Sunday, November 14, 2010

Just Because it is Not Cancerous

This 60 year-old woman had had this facial blemishes since 5 years ago. She went to her local  polyclinic and was told by the doctor they were not cancerous and she needed nothing done. However, the lesions were causing her a lot of mental distress not least because her grandchildren found them grotesque and refused to be seen with her in the public. She went back to the polyclinic and asked to be referred to a specialist but was told that any removal would result in severe facial scarrings which put her off. Eventually, she decided to put up with them and rarely ventured outdoor. She came to my eye clinic in Sarawak General Hospital two years ago because she developed diabetes and needed eye screening. She was very conscious of her facial lesions so I offered her surgical removal. At first she declined, saying that the previous doctor warned her about the risk of severe facial disfigurements if she were to undergo surgery. Eventually,the desire to appar normal in the public took the better of her and she agreed to undergo surgical removal.

Multiple warty lesios of the face.

Immediate post-opeative appearance of the face.

Appearance of the face two years later. Some lumpy skin
lesions remained but she was happy to leave them.

I excised the lesions below the eyelid and sutured the cut edges. The scar would not be obvious as it follows the natural line of the skin (relaxed skin-tension lines as shown in the picture below). The lesions around the mouth were shaved superficially instead of excisions so that they would not form obvious suture marks. The patient was extremely pleased with the result and the first thing she did was to change her hair style and bought some new clothes. I am pleased that her confidence was restored and she not longer became the centre of attention whenever she appeared in public or shun by her grandchildren.
Diagrams showing the relaxed skin-tension lines.
Incision along these lines creates minimal scarring.

Lesson of the story:
1. Facial blemishes can severely affect the patient's confidence even if it is not cancerous.
2. Doctors can discouraged the patients from operation if they exaggerate the post-operative complications.

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