Radio surgery offers a variety of techniques to remove superficial skin
lesions. In this article, Dr Peter Raus discusses the process and why many
patients are now opting for it.
Not all skin lesions are the same
We all want a smooth skin, preferably without wrinkles, but all of us
have some superficial skin lesions. Although most of the time these lesions can
be removed without any problem, there is no such thing as a magical technique
that can be used on all of them. Besides, not all lesions are benign and, when
in doubt, a microscopic study has to be performed after the removal to check
the real nature of the lesion or to confirm that it has been removed
completely.
The use of radio surgery in
removing skin lesions
The introduction of radio surgery in the late 1950s has made skin
surgery for small lesions a lot easier. Radio surgery uses a high frequency,
alternating current like radio waves (3.8 to 4.0 Megahertz) to cut through soft
tissue to coagulate or remove that tissue. The surgeon uses a hand piece with
an active electrode that is connected to the unit. An antenna plate is placed
behind the treated tissue to concentrate the radio waves. In radio surgery the
electrode itself does not get hot. Our
cells do not conduct radio waves but the energy of the waves leads to the
intracellular production of steam that cuts the cells. The lateral spread of
the heat is minimal.
The difference between radio
surgery and electrosurgery
Radio surgery is very different to electrosurgery, which uses a low
frequency, alternating current that heats the electrode. In the case of
electrosurgery, the tissue is cut by burning it. This technique results in more
tissue destruction, which makes it less suitable for skin surgery. Indeed,
coagulation of tissue can lead to ugly scars and when the edges of the removed
lesion are damaged, the pathologist cannot check if a suspicious lesion has
been completely removed.
Radio surgery enables a variety
of different surgical techniques
A whole collection of different radio surgery electrodes are available
for different surgical techniques. A ‘needle’ electrode plugged into the hand
piece can be used as a scalpel. The incision with radio surgery will be without
pressure, thus more precise and it will bleed less thanks to the ‘steamer’
effect of the unit.
Round ‘loop’ electrodes are wonderful to ‘shave’ superficial lesions.
Most of the times this treatment does not need any sutures and the excised
specimens can be sent to the lab for microscopic examinations. Of course, when
malignancy is suspected, the excision has to be deeper.I it is better (and
safer) to do a complete removal of a malignant lesion in one procedure than to
shave the top for cytological examination and then undergo additional surgery
if the pathologist says the lesion is not benign.
Hospitalisation is not required
for radio surgery
Most radio surgery on superficial skin lesions can be done in the clinic.
Patients’ acceptance is excellent since they do not have to go to the hospital,
the cosmetic results are excellent, recovery is fast and most of the time,
sutures are not necessary.
