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 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.
It 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. 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
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.