Definition & Overview
The destruction of premalignant lesions is the process of removing skin abnormalities using different surgical procedures. These include electrosurgery, laser surgery, cryosurgery, surgical curettement, and chemosurgery.
Skin lesion occurs when a part of the skin changes in colour, texture, or thickness. Although most skin lesions are harmless, there are some that can lead to cancer. These lesions are considered premalignant and may develop into any of the three types of skin cancers. These include squamous cell carcinoma, melanoma, and basal cell carcinoma. Under the microscope, a premalignant skin lesion appears as a disordered group of cells with abnormal appearances. Because of their high probability of turning into cancer cells, premalignant skin lesions must be removed and treated as soon as possible.
Who Should Undergo and Expected Results
The destruction of premalignant lesions can be recommended for patients who are diagnosed with the following skin conditions:
- Actinic keratosis - Characterised by scaly skin growths that are rough in texture and are elevated. In most cases, actinic keratosis resembles warts. These growths often occur in parts of the body that are always exposed to the sun. These include the face, lips, scalp, and back of the hands. Because of this, this condition is also known as solar keratosis. This type of skin lesion undergoes slow development. As it grows, the lesion would appear tan, light pink, or red. Some patients might also feel itching as actinic keratosis grows.
- Actinic cheilitis - A type of actinic keratosis occurring on the lips. It is characterised by inflammation caused by prolonged exposure to the sun. The lips are persistently dry with cracking. Over time, the skin appears grey and scaly. This condition can also potentially develop into squamous cell carcinoma of the mouth.
- Bowen’s disease – This develops as a growth of scaly cells, which are typically red in colour. This type of premalignant skin lesion is also slow growing and can either be flat or elevated on the surface of the skin. In some cases, it can be quite itchy. Most patients diagnosed with Bowen’s disease are over the age of 60. However, there are rare cases when it occurs in younger individuals. It can occur anywhere in the body, even in the male and female genitalia. Some cases of Bowen’s disease develop into squamous cell carcinoma. This condition is also known as squamous cell carcinoma in situ, since it is not known to spread to neighbouring tissues.
- Lentigo maligna - Another premalignant skin lesion caused by long-term exposure to the sun. It is another slow-growing condition that typically affects the elderly. It occurs in the neck, nose, cheek, and other parts of the face. During the early stages of this condition, the lesions may appear as freckles, slowly growing in an area of skin with reddish to dark brown patches. It also has a smooth surface with an irregular border. When the lesion appears to thicken and becomes itchy or bleeds, then it is said to have developed into invasive melanoma.
The different techniques for removing premalignant skin lesions have high success rate. In most cases, patients avoid developing skin cancer after the procedure.
How is the Procedure Performed?
Laser surgery - The borders of the skin lesion are marked before the procedure. Depending on the need, patients are placed under local or general anaesthesia. There are different types of lasers that can be used for this procedure. Carbon dioxide lasers are often used to treat skin lesions, especially on the lips. With the use of a microscope, the surgeon sends laser pulses to the target site. This action vaporises the tissue and coagulates the nearby blood vessels. This effectively removes the skin lesion while minimising bleeding.
Electrosurgery - This technique uses electrical energy to destroy abnormal tissues. A specialised device, called a treatment electrode, is used to transfer electrical energy to the outer layer of the skin. For shallow lesions, the electrode is held a tiny distance away from the skin surface. An electric spark is then produced to destroy cellular proteins. This kills the targeted cells or tissues with minimal to no damage to the surrounding parts. If the surgeon needs to remove parts of the lesion underneath the epidermis, he can insert an electrode tip slowly into the affected tissue. The electrical energy released by the electrode tip causes the cell membranes to rupture and break apart. The tip can then be manipulated to cut away the lesion.
Cryosurgery - A local anaesthetic is applied to the skin where the lesion is located. The surgeon then uses an aerosol spray or a cotton applicator to apply liquid nitrogen onto the affected area. The treatment area may swell after the procedure and may leave a permanent white mark.
Chemosurgery - The surgeon applies a layer of zinc chloride fixative paste onto the lesion site. Using a scalpel, the surgeon cuts away a thin layer of fixed tissue, places it on slides, and applies a staining agent. The surgeon then examines the slides under a microscope to determine the presence of premalignant cells. The surgeon then proceeds to repeat this process until the excised or removed tissue does not show any abnormal features under the microscope.
Surgical curettement - After applying local anaesthesia to the target site, a spoon-like instrument called the curette is used to scrape the surface of the skin to remove the lesion. In most cases, this procedure also involves the use of electric current to cauterise the remaining tissue.
Possible Risks and Complications
- Swelling of the target site
Risk of being burned or shocked (for those who undergo electrosurgery)
Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2005, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2005/, based on November 2007 SEER data submission, posted to the SEER web site, 2008. 2008;
Silverman S Jr, Gorsky M, Lozada F. Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer. 1984 Feb 1. 53(3):563-8.