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Surgical removal of basal cell carcinoma

Basalioma refers to malignant skin tumors, which occurs against the background of atypical cell growth of the basal layer of the epidermis. Of all types of skin cancer, this type of tumor is found in 75-80% of all cases of disease. Basalioma affects men more often, and is generally more characteristic of older people 50 years and older. Approximately one in three men and one in four women in this age group are confronted with skin diagnosed with basal area.

The main and main method of treatment of basal cell carcinoma is the surgical removal of it.

Basalioma diagnosis: what it is and how it is treated

Basalioma is a malignant skin formation that occurs as a result of the appearance of a malfunction in the processes of growth, reproduction and dying off of originally healthy cells. If the mechanism of their vital activity is disturbed, and the processes of division occur with a deviation from the norm, a tumor begins to form at the site of injury.

Among all malignant skin tumors, basal cell carcinoma has the highest chances of survival and complete recovery of the patient. This type of education does not spread metastases to nearby tissues, so it is easier to remove. The likelihood of recurrence with qualified treatment is usually low - about 10-20%.

Most often, the tumor is formed on the scalp, on the ears, or on the face: on the upper lip, in the nasolabial fold, on the eyelids, cheeks. Less commonly, it can be found on the limbs or on the body, for example, on the back, on the stomach or on the chest, and, in most cases, a superficial type of education appears on the body.

The peculiarity of the structure of basal cell carcinoma is that it does not develop in the shell or capsule - a growing tumor spreads infected cells around, into the nearest tissue. At the same time, it can increase not only along the surface of the skin, but also go deeper into it, reaching the subcutaneous fatty tissue.

Penetrating deeper, basalioma can even affect bone tissue and internal organs. If it is located on the head, the membranes of the brain, the auditory and visual apparatus and organs, and the cranial bone structure are in danger.

Basal cell carcinoma of the skin consists of several varieties, which are differentiated depending on the symptoms, tumor localization, its shape and size.

There are these types of basal cell carcinoma:

  • superficial;
  • nodular;
  • cicatricial;
  • ulcerative;
  • pigment;
  • scleroderma-like.

Superficial tumors, most often formed on the limbs and the body, are round or oval, bodily or pink in color. Typically, these formations are distributed over the skin in groups.

Nodular basalioma got its name because of its characteristic shape - it looks like a transparent nodule, from 5 to 10 millimeters in diameter. They are often located on the eyelids, cheeks, nose wings, upper and lower lip. Its thin shell of a gray-flesh-colored color makes it possible to make out small blood vessels. A characteristic feature of the tumor is its peripheral growth into closely located tissues. The density of the nodule itself is similar to cartilage tissue. If, against the background of the development of nodular basal cell carcinoma, associated infections join it, there is a significant risk of tumor degeneration into the next stage of basal cell carcinoma.

Cicatricial neoplasm does not rise above the skin - it has a dense structure and a pinkish-gray color. Above the pathological focus characteristic pink-pearl edges are noted, which can gradually turn into ulcers.

A peptic ulcer, most often, is the result of a neglected neoplasm that has not been treated previously. It can reach over 10 centimeters in size, and its surface looks like a roller. It can periodically bleed and inflame.

Pigmented basal cell carcinoma is a skin tumor with pronounced pigmentation - usually from gray-brown to dark brown.

Scleroderma-like tumor is another variant of neglected basal cell carcinoma. It is characterized by the presence of a large plaque with multiple lesions along the perimeter.

In general, the detection of this type of tumor is not a cause for panic. Today, medicine offers several ways of getting rid of basal cell carcinoma, among which the most popular are:

  • cryodestruction: destruction of tumor tissue with liquid nitrogen;
  • laser removal: exposure to a laser beam, as a result of which the tumor disappears;
  • radiation therapy;
  • surgical removal of basal cell carcinoma.

Indications and contraindications for surgical removal of the tumor

The method of surgical removal of basal cell carcinoma is prescribed by physicians in most cases of disease detection.

The indication for the operation is:

  • diagnosed superficial, ulcerative, scar or nodular tumor;
  • rapidly progressing basalioma (with a growth rate of more than 5-7 millimeters in six months);
  • the presence of a tumor, which changes its color, becomes darker;
  • Basalioma shape change.

Before choosing a method of treatment for a particular patient, the doctor for some time oversees the growth of the tumor over time.

Among the contraindications to the removal of the tumor surgically are such factors:

  • impaired blood coagulability, if they are not amenable to correction;
  • general severe condition of the patient;
  • the presence of an acute infectious or inflammatory process.

Pregnant women, in some cases, doctors recommend to postpone the operation until the baby is born.

General rules for surgical removal

In preparation for surgery, the attending physician prescribes some examinations and a series of tests:

  • total blood and urine;
  • coagulogram;
  • PCR for hepatitis and HIV;
  • electrocardiography.

The procedure itself, most often, is carried out with the use of local anesthesia, so the patient arrives at the medical institution on an empty stomach at the appointed date. Dinner on the eve should be light. The operation usually does not require the placement of the patient in the hospital. Often he does not even open a sick-list.

Surgical removal involves cutting out the basal cell carcinoma and a number of adjacent tissues within a radius of 4 to 15 millimeters around the tumor. The size of the indent may depend on the type of tumor and its size. If, for example, a small nodular, pigmented or cystic basalioma is operated, the radius of coverage will be 4-5 millimeters. In this case, with a probability of 95%, tumor recurrence can be avoided. 3 mm indentation guarantee only 85%. If the basalioma is a sclerosing type, or has a diameter of more than 2 centimeters, the size of the grip is 10-15 millimeters.

The depth of the incision reaches the subcutaneous fat layer, on the forehead it is done up to the fascia of the facial muscles, on the ears and nose - to the outer shell of cartilage tissue, the periosteum of the skull.

It should be noted that after the radiation treatment method, the tumor is much worse to be surgically removed, since irradiation provokes the accumulation of a certain number of cell mutations that enhance its malignant character.

There are several options for surgical removal of the tumor, depending on the technique.

Removal with an elliptical piece of skin

The most common type of surgery is the one during which the skin of the spindle-shaped or elliptical shape is cut. The process applies only local anesthesia. The piece that is to be removed has a ratio of height to width of about 3/1 - this allows for the most accurate scar, and the absence of conical elevations at its ends.

Before the operation, the doctor marks on the skin the boundaries of the tumor and the limits of the planned indentation, as well as features of the future incision.

As soon as the anesthesia begins to act, the surgeon, using a scalpel, electrocautery, or radiohead, begins to operate.

To make the edges of the wound more convenient to match, the doctor produces partial exfoliation from the underlying tissues. Such peeling can be carried out in a sharp or blunt manner, after which the wound is closed with a regular or cosmetic suture. After closing with a conventional suture, the site of the operation has the shape of a ridge, which after a while finishes itself.

Circular excision of the skin surface

If the appearance of a long scar is undesirable for the patient, or if due to the high tension of the skin it is not possible to close the defect, the tumor is removed with a cut of the skin in a circle. The edges of it are subjected to a blunt method of detachment, then the surgeon stops the bleeding, and closes the wound with a purse-string.

Removal of basal cell carcinoma with skin flap overlap

This type of surgical procedure is used if it is necessary to hide skin defects as much as possible after removal of basal cell carcinoma, if simple joining of the edges cannot be done due to strong tension, or if the edges of the wound are peeled off after peeling. The method is recommended when carrying out an operation on the face, when obtaining an unsuccessful cosmetological and aesthetic result is unacceptable.

After the usual removal of basal cell carcinoma is performed, several additional cuts are made around, due to which several skin patches appear that are associated with the general flap. Then they are stitched in the right order and direction.

In some cases, skin areas taken from other parts of the patient's body are used to close the resulting wound surface - this reduces the likelihood of necrosis of the transplanted tissue.

Curettage and electrodissection

This method of removal is usually used for the surface and nodular type of basalis. The operation is performed with local anesthesia. After the anesthesia begins to act, the surgeon with the help of a special curette in the form of a miniature spoon with a hole scoops out the tissues of the neoplasm. Due to the loose and soft structure, the tumor tissues are easily amenable to the process of mechanical removal in this way. After all the basal area of ​​the eye is removed, the remaining tissue and bleeding vessels are burned by an electrocautery. The skin around the tumor due to cauterization also becomes loose and soft — this is how the necessary indentation is achieved in depth and in area to eliminate the likelihood of the presence of cancer cells in the surrounding structures.

The edges of the wound are not stitched, it heals under the crust, which is formed from electric cautery. If the surface of the basal cell carcinoma is very small, only electrodissection can be used.

The disadvantage of this method is a high probability of recurrence if the doctor has not adequately qualified curettage. The percentage of tumor recurrence is from 7 to 40%.

Mohr's Micrographic Surgery - How the Surgery Is Performed

The technique is one of the most expensive treatment options for basal cell carcinoma, with a tumor recurring in only 1-2% of operated patients.

Initially, the procedure begins as an elliptical excision or surgery, followed by closure of the wound with skin grafts. Tissues cut off together with a tumor are immediately sent for histological analysis in frozen form. If basal cell carcinoma cells are detected at the edges of the excised skin, skin excision occurs at the site of detection. Thus, in one operation, as many incisions and tissue removal can be made as necessary to completely remove all cancerous structures. In many cases, the final incision is significantly larger in size than the tumor was initially visible to the eye.

Recovery after surgery: wound care and rehabilitation process

The rules of care may differ slightly depending on whether the edges of the wound were sutured or whether it has remained open.

When the wound is closed with flaps, and also if the edges of the wound were stitched, the doctor, upon completion of the operation, places a tight bandage on the site of the excision, which provides the necessary pressure to the surface. After the procedure, the appearance of edema is likely, therefore the patient is recommended to apply cold compresses. Twice a day, the wound should be gently washed with soapy water, avoiding rough movements and friction.

Open wounds must be treated with bactericidal ointments and solutions daily, mainly the surgeon himself is engaged in this. Acceleration of skin healing contributes to the intake of vitamin complexes. Mandatory imposition of sterile gauze dressings on the operated site.

The entire healing process can be from 3 weeks to one and a half months. At this time, until the wound is fully healed, the patient is forbidden to go to the saunas and the bath, to swim in open reservoirs and pools. In order to avoid relapse, it is necessary to avoid exposure to ultraviolet rays during the year after surgery.

Cancers, even after surgical treatment, doctors prohibit working with toxic substances, especially if in the process they come into contact with the skin. In the first year after the operation, the patient needs to undergo a routine onsite examination by an oncologist every three months, then every six months. This measure reduces the likelihood of recurrence of the tumor.

Consequences and complications: the danger of surgery

A natural consequence after removal of basal cell carcinoma is a local violation of the sensitivity of the skin, as well as postoperative scars.

Approximately 1% of patients have post-traumatic bleeding. Its development occurs in the first day after surgery, and is associated with impaired clotting function. Preventing this helps in advance of a blood test - a coagulogram.

Allergy and contact dermatitis after surgery can occur against the background of prolonged use of ointments and medical patches, wearing dressings. Manifestations of bactericidal dermatitis significantly complicate the process of wound healing, therefore, for any signs of rash and allergic reactions around the wound surface, you should visit your doctor.

About 2.5% of patients experience wound infection due to non-compliance by the surgeon with aseptic rules. Timely lesions are amenable to medical and local treatment with the use of special antibacterial drugs.

Ischemia of the skin at the site of operation is expressed by tissue necrosis, peeling of the skin. In case of partial necrosis, the wound is constantly treated with an antiseptic, washed and observed.

If the transplanted skin has undergone complete necrosis, this is an indication for re-surgery.

Surgical intervention for the treatment of basal cell carcinoma is the method most often chosen by doctors. The operation, despite its apparent simplicity, requires a high level of skill and knowledge of aseptic rules from the surgeon. If the doctor does not completely remove the tumor and cancer cells from nearby tissues, the chance of a relapse will be very high.

Watch the video: Mohs Micrographic Surgery: Smaller Scars, High Cure Rate (April 2020).