph nodes or other parts of the body. Risk factors for skin cancer include chronic sun exposure, smoking and immunodeficiency conditions.

Worrying features of skin tumours include an accelerated change in size, shape, colour or if the border becomes irregular. Remember to look out for the A, B, C, Ds (Asymmetry, Borders, Colour, Diameter)! 

Seek a plastic surgeon or dermatologist if you develop a skin tumor which is either worrying you or causing a functiona/aesthetic problem. The specialist will examine the tumor and may send off some tissue for testing.

Proper skin cleansing and care can help to prevent some benign skin tumours. Sun protection by covering up and sunblock along with avoidance of other carcinogens such as smoking can help prevent the development of skin cancers. If you are prone to skin tumours, you should have a regular check up with a skin cancer specialist.

Skin tumours treated by plastic surgeons include but are not limited to:
Benign
  • Dermoid cysts
  • Epidermal inclusion cysts
  • Lipomas
  • Neurofibromas
  • Pilomatrixoma
  • Sebaceous cysts
  • Seborrheic keratosis
  • Warts
  • Xanthelasma
Malignant
  • Basal cell carcinoma
  • Dermatofibrosarcoma
  • Melanoma
  • Sebaceous gland carcinoma
  • Squamous cell carcinoma

TREATMENT

The majority of skin lesions and skin cancers are treated surgically. In some cases, your plastic surgeon may recommend other therapies such as creams and radiotherapy where indicated.
  • Preparing for Surgery

    The majority of surgery for skin cancers can be performed as day cases under local anaesthetic, without the need for fasting. In cases where larger defects are expected, you may require general anaesthetic and stay in hospital for monitoring of recovery.

  • Surgery

    Most skin tumours can be excised under local anaesthetic as day surgery procedures, and in cosmetically sensitive areas can be done using Mohs micrographic surgery, in collaboration with our dermatology colleagues.


    Following resection of skin tumours, the aim is to minimize disfigurement and scar, especially on cosmetically sensitive areas like the face. The wounds resulting from excision of smaller tumors can be primarily closed while larger wounds require more complex reconstructive techniques to restore normal anatomy and function. This can be done with the use of grafts or flaps.


    Malignant skin tumours may require other treatments such as radiotherapy and chemotherapy. These modalities can be discussed with your plastic surgeon, dermatologist or skin cancer oncologist.


  • Post-Surgery Care

    In the immediate post-operative period, patients may experience some bruising and mild pain, which are expected and can be managed very well with medication. Further down the road, patients are followed up for healing and scar management. Malignant skin tumours often require multi-disciplinary team management with adjuvant surgery and therapy, as well as regular follow up and monitoring. Plastic surgeons are well placed to excise these tumours and to coordinate care along with other specialties such as dermatology and oncology.

COMPLICATIONS AND MANAGEMENT

Healing after skin tumour excision with or without reconstruction is usually uneventful. Minor complications such as localized infection and bleeding may occur, and in most instances can be managed with antibiotics and local pressure respectively. Very rarely is an unplanned return trip to the operating room required.
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