Skin surgery is a critical aspect of dermatology, primarily performed to remove cancerous skin lesions, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Among the various surgical techniques, ellipse excisions, also known as wedge excisions, are widely used to ensure complete removal of malignant tissue while minimizing scarring and preserving skin function.

Ellipse excisions involve removing the lesion along with a margin of healthy skin to ensure that all cancerous cells are excised. The shape of the excision is elliptical or wedge-like, which allows for easier closure of the wound and reduces the risk of tension on the skin edges, promoting better healing. The procedure begins with marking the area around the lesion, followed by injecting local anesthesia to numb the skin. The dermatologist then uses a scalpel to cut along the marked lines, creating an elliptical incision. The tissue is carefully removed, and the specimen is sent to a laboratory for histopathological examination to confirm that the margins are clear of cancer cells.

Ellipse excisions are advantageous because they provide a balance between adequately removing the lesion and minimizing cosmetic concerns. The linear closure typically results in a less noticeable scar compared to other excision types, making this method a preferred choice for removing cancerous skin lesions in cosmetically sensitive areas.

Skin biopsies are a fundamental procedure in dermatology, primarily used to aid in the diagnosis of various skin conditions. When a dermatologist encounters a suspicious lesion or rash, a biopsy allows for the extraction of a small skin sample, which is then sent to a laboratory for histological examination. This detailed analysis helps determine the nature of the skin condition, whether it is benign, malignant, or inflammatory, guiding further treatment decisions.

There are several techniques for performing a skin biopsy, with punch biopsy being one of the most common. During a punch biopsy, a small, circular blade is used to remove a core of tissue, including all skin layers—epidermis, dermis, and sometimes subcutaneous fat. The procedure is quick, minimally invasive, and performed under local anesthesia. One of the significant advantages of a punch biopsy over a wedge excision is that it typically results in less scarring, as it removes a smaller area of skin.

Wedge excision involves removing a larger, wedge-shaped piece of skin, which can provide more extensive tissue for examination but often results in more noticeable scarring. Skin biopsies, particularly punch biopsies, offer a balance between obtaining an adequate tissue sample and minimizing cosmetic concerns, making them a preferred diagnostic tool in dermatological practice.

Curettage and cautery are widely used techniques in dermatology, particularly effective for removing certain types of skin lesions, such as superficial basal cell carcinomas, seborrheic keratoses, and warts. This minimally invasive procedure offers several advantages, including no need for stitches and a typically better cosmetic outcome compared to wedge excisions. The resulting scars are often less noticeable, making it a preferred choice for specific type of lesions in cosmetically sensitive areas.

The procedure begins with local anesthesia to numb the treatment area. The dermatologist uses a curette, a small, spoon-shaped instrument, to scrape away the lesion. This step is followed by cautery, where an electric current is applied to the treated area to stop any bleeding and destroy any remaining abnormal cells. This dual approach ensures effective removal of the lesion while minimizing blood loss and promoting rapid healing.

While curettage and cautery are highly effective for specific superficial lesions, not all skin lesions can be treated with this method. Deeper or more invasive cancers, such as some types of melanomas or large squamous cell carcinomas, require more extensive surgical excision. However, for suitable cases, curettage and cautery offer a quick, simple, and effective treatment option with excellent cosmetic results and minimal recovery time.

Mole removal is often performed for two main reasons: when there is a suspicion that a mole might be a malignant melanoma, and for cosmetic or mechanical reasons, such as when moles catch on clothing or cause discomfort. Shave excision is a common technique used for removing non-suspicious moles that are being removed for aesthetic or mechanical purposes.

Shave excision involves literally shaving the mole flush with the surrounding skin. This technique does not require stitches, which typically results in a better cosmetic outcome compared to traditional excision methods that involve suturing. The procedure is quick and relatively painless, and patients can often resume their normal activities immediately afterward.

A common misconception is that removing normal moles can reduce the risk of developing malignant melanoma. This is not true for a melanoma can develop anywhere on the skin. For suspicious-looking moles, complete excision is necessary, and the tissue is sent to a laboratory for histological evaluation. If the mole is confirmed to be malignant, a wider re-excision is usually required. However, for benign moles, shave excision offers a safe, effective, and cosmetically favourable solution without the need for stitches.

Cryotherapy, also known as "freezing," is a widely used dermatological treatment that involves the controlled freezing of skin lesions. This technique is essentially a localized induction of frostbite, where a cold liquid, typically liquid nitrogen at a temperature of -196 degrees Celsius, is sprayed onto the skin lesion in aerosol form. The extreme cold destroys abnormal or diseased tissue, making it a valuable tool in dermatology.

Cryotherapy is commonly used to treat a variety of skin lesions, including warts, solar keratosis, seborrheic keratosis, and molluscum contagiosum. While it is a versatile and effective treatment option, cryotherapy can be uncomfortable and sometimes painful, particularly for children. Therefore, alternative therapies, such as wart immunotherapy or cantharidine application, are often considered for pediatric patients due to their less painful nature.

For conditions like solar keratosis and extensive sun damage, there are more advanced treatments available, such as photodynamic therapy, which may provide better outcomes. Despite these newer options, cryotherapy remains a valuable treatment choice for certain skin conditions due to its effectiveness and simplicity. It continues to be an important tool in dermatological practice, especially when other treatment methods are not suitable or available.