Dermatology

Mohs micrographic surgery is a surgical technique used to very precisely treat skin tumours, allowing us to avoid removing more than necessary (reduces the risk of scarring) or less than necessary (reduces the risk of recurrences).

This surgery is recommended when the tumour has been treated previously and has recurred, as well as in areas where it is in the patient's interest to preserve the tissue as far as possible for functional or aesthetic reasons (nose, eyelids, eyes), in young people, and in tumours with poorly defined edges.

The tumour is removed and analysed under a microscope immediately to check that removal has been carried out fully. If it has not, the tumour will continue to be removed from the affected area until completely eradicated.

RECOMMENDATIONS

Days before: In some cases, your dermatologist may recommend you take an oral antibiotic before surgery. Do not take any anti-inflammatory medication or consume alcoholic drinks. If you are taking anticoagulant medicine, consult your doctor as in some cases it must be stopped or changed before surgery.

The day of surgery: Have breakfast and take your usual medication. We recommend somebody accompanies you. The process may take 2-6 hours. In the majority of cases, you may return home after surgery. We recommend 24 hours of rest and the use of analgesics for the pain.

• Electrocoagulation and curettage. Operation in which the lesion is burned and then removed with a cutting instrument.
• Cryosurgery. Operation in which the tumour is frozen and destroyed.
• Micrographic surgery. Operation in which the cancer is removed along with the smallest amount of normal tissue possible. During this form of surgery, the doctor removes the cancer and then immediately uses a microscope to examine what has been removed to ensure no cancer cells remain.
• Laser beam. In this procedure, a narrow light beam is used to eliminate cancer cells.
• Simple removal. Operation in which the skin cancer is removed alongside part of the surrounding healthy tissue.

Surgery may leave a scar on the skin. Depending on the size of the cancer, skin from another part of the body may be grafted onto the area where the cancer was removed from. There are different surgical methods and plasties that can reduce scarring.

The goal of biological therapy is to try to help the body fight cancer. In biological therapy, substances produced by the body itself or manufactured in a laboratory are used to boost, guide or restore the body's natural defences against the disease. Biological therapy is also known as biological response modifier (BRM) therapy or immunotherapy.

In photodynamic therapy, a certain type of light and special creams are used to eliminate cancer cells.

We have phototherapy equipment (UVA, UVB, PUVA baths), the latest treatments (biological therapy) and classic treatments (systemic therapy, topical treatments) that we use to treat psoriasis.

Laser or pulsed light treatments for vascular lesions, pigmented lesions, photo rejuvenation and photodepilation.

The presence of actinic keratosis indicates a lesion caused by the sun and may be the first stage in the development of skin cancer (precancerous skin condition).

It develops slowly over several years. Actinic keratosis usually appears on the face, ears, scalp, neck, back of the hands, forearms and lips. It's important to detect these lesions in their early stages to prevent them from increasing in size and invading the surrounding tissues. Sometimes they can lead to metastasis or spread to the internal organs.

This lesion can turn into squamous cell carcinoma.

Basal cell carcinoma appears predominantly in people with white skin and light-coloured eyes who tan with difficulty or those who have been exposed to the sun for a long time.

Lesions are localised in the areas exposed to the sun, such as the face, neck, back of the hands and forearms.

The most frequent sub-types of skin cancer are:

• Basal cell carcinoma (70-80% of skin cancers)
• Squamous cell carcinoma (20%)

1. Basal cell carcinoma

Basal cell carcinoma is a slow-growing skin cancer. It originates in the cells of the epidermis' basal layer and the pilosebaceous follicles, and it usually develops on areas of skin that are exposed to sun radiation.

2. Squamous cell carcinoma

This cancer originates in the intermediate layer of the dermis and also usually develops in areas of skin exposed to the sun, although it may also appear in areas that are not exposed, such as the tongue or the oral or genital mucosa (where it can be more aggressive).

It is faster-growing than basal cell carcinoma and is usually more aggressive.

Melanoma is a skin disease in which there are alterations to the melanocytes, the cells that produce colour or pigment in the skin, named melanin. This condition usually affects adults, although it can occasionally develop in children and teenagers. Melanoma normally affects adults, but it can also occasionally affect children and teenagers.

The most dangerous and less common form of melanoma is skin cancer. Although melanoma has a lower degree of occurrence than other types of skin cancer, this is the form that has the highest mortality rate and is responsible for 75% of deaths caused by skin cancer.

• Surgical excision: This is the preferred technique, where possible, since it allows the tumour to be fully removed. An anatomopathological study is carried out afterwards to assess whether the edges of the surgical specimen are free. In addition, there is the Mohs micrographic surgery option in which the specimen undergoes an histological study during the operation, thus determining whether or not the margins of the excision need to be expanded. Sometimes skin grafts are carried out (especially when large areas of skin are removed).
• Curettage and electrocoagulation: Removal of the tumour via curette: the treated area is then burned to eliminate possible remains.
• Cryosurgery (liquid nitrogen): Suitable for small areas.
• Topical cytotoxic agents: 5-fluorouracil can only be used to treat superficial basal cell carcinoma.
• Radiotherapy: For large lesions in people of an advanced age, especially in cases where surgery failed or was difficult.
• Imiquimod: this is a drug that is also occasionally used to treat small, superficial basal cell carcinoma. It has an immunomodulatory effect and stimulates the individual's immune response. There are several studies that support its anti-tumour effect.
• Hedgehog pathway inhibitors