INTRODUCTION
Dr Hussein performs classical skin surgical procedures if required. Some skin lesions require conventional surgery. Occasionally when diagnosis cannot be confirmed from history and examination a diagnostic biopsy may be performed. These procedures are carried out under local anaesthetic. Dr Hussein has briefly summarised below some of the common types of skin surgery he routinely performs in clinic.
Cyst removal (sebaceous cysts)
Sebaceous cysts (correct term – epidermoid cysts) are a common type of benign cyst found within the skin. Once these are formed they are not easy to get rid of. ‘Popping’ a cyst or just draining a cyst with a needle is not the correct way of treating a cyst (as commonly seen on amateur youtube videos). To permanently treat a cyst the cyst must be removed along with the membrane that it is encased in. If the membrane or cyst wall is left behind the cyst will form again. Removal of cysts requires use of a surgical technique that will result in successful removal of the cyst wall. In cosmetically sensitive areas Dr Hussein can make use of minimal access techniques. This is where the cyst is drained prior to removing the membrane through a smaller hole. This type of technique results in a smaller scar but carries a slightly higher infection risk. Stitches are usually inserted. Depending on the location of the cyst the stitches can be removed at between 7-14 days. Please see the video section to see how Dr Hussein removes a cyst from the neck.
Skin Tag removal
Skin tags (Acrochorda) are benign fleshy tumors of the skin. They most commonly develop on the neck and underarm areas. They can technically be found in all locations. Groin and around the eyes are particularly common areas also. Although these lesions pose no threat they are often either a cosmetic nuisance or can get rubbed, caught or irritated. As a result Dr Hussein is asked frequently to remove these lesions. Most of them are small and can be removed easily but occasionally they can be larger requiring the resulting wound to be closed with a stitch. For the smallest skin tags Dr Hussein uses a device called a hyfrecator which cauterises the tags. They can then be scraped off or will fall away on their own. Depending on the initial size there may be a small scar or mark left on the skin. Typically this is much less visible than the tag itself.
Lipoma removal
These are benign tumors of the soft tissue below the skin. They grow to form soft fatty lumps underneath the skin. These fatty tumors can become significantly large (think half a tennis ball size on occasions). They can occur in all age groups but most commonly tend to occur in middle age adults. Their cause is unknown. Often people are unaware that they have a lipoma until it has grown large enough to become visible or palpable. Obviously these tumors will develop into cosmetically unacceptable lumps for many people. They can be removed with minor surgery via an incision made in the skin. The tumor once removed will always be sent for histological (microscopic) analysis to confirm that the lesion tumor is benign. Please see video of Dr Hussein performing Lipoma removal to understand how these tumors are removed.
Wart Removal Plane Warts & Filiform Warts
For removal of warts and verrucae on the hands and feet please refer to the Warts and Verrucae section of the treatment menu. Viral warts can occur on any areas of the body. There is a type of viral wart known as plane warts. This type of wart occurs in multiple numbers usually on the face and on the back of the hands. These small flat-topped warts are usually small and less than 5mm in diameter. If on the face shaving can cause inoculation of further sites in males over the beard area. It is tricky to permanently get rid of all of these warts. Dr Hussein will use a technique called hyfrecation to get rid of these lesions. The potential for recurrence is high. Dr Hussein will sometimes prescribe a special cream called Imiquimod (Aldara) for use in conjunction with treatment. This cream can help to trigger the body’s immune response in tougher to manage cases like plane warts. This treatment although not a licensed use of imiquimod is used often by dermatologists in an attempt to succeed in difficult to treat cases. There is no guarantee of complete and permanent removal but it provides a potential solution.
Filiform warts are a variant of viral warts that commonly occur on the face but can occur elsewhere. These are usually solitary in nature and can be easily treated with hyfrecation and curettage (burning and scraping).
Plane Warts
Filiform Warts
Skin Biopsy
Occasionally where diagnosis is uncertain or confirmation of diagnosis is required then a skin biopsy may be required. This is often done in the form of a punch biopsy or a shave biopsy. Both techniques can leave small scars. They will therefore only be used if there is diagnostic uncertainty or failure of previous treatments. Exclusion of skin cancer as a diagnosis is also an important reason for biopsy. The three typical techniques used for these types of biopsy are a diagnostic punch biopsy, shave biopsy and incisional biopsy. Sometimes a punch biopsy or an excisional biopsy can be performed. These techniques remove the whole lesion and may result in complete treatment being achieved at the same time.
