CENTER FOR SKIN SURGERY - BERLIN AND BRANDENBURG

Your experts for skin tumors such as atheroma, lipoma or white skin cancer, ingrown nail and pilonidal sinus in Berlin

Many people have tumors on the body in the subcutaneous fatty tissue or in the uppermost layer of the skin. Often these structures are "only" aesthetically disturbing as skin changes, but can also lead to pain or a pricking sensation if they increase in size.

 

An initial consultation and follow-up care can take place at our locations in Dahlem and Lankwitz. The operations only take place in Lankwitz.

 

What diagnostics are important for skin tumors?

In most findings, the surgeon's visual diagnosis is sufficient to determine the type of tumor. In some cases, a brief ultrasound examination is useful for deeper structures to differentiate them from the musculature or larger blood vessels. In the case of larger tumors in the head and neck region or structures that are difficult to move, magnetic resonance imaging (MRI) is also rarely indicated for clarification.

 

Are the costs of an operation covered?

In the case of skin changes and tumors, it is always decisive whether the problem is cosmetic or whether there are real complaints. If patients have e.g. pain or recurring inflammations, the medical indication for an operation is given and the costs are always covered. Since only doctors with a health insurance license (KV Zulassung) work in our practices, all surgeries can also be billed to the health insurance company - there are no costs for you

 

For aesthetic operations, on the other hand, there is no medical indication and therefore the costs of an operation are not covered by health insurance. These must then be paid for independently as so-called IGel services, which we also offer. 

 


"Even with difficult findings - a beautiful scar is the surgeon's signature and particularly important to us"


How are skin tumors operated?

Most findings in skin surgery can be performed on an outpatient basis under local anesthesia without any problems. As experienced surgeons, we perform these procedures routinely and safely in our operating room in Steglitz. Patients do not have to wait and can go home a few minutes after the operation.

A typical procedure looks like this:

  • We review the findings and arrange an appointment for the operation. At the same time, we inform the patient about the surgical procedure. Except for emergency situations, such as an abscess, this information must be given at least 24 hours before the operation in accordance with the Patient's Rights Act.
  • On the day of surgery, patients come to our office about 10 minutes before their surgery date and are taken to the preparation room without waiting. Because of the local anesthesia, patients do not have to be fasting, a full stomach is even desired. Comfortable clothing is recommended because of the bandages and music with headphones is also welcome.
  • During surgery, the area to be operated on is anesthetized with a local anesthetic. This consists of xylocaine with some adrenaline added. During administration, a burning sensation and unpleasant feeling of pressure may occur for about 5-15 seconds. After that, the skin and the adjacent subcutaneous fat tissue are anesthetized. There is no pain, but the feeling of pressure, heat and cold remains. The tissue is carefully removed. Clean wounds are sutured with a thread. It depends on the load of the wound whether we use a self-dissolving thread or the threads have to be pulled. In the end, a dry bandage is applied to the wound.
  • After the operation, patients must remain in our practice for about 20 minutes for a final check. If the dressing is dry and the circulation stable, you can go home alone or accompanied
  • The following day, we order patients in again for a wound check. We remove the dressing/plaster and assess the wound. In the case of open wounds, such as after sinus pilonidalis surgery or an abscess, the first dressing should always be performed by us. Otherwise, an independent change can lead to annoying small bleedings due to stuck compresses. If everything is in order, open wounds can usually be cleaned by the patients themselves by washing them out with tap water and then dressed. In the case of sutured wounds with a non-dissolving suture, patients are called in again after 10-12 days for suture removal. The result of the histological examination is also reported at this time.

ATHEROMA

Atheromas (synonym: trichilemmal cysts) are benign cysts in the subcutaneous tissue that can grow from the size of a pinhead to an apple. 

 

Atheromas develop from a blockage of the excretory duct for the sebaceous gland secretions, which are closely connected to the hair roots. Due to the stagnation, a somewhat foul-smelling mixture of, among other things, fat crystals and skin cells is formed. Because of the connection to the hair roots, atheromas are mostly found on the hairy head or neck as well as on the back or in the intimate area.

 

If atheromas are present and there are no symptoms, surgery need not be performed. However, atheromas are often prone to inflammation and are the most common cause of abscesses in the neck/back and earlobe. In the case of advanced abscesses with pus formation, surgery is inevitable and should also be performed radically. It is especially important not only to cut into it, but to remove the entire atheroma with capsule, otherwise it will come back. Afterwards, the infected wound cannot be sutured, but remains open. 

 

Therefore, in case of recurrent inflammation with swelling of the atheroma, we recommend surgical removal in a non-inflammatory interval, as the entire atheroma can be completely removed and the wound closed with a suture, which is always the better option aesthetically, especially in the face. However, atheromas also have a tendency to recur.

 

FIBROMA

Fibromas are benign mesenchymal tumors that arise from a proliferation of connective tissue cells (fibrocytes). Most often, fibromas develop on the arms and legs and can grow up to 1cm in size. Fibromas vary greatly in consistency and number. Sometimes they appear as single nodular growths on the face or occur in large numbers of small, soft lobules such as under the armpits. The causes are unclear and fibromas occur more frequently in obese people.

 

LIPOMA

A lipoma is also called a fat tumor and is a benign growth (tumor) consisting of a proliferation of adipose tissue cells (adipocytes). Lipomas are the most common tumor in humans and men are affected slightly more often. Usually they are small nodules palpable under the skin, which one suddenly notices. As a sign of a benign tumor, lipomas are easily movable and can also be easily demarcated. Symptoms such as pain are rare, but an increase in size can cause an annoying pricking sensation or the squeezing of venous blood vessels.

 

Many lipomas are located superficially on the arms and legs and can be palpated well there. However, there are also lipomas in deeper layers between the muscles, which can be well diagnosed by ultrasound. Some people have a pathological proliferation of lipomas, which is called lipomatosis.

 

Lipomas have a fine capsule that separates them from the "normal" subcutaneous fat tissue and never go away on their own. The sole treatment is surgical removal (extirpation) of the entire lipoma. There is also the possibility of suction or dissolution, but this is only possible for small findings and is usually an IGel service.

 

BASALIOMA (BASAL CELL CARCINOMA)

Basal cell carcinoma (Basalioma) is a malignant disease of the skin and develops from cells of the basal cell layer of the skin and the root sheaths of the hair follicles. Colloquially, it is also called "white skin cancer" in distinction to "black skin cancer", although there are definitely also dark forms of basal cell carcinoma. It is the most common skin cancer worldwide, affecting men and women equally. With an average age of 60 years, approx. 180,000 inhabitants in Germany are newly affected by the disease. 

 

Basal cell carcinoma is most common in areas of the body that are directly exposed to sunlight, such as the face, especially the forehead, nose and ears. As a malignant tumor, basal cell carcinoma can grow into (infiltrate) surrounding tissue such as cartilage or bone, but unlike black skin cancer and most other malignant tumors, it does not form tumor metastases in other organs.

 

Dr. Haase specializes in basal cell carcinoma surgery with skin plasty. An initial consultation and follow-up care can take place at our locations in Dahlem and Lankwitz. The operations take place only in Lankwitz.

 


"We operate on basal cell carcinoma in large numbers on an outpatient basis with plastic coverage and beautiful scars"


How is basal cell carcinoma treated?

If basal cell carcinoma is suspected, surgical removal should always be performed. In this case, the entire skin change is completely excised with a safety zone of at least 5mm and then histologically examined. Since some defects can be quite large due to this precipitation in healthy tissue, a displacement plastic must often be performed to close the skin without tension. Therefore, it is recommended to have the operation performed by an experienced surgeon in plastic surgery, so that the wound is also primarily closed. 

 

The edges of the incision are examined microscopically and if tumor remnants can be detected in one or more areas, recutting must be performed at the sites. 

 

INGROWN NAIL

The ingrown toenail or also called "unguis incarnatus" is a very painful and purulent inflammation of the nail bed. When the nail of the usually big toe grows into the skin on the sides, we speak of an ingrown toenail.

The inflammation is common and affects all ages and men and women equally.  

 

An initial consultation and follow-up care can take place at our locations in Dahlem and Lankwitz. The operations only take place in Lankwitz

 

How does an operation proceed?

The most common variant is a nail bed reduction. The nail is reduced by about one fifth and part of the nail bed must also be removed. This leads in most cases to a permanent success without re-growth. Visually, the nail is somewhat narrower as a result.

 

The procedure is usually performed under local anesthesia. For small children or patients with very pronounced anxiety disorder, the procedure can also be performed under short anesthesia.

  • At the beginning, the corresponding toe/finger is thoroughly disinfected and covered with a sterile cloth. This is followed by local anesthesia with Xylocaine using the so-called Oberst technique. This numbs the nerves in the area of the metatarsophalangeal joint on both sides. There may be a pecking and burning sensation for a few seconds. After about 15-20 seconds, the toe is numb and painless. However, pressure, heat and cold are still felt. A compression tube is often applied so that it does not bleed too much.
  • Once the anesthesia is fully set, the excess tissue at the edges is first removed and the nail plate with the nail bed and some bone is cut out to one fifth with a scalpel. Bleeding is carefully stopped.
  • Finally, the lateral cuticle is sutured to the remaining nail with 2 sutures. A bandage is applied and the patient can leave the practice immediately after the operation.
  • The effect of the anesthesia lasts about 2-4 hours, so painkillers must be taken afterwards, otherwise more severe pain may occur. Also, the foot should be elevated on the first day after the operation and should not be subjected to unnecessary stress. Patients should not drive a car or ride a bicycle for the next 12 hours because of the anesthesia and the resulting change in sensation.
  • On the day following the operation, patients present themselves at the practice for a change of dressing. Further dressing changes can be performed by the patients themselves. The stitches have to be removed in the surgery after about 10 days. 

There are also therapy approaches with the laser, but due to the insufficient study situation and thus comparability of the results, we currently do not use this therapy.  

 

PILONIDAL SINUS

Pilonidal Sinus is an acute or chronic inflammation in the subcutaneous fatty tissue. In most cases, the coccyx region is affected, but there are also descriptions of this disease, for example, in the interdigital spaces or in the umbilical region.

 

The word coccygeal fistula, which is often used in the German language, is inaccurate, since this is a pure skin disease and the bone (coccyx) is not involved. The word pilonidal sinus or sinus pilonidalis is composed of the Latin words "pilus" for hair and "nidus" for nest, thus translated hair nests.

 

What are the classifications of Pilonidal Sinus?

  • The asymptomatic form, which is an incidental finding and causes no symptoms. No therapy necessary, but may progress to the acute or chronic form.
  • The acute inflamed form with pain, swelling and pus. No antibiotics, immediate therapy with lateral incision and drainage of pus. After several weeks, planned surgery if necessary.
  • The chronic form with mild symptoms such as a feeling of pressure and fluid secretions. Surgery always advised, as no spontaneous healing, surgical procedure according to findings.

"In Berlin, we are specialized in minimally invasive surgical methods for Pilonidal Sinus"


What is the treatment of a Pilonidal Sinus?

The therapy of a pilonidal sinus is always surgical and antibiotic therapy is not indicated. A simple sentence that actually explains everything. However, when patients are sent to the surgeon or to the neighboring hospital by their family doctor, the large-scale excision is usually always recommended, which is better known to patients as the so-called "slaughter method". The shock runs deep.

 

This is definitely a simple, inexpensive and quickly performed operation with a low recurrence rate, which any surgeon can do and is also recommended in the guidelines. 

A problem is only the long time of wound healing, which (by the way, earlier also by me) is indicated with 6 weeks, after that the wound is closed. Unfortunately, this is not the case and in our practice we have many patients after external operations, where after 6-12 months there is still an open wound with understandable physical and psychological problems of the (often young) patients.

 

We have therefore thought about what alternatives there are and have specialized in minimally invasive therapy procedures in the treatment of the sinus pilonidalis for 6 years.

 

Minimally Invasive Therapy of Pilonidal Sinus

Minimally invasive procedures include operations in which no major tissue is excised and which can be performed under outpatient conditions. 

 

Because of the small wounds, these operations are associated with less pain, faster wound healing and significantly shorter work absences

 

NEW: From 01.06.2021, the costs of gentle laser therapy and pit picking will be covered by many company health insurance carriers (Betriebskrankenkassen). Patients from other federal states in Germany can also be operated on minimally invasively in our practice. 

 

Here, under local anesthesia, the abscess cavity with the fistula ducts is excised via a small lateral incision. The small fistula ducts (pits) in the midline are punched out.


Under general anesthesia, a laser diode is used to close the fistula tract with the pits by emitting energy in a circular pattern. Small scars remain. Only suitable for longer, not too wide fistula tracts.


You can find detailed information on the topic of Pilonidal sinus on our homepage proktologen.berlin

You are welcome to book an appointment online at www.doctolib.de with our doctors. You can reach us by phone at 030 76 88 66 33 and by eMail at info@copv.berlin. We are looking forward to it.