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Plastic and Reconstructive Surgery

Skin Lesions

The Division of Plastic & Reconstructive Surgery is involved in the management of various types of skin lesions in children.  Referrals are received from family physicians, dermatologists, general surgeons and reconstructive surgeons for opinions, surgical discussions or complex management.  

Many are small and easily addressed surgically.  Others, however, are large or located in complex areas such as the face, and require careful consideration as to which management course is best for the individual child.  We often collaborate with our dermatology colleagues on such cases to develop a plan for management.

Pigmented lesions

A congenital nevus is a pigmented skin lesion consisting of pigment and nevus cells, which is present on the skin at birth or shortly after.  The colour of congenital nevi ranges from light brown to black.  The size varies from small (<1.5 cm), medium (1.5 – 19.9 cm), to large (20 – 49.9 cm) and giant (>50 cm), which usually involves the trunk (bathing trunk nevus).  Increased hair growth is commonly associated with these lesions.  Although the risk of malignant change in these congenital melanocytic nevi is low, they can be of concern aesthetically.  Surgical excision is preferred but care must be taken not to create excessive scarring or distortions that may not only be cosmetically unacceptable, but may cause functional problems.  Thus, careful planning is necessary.

Surgical excision

Surgical excision of any type of skin lesion is carried out for lesions that are concerning regarding their malignant potential, in areas that are difficult to monitor, where there is a strong family history of malignant skin lesions or to improve aesthetics.  This may involve simple excision and closure, the use of regional tissue to close the defect left after excision, or the use of tissue expanders, particularly in large lesions of the face or trunk.

Our division has had a particular interest and made significant contributions in the field of tissue expansion in children.  In this technique, the normal tissue adjacent to the lesion is expanded so that it can be used to cover the defect left after excision of the lesion.  A silastic balloon is placed beneath the normal adjacent tissue and with weekly injections it is expanded for three or four months.  It is then removed at a second surgery, when the lesion is excised and the expanded tissue is used to cover the defect left by the excision.  It is a very effective technique, but requires careful planning and execution.  Even with this there are complications, so a full understanding on the part of the child and family is mandatory.

Our expertise with cross-specialties

At SickKids we have easy access to a wide variety of experts.  With some skin lesions, we utilize these resources extensively, collaborating with dermatologists, pathologists, general surgeons, oncologists and interventional radiologists.  We are well positioned to provide everything necessary for the child with virtually any type and any extent of skin lesion.