Our department adopts minimally invasive techniques in the process of various trauma repair surgeries, and obtains more satisfactory cosmetic results after the surgery. With the development of society and the improvement of people’s living standard, people’s expectation on the results of cosmetic surgery, especially head and facial cosmetic surgery, is increasing, which is a test for plastic surgeons. Only those who have undergone strict formal training and can master various minimally invasive techniques are able to handle this challenge with ease.
Take nevus surgery as an example, our department treats hundreds of nevus patients every year, with facial and neck nevi being the most common. They vary in size. Smaller facial nevi can be treated with high-frequency cosmetic instrument, laser treatment or ring drill circumferential excision, while larger ones are mostly removed surgically. There are more surgical treatment methods, such as direct excision cosmetic suture, split excision, skin expansion and flap transfer repair, etc.
In other surgical procedures, large needle and thick sutures are often used, which will leave obvious needle marks and suture scars on the skin, similar to “centipede feet”. The cosmetic sutures are made with micro-needles and fine threads, and most of the subcutaneous sutures are made with imported absorbable non-damaging sutures, while the skin sutures are made with hair-like cosmetic threads. In terms of suturing technique, “trapezoidal” excision of subcutaneous tissues is used, so that the suture tension is mainly distributed in the subcutaneous layer, while the skin layer is healed under no tension, resulting in a small and flat postoperative scar. During the whole operation, we should strictly follow the delicate and meticulous operation style, and operate under the surgical magnifying glass if possible, so as to exchange the smallest tissue trauma for the most satisfactory operation effect. Plastic surgeons must have a high aesthetic point of view and master various minimally invasive techniques in order to achieve good cosmetic results.
I. What is a mole and can it become skin cancer?
Mole is a kind of benign tumor on the body surface. There are three types of nevi according to pathological classification.
(1) Junctional nevus: located at the junction of epidermis and dermis. They are mostly found on the palms of hands, soles of feet, lips of mouth and external genital area. The surface is flat or slightly elevated, and the size is between 1-2 mm, with a light brown, brown-black or blue-black color. There is a possibility of cancerous transformation, which can occur as melanoma.
(2) Intradermal nevus: exists within the dermis. The surface is smooth and clearly delineated. It is larger than 1 mm, grows in sheets, and is flat or slightly elevated. The color is dark and uniform, light brown, dark brown or inky black. Usually no cancerous transformation occurs.
(3) Mixed nevus: It is a mixture of the above two kinds of nevi, generally like an intradermal nevus, and can also become cancerous because it has components of junctional nevus.
Everyone has moles, but which moles are prone to cancer? What are the signs and symptoms when a normal mole turns into melanoma? If a nevus suddenly increases in size within a short period of time and rapidly forms a raised nodule with deepening color, you should be alerted. When the nevus expands to a certain extent, it will become papillary proliferation or rupture, forming a small ulcer (often in the shape of a spitfire), and the surface will bleed easily, ooze, or be covered with bloody crusts, and black dots, black halos, or pigmented nodules often appear around it. At the same time, the patient feels localized itching, burning and painful discomfort. If these changes occur on the body nevus, one should seek medical attention immediately, preferably by taking biopsies for pathological examination to make a clear diagnosis.
II. What kind of moles should be removed, and is the younger the age of mole removal, the better?
Most of the moles on the face or other parts of the body are benign and can “live peacefully” with their owners without any treatment. However, some moles need to be treated.
1) Moles that are too large The size of a mole can sometimes indicate whether it will cause trouble in the future. Studies have shown that larger moles have a higher chance of becoming malignant than smaller ones (except for giant moles).
2) Moles that are prone to friction Moles that grow in areas prone to friction have a higher chance of becoming malignant. For example, pigmented moles on the palms and feet, neck, underarms, chest, head, back, genitalia and other parts of the body that are prone to wear and tear have a high chance of malignant transformation and must be observed regularly or removed directly to prevent malignant metastasis.
3) Exposed moles Sunlight or ultraviolet rays may increase the chances of moles changing, so moles on long-term exposed areas are best removed.
4) Moles on the extremities Moles on the soles of the feet are the most common sites for melanoma. According to medical statistics, moles on the ends of the extremities, such as those under the fingers or nails, should be given special attention. Most of the malignant melanomas in Oriental people occur on the hands and feet. Therefore, if you find that moles on the palms of your hands and feet are growing abnormally fast, you must seek medical attention as soon as possible.
5) Indeterminate moles Moles that are painful, itchy, and change color.
6)Moles that were born (must be treated!) The risk of a congenital mole becoming cancer is much higher than that of an acquired mole.
In order to prevent the disease before it happens, experts suggest that people who are over 40 years old should conduct self-examination once a month: take off the whole body clothes, hold a small mirror in front of the whole body mirror, and check the moles on the whole body skin, especially if there are any newly discovered moles. Melanoma is characterized by: uneven edges, irregular tortuosity and distortion; not clear black, but miscellaneous colors, interlocking; starting small and not easily detectable, but showing progressive growth. A normal nevus, on the other hand, has neat edges, is uniformly black or dark brown, and can easily be divided into two symmetrical parts with a straight line. Melanoma, if detected early, can be completely removed under local anesthesia with no worries.
If it is a congenital giant nevus it needs to be treated early. There are several main reasons for this: ①The nevus cells of congenital giant nevus will migrate from superficial skin tissues to deeper layers with age, so the younger the age, the more superficial the location where the nevus cells are located, the better the treatment effect; the older the age, the more the nevus cells will infiltrate to deeper skin tissues, and the more tissues need to be removed during treatment, i.e. the greater the loss. ②The absolute area of lesions in most patients with congenital nevi increases with age, so increasing age increases the area of lesions to be removed, which increases the difficulty of treatment and reduces the effectiveness of treatment. ③Nevus is a benign lesion, and its natural course is very stable, and malignancy is extremely rare in the course of nevus; however, congenital giant nevus has a high malignancy rate, which is 1%-20% according to domestic scholars, and 1.2%-42% according to foreign scholars. No matter which specific data is accurate, in any case, congenital nevus must be treated early to prevent its malignant transformation.
III. Nowadays, there are various methods to remove moles, which one is the best one to choose?
Mole removal surgery can vary according to its size. Small moles (the size of a grain of rice) are best treated with medical mole machine (carbon dioxide laser or high frequency beauty instrument). Larger moles (the size of a peanut grain) require plastic surgery to remove and close them. The current methods of mole removal usually include chemical erosion, electrocautery, freezing, laser, cosmetic surgery, etc.
If a cut mole is suspected to have malignant changes, it is best to send it for pathological examination to determine whether there are malignant changes. If the doctor confirms that the mole is malignant melanoma, further comprehensive treatment is needed.
What should I pay attention to after mole removal?
Just after removing a mole with laser, there will be a local scab, so you should pay attention to avoid local infection. You can wash your face afterwards, but you should wipe it clean immediately after washing, and you should also pay attention to avoid sunlight. Usually the scab on the surface can fall off naturally after a week, do not remove the scab by yourself, otherwise it will easily leave a scar. The best choice of season is spring and autumn. In summer, the weather is hot and easy to sweat, so the wound is more likely to be infected.
Can particularly large moles or moles with long hair be eradicated? What is the solution?
Extremely large moles and hairy moles can be difficult to treat, but they can be eradicated but often leave scars. It depends on the location, size and type of the mole. Some moles can be removed by laser, and some moles can be excised in stages. The skin defects formed after excision of larger moles can be repaired by plastic surgery techniques such as skin implants, flaps and skin expansion, which require treatment at the plastic surgery department of a regular hospital.