The Surgical Treatment of Skin Tumours in East-Tallinn Central Hospital is Becoming More Comfortable for the Patient

11. March 2016

With spring and summer coming up, the number of patients with skin problems coming to see a surgeon in addition to a family physician or a dermatologist is increasing. Which is natural as we need fewer layers of clothing when the weather becomes warmer and the changes on our skin which we might have not focused on in the winter start to show. The beginning of summer is the right time to check the condition of your skin and its readiness for tanning.

Airi Oeselg, a general surgeon at East-Tallinn Central Hospital, confirms that the most common changes in skin are moles, which a person might have had since birth or which have appeared later.

Dr Oeselg explains, "Small and average birthmarks are round or oval, a bit elevated from the skin, well defined, occasionally have hair, have either regular or irregular margins and are light to dark brown in colour. These moles are already present at birth or appear within the first three months of life. With large moles, the risk of melanoma increases 5%-20% throughout life, usually within 1-5 years. Therefore it is recommended that these moles be removed either surgically or with a laser, depending on their depth."

Regular innate moles

According to the surgeon, innate or regular birthmarks appear when the person is 6-12 months old, and their number increases in the next 30-40 years. These are usually less than 1 cm in diameter. Moles are skin tumours that have even or uneven margins, are mostly round or oval in shape and range from brown to black in colour. These are classified according to their growth depth. The moles closest to the skin surface are average or dark brown spot-like formations that are mostly located on the upper limbs or torso. The surgeon says, "Regular moles have very little transformation potential, although it has been histologically proven that about one third of melanomas originate from regular moles. An increased number of moles is considered a risk."

Dr Oeselg confirms that moles that have changed have a central role in the evolution of melanoma. Their formation usually occurs until the age of 60. The causative factors are thought to be genetic predisposition, UV light and immunosuppressive treatment.

Dr Oeselg adds, "An atypical mole is spot-like or a small knotty mole that may be asymmetrical with uneven margins and pigmentation and either smooth or rough on the surface. The size varies from 0.5 cm to 1.5 cm, they are round, oval or ellipsoidal in shape and may be located alone or spread out randomly. Atypical moles are usually found on the torso, arms, legs, the back of the hand, thumbs and scalp."

Atypical mole

Dr Oeselg advises people who have atypical moles to avoid solariums and to use sunscreen. Surgical treatment is not a routine procedure; removing the mole is more often recommended when malignancy is suspected, there have been changes in the mole or if the person will not come in to get the mole checked (it is recommended to get check-ups every 6 months). Laser treatment is not used to remove moles like these.

Dr Oeselg claims that there is a general rule that all moles that a person has should be similar - in their colour, size and other characteristics. Moles that have darkened, enlarged, heightened, been bleeding or have changed in any other way should always be shown to a doctor.

An indication to remove moles occurs when there is a certain diagnosis or a malignant process is suspected (basalioma, melanoma, squamous cell cancer) or a painful formation due to a cosmetic or constant trauma/friction (e.g. located under the bra or waistband).

You can also get help with malignant formations

In East-Tallinn Central Hospital, it is possible to see a general surgeon with a letter from a family doctor or a specialised physician in the general queue as well as without a letter for a fee. When paying, the patient can get a surgeon's appointment within a few days and a service package for removing the mole right away with wound care right after and histological analysis without the patient having to come to see the doctor multiple times.

According to the surgeon, there are different surgical options during an out-patient appointment. For example, it is possible to remove the formation with an electric knife with which no sutures are needed. Dr Oeselg explains, "This is suitable for removing acrochordons, smaller papilloma and moles."

In addition, it is possible to have a biopsy of the formation for diagnostic purposes. In case malignancy is suspected, a tissue sample of a few millimetres is taken and sent to histological analysis. This procedure does not require sutures.

The most traditional method, however, is still removing the entire formation, in which case sutures are needed. This includes all changes in skin and subcutis - bigger moles, haemangiomas, keratocyte nevi, atheromas and lipomas. It is also possible to remove the ugly scar in these cases.

The general surgery outpatient clinic has a separate room for out-patient procedures with modern furnishings and which offers the ability to perform procedures with different scope and local anaesthesia in a sterile environment.

"I recommend that people critically check their moles and take note of new appearances and even the slightest changes due to the increasing risk of skin cancer/melanoma in the Nordic countries. One should come to a dermatologist for a dermatoscopy or to a general surgeon to remove the formation right away in case there is any suspicion because skin cancer can be treated in its early stages. One must not come to a general surgeon only when suspecting cancer. We now also offer the removal of nevi and histological analysis of them for cosmetic purposes for a fee." The surgeon encourages people to keep an eye on moles and different skin formations that they or their loved ones have.

COMMENT BOX

When evaluating moles, the ABCDE rule must be kept in mind to evaluate cancer risks:

А – Asymmetry: Normal moles are completely symmetrical. If you draw an imaginary line through the middle of the mole, then the halves should look absolutely symmetrical. In suspicious cases, the different halves of the mole look different.

В – Border: Normal moles have clear borders. Suspicious ones, however, have irregular and fuzzy borders.

С – Colour: Moles that include different colours or tones are suspicious. These should definitely be shown to a doctor. Normal moles have one colour although they might sometimes have tones that are one step lighter or darker.

D – Diameter: If a mole is larger than the eraser tip of a pencil (6 mm), then it should definitely be shown to a dermatologist. This rule applies even when all other indicators (colour, asymmetry and borders) are normal.

E – Evolution: If the number of moles, their borders or colour has changed, then they should be shown to a doctor. One should remember that even one deviation from the norm is sufficient to consider a mole suspicious.

 

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