Lifestyle Choices

Treatment of skin lumps

Cryotherapy

The destruction of skin tumors by bringing the temperature well below freezing point is called cryosurgery. Liquid nitrogen is the most popular refrigerant (temperature in the flask -196°C). It is applied to the skin either on a cotton swab or as a spray through a nozzle from a flask. The use of liquid nitrogen for the treatment of warts is described elsewhere. Other uses are treating seborrheic warts, actinic keratoses (see under sun-induced skin changes) and occasionally small basal cell cancers.

Curette

This is best suited for tumors with clear margins and soft or firm consistency, like viral warts, seborrheic warts and actinic keratoses. Sometimes this technique is used to treat rodent ulcers but it is important to remove every fragment of tumor: the base is then cauterized to destroy any malignant cells that might remain.

Excision

The scalpel, with a sharp blade, is a time-honoured instrument for skin surgery. A local anesthetic is injected to make the skin numb. The simplest technique is called a biopsy: this is the removal of a piece of skin. The usual method is to make it slit-shaped, so that the gap can easily be closed with stitches. A small piece of skin may be removed as a curative procedure. When performing a biopsy due care must be given to the subsequent repair. If possible the scar should lie in an existing skin crease or wrinkle. It may be tempting to make a small round excision but the result of sewing up such a defect is often puckered at the ends. It is much easier to remove a tumor in areas of loose skin such as the armpit or the neck than in sites with no slack - for example the front of the shin. With increasing age the skin loses elasticity, as seen in the lined faces of the elderly, and surgery becomes easier. When insufficient skin is available to remove a tumor and stitch the edges directly the services of a general surgeon or plastic surgeon may be required.

The methods they use are of two types - flaps and grafts. Flaps are a clever way of using nearby loose skin to fill the defect. An example would be if a tumor the size of a penny piece was removed from the bridge of the nose. To fill the gap a similar-sized incision is made between the eyebrows but leaving the skin attached by a narrow stalk to maintain its blood supply. This piece of skin can be swung down to the bridge of the nose and stitched into place. There is now, of course, a defect between the eyebrows but this can be stitched together easily because the skin is much looser. Skin grafting is the transfer of skin from one body area to another. A graft may be the full thickness of the skin or only part of it, depending on the requirements. The donor and recipient skin must be matched for color, thickness and hairiness.

Lasers

Lasers produce very high-intensity energy either in the visible range - i.e. light - or the invisible range- e.g. infrared. Increasing uses are being found for lasers in medicine. The energy from the laser is converted into heat that is used in much the same way as a scalpel. The main advantage is that blood vessels are sealed instantly so there is little bleeding. This is particularly useful in areas with a generous blood supply e.g. the tongue.

Radiotherapy

This is the treatment of tumors with various types of radiation, most commonly ionizing radiation, for example X-rays, beta rays or gamma rays. Both basal and squamous cell cancers may be treated in this way and there are many instances where it is the best form of treatment. Several treatments are given over the course of a week or two. There is no discomfort at the time but the skin may become inflamed at a later date. Radiation tends to be reserved for older patients because the scars, which are cosmetically good to begin with, can deteriorate over fifteen to twenty years and become unattractive.

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