Cutaneous / Subcutaneous Neoplasia

Cutaneous neoplasms are one of the most common surgical conditions treated by general practitioners.  In addition to myriad benign lesions, malignancies such as mast cell tumors, soft tissue sarcomas, and mammary carcinomas are frequently encountered.  Most of the time these tumors are found at a reasonably small size and do not present much of a challenge to the experienced practitioner.  Sometimes, though, we see masses that are very large, very aggressive, or in very inconvenient locations. 

In cases where I am seeing these challenging cases as a second opinion, it is common for clients to say that they have been told a mass is unresectable or that removal would require amputation of a limb.  I also frequently consult on recurrent masses after a previously incomplete excision.  Fortunately for these patients and clients, we can often find a solution.  

I begin these consultations by telling my clients that getting clean margins is easy. All you have to do is draw a circle around the mass, and another circle around that one at the distance of your desired margins. Then close your eyes, cut on the dotted line, and look to see what kind of a mess you've created!  This tongue-in-cheek explanation emphasizes the importance of being aggressive to ensure that surgery is curative on the first attempt.

When taking large masses or masses in difficult to close areas, I often will use tension-relieving tachniques such as Z-plasty, or will utilize a rotational skin flap to close a defect (EXAMPLES). For masses on distal extremities I will take appropriate margins, then bandage the defect and allow it to heal by second intention.  Such techniques have allowed me to completely remove masses deemed unresectable, and to spare limbs previously recommended for amputation.  An aggressive approach ensures a very high likelihood of tumor-free margins and precludes the need for revision surgery. 

If you are interested in learning more or you have a case that you think I can help with, please feel free to reach out for a consultation.