What is a non pigmented skin tumor?

The most frequently observed non pigmented skin tumors that require surgical treatment are basocellular and spinocellular carcinomas. These lesions are located especially in areas that in the past have been exposed to the sun prolonged and frequently. The most commonly affected area is the face, mainly in fair skin type individuals. The lesions will generally become noticeable at ages above 60 years, but in the past decade, lesions are unfortunately also observed in individuals of younger age. This type of lesion develops in the course of several years. Initially, it shows itself as a discrete, well aligned, reddish, slightly elevated skin zone that sometimes is exfoliating. In this early stage, the lesion seems to disappear. This is misleading because it soon will reappear.

How does the lesion present?

The most common presentation forms of a basocellular carcinoma are:

A spinocellular carcinoma generally is characterized by a relatively fast growing elevated, inflammatory, exfoliating or keratinizing, skin area. These carcinomas are most frequently seen on the lips of smokers.

How can the diagnosis be made?

Inspection of the lesion with the naked eye is generally sufficient to diagnose suspicious skin areas. Each lesion present for more than a month in a sun exposed skin area, especially in older persons, should be evaluated by a doctor. A final diagnosis can only be made by means of microscopical investigation of a biopsy taken from the lesion.

Why must the lesion need to be removed?

A basocellular carcinoma is principally benign, which means that the tumor cells will not spread throughout the body. The lesion will expand locally. Sometimes it becomes deep and infiltrative; consequently, a large and deep facial area may become affected. Lesions are therefore preferably removed in an early stage, as the resulting skin defect can be closed primarily.

A spinocellular carcinoma behaves generally more aggressive as compared to a basocellular carcinoma; it grows faster and more aggressive into the deep tissues, and it even might spread to local lymph nodes. Early treatment is imperative.

Which treatments are possible?

Small, superficial and often multiple lesions can be eleminated by means of curettage, laser treatment or freezing, but only if the lesions are tiny and the diagnosis has been made microscopically.

Medium sized lesions can be simply excised and the skin defect can be closed primarily by means of approximation of the wound margins. This kind of treatment can be performed by a general practitioner, dermatologist, or plastic surgeon. If the defect after excision of a large tumor will be too extensive to approximate the wound margins, a complexer closure technique is required. Referral to a plastic surgeon is then preferred.

As the lesions occur mainly in the facial region, local tissues are preferable used for reconstruction with respect to the best tissue color and texture match. Final scars will thus be as unnoticeable as possible. In exceptional cases a skin graft has to be used. Most interventions can be performed under local anesthesia. The type of reconstruction to be applied is dependent on the localization and the extent of the lesion, as well on the mobility and amount of adjacent skin excess.

An individualized approach is inevitable because there is a large variety in type, extent, and localization of these lesions. Each patient needs therefore to be seen and examined clinically in order to determine and explain treatment possibilities.

What happens after the intervention?

You will receive instructions concerning wound care immediate after the intervention. After one week you have to return to the surgeon in order to remove the stitches. The result of the tissue examination will then also be available.

What else should you know?

If the lesion is completely removed it will normally not return. However, some lesions show a sprouting type of growth. Unexpectedly, a microscopically small part of the tumor may have been left so that the lesion may reoccur slowly. On the other hand, a new lesion may occur in an adjacent sun damaged skin zone. Subsequently, it is necessary to have a skin check every half year during 5 years after the operation, since in approximately 36% of the cases a new lesion develops within 5 years after removal of such a skin tumor.