SKIN CARCINOMAS

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Introduction

Skin cancer is the most frequent malignancy in the Caucasian race. The infection is more frequent in the head and the neck. The diagnosis is easy and its metastatic spreading is reduced. This gives us the opportunity of full recovery. However, the patient must act as soon as he observes a lesion in his skin which increases in size, appears like a wound and bleeds or like a wart that existed already, but suddenly started changing shape and behavior.

Immediate removal of the damage and biopsy are needed. Depending on results, additional removal will be carried out or additional treatment will be needed.

The surgical techniques for reconstruction depend on the damage area. Flaps from healthy skin areas are used when the incision or the gap left do not permit immediate closure.

The flaps used are designed according to the size of the damage and according to the position in the face, the skull or the neck.

These may be rotating flaps, rhomboids, bilobe, propeller flaps and are used by surgeons with experience and ease in the flawless execution, so that we have the best aesthetic and functional results.

Analysis in parts:

Α) Forehead, skull

They are difficult areas for closure after removing a tumor as there is no mobility and elasticity in the skin.

We are concerned with the maintenance of the mobility in the sensory units at the temple and the forehead, the hair line and eyebrow symmetry.

For the correction free skin grafts or area flaps are used.

Β) Eyelids

After removing the tumor from the upper or lower lid, there are various techniques and flaps to close the gap. We are interested in eye functionality and protection, eyelid hardness, the stability and position of the inner and outer canthi (corners of the eye), like opening and closing eylids.

C) Nose

The nose is divided in anatomical sub-groups (dorsum, lateral walls, the columella and flaps).

The skin of the nose has particular characteristics and its cartilage anatomy needs special restoration. particularly in the low third of the nose the skin is tightly attached to the cartilage, has no elasticity and so, if there is a gap larger than 0,5 -1 cm it does not close easily.

The closure of nose deficits with free skin graft does not present a flawless aesthetic result. The attempt for immediate closure of the deficit causes aesthetic side-effects in the nose, therefore the above-mentioned are only acceptable for aged patients.

The best method is the design of local and area flaps depending on the position of the deficit. The flaps are usually selected from lateral areas of the nose or the forehead or the cheekbones, for better aesthetic results.

In difficult cases with large tissue loss also cartilage grafts and internal flaps from the nose mucous membrane will be needed.

D) Lips

Small tumors on or around the lips, demanding special closure techniques.

The aim is to maintain the closure force of the lips, the aesthetic line of the lips, the opening of the mouth, but also its good aesthetic image.

The aesthetic unit of the lip must match in color and texture its natural image, present good symmetry, maintain the lateral fissures and maintenance of the filtrum.

Restoration of ear pinna

The ear pinna has a unique architectural structure and its reconstruction is one of the most difficult restorations in restorative surgery of the head and neck.

The philosophy of restorative surgery is the exact copy of the missing anatomical piece.

The restoration is easy if a small piece is missing, but becomes much more demanding when we are facing the loss of a big piece of the ear.

For this purpose, the ear may be divided into sub-groups and there is a distinct method for the restoration of each group.

For example, a deficit in the upper third of the pinna requires a different technical restoration than its middle or low third.

Based on the above-mentioned principles we no longer leave the patient after an injury or the removal of a tumor with an unsightly deformation, but we proceed to the restoration, so that he has a satisfactory aesthetic result and is not stigmatized.