Dermatosurgical functional area
Dermatosurgery is one of our main areas of specialisation and therefore offers specialist expertise and a modern medical infrastructure for carrying out a wide range of dermatosurgical procedures. Our department has two modern operating theatres and one operating theatre.
Our specialities include reconstructive tumour surgery, sentinel node biopsy for malignant melanoma and Merkel cell carcinoma, surgery for inflammatory dermatoses (e.g. hidradenitis suppurativa), nail surgery, vein surgery, etc. (see range of services).
Therapeutic procedures for benign and malignant tumours of the skin are carried out in accordance with the guidelines of the Working Group of Dermatological Oncology and the German Dermatological Society. Depending on the size of the skin tumours we are treating, different reconstruction techniques such as flap surgery or skin grafts are used. Metastatic skin tumours as well as rare tumour entities are discussed on an interdisciplinary basis in the tumour board. This coordinated approach allows us to provide the best possible care for our patients.
We carry out around 3300 operations a year, both as inpatients and outpatients. The majority of operations are performed under local anaesthesia or tumescent anaesthesia. However, larger procedures (such as large flap plasty, sentinel lymph node biopsies) sometimes require sedation or general anaesthesia as well as a stay in hospital for a few days to ensure optimal and individually adapted post-operative wound care. An inpatient stay is also necessary in the case of skin tumour operations that are performed under micrographic control (incision margin control before closure, widening of the safety margin) in order to ensure that the necessary measures can be carried out.
Interdisciplinary collaboration with other specialist areas of our clinic (ENT, vascular surgery, visceral surgery, oral and maxillofacial surgery) and cooperation with colleagues in private practice enable us to provide optimum patient care.
Our range of services
- White skin cancer:
- Basal cell carcinoma
- Plettenepitel carcinoma
- Black skin cancer:
- Malignant melanoma
- Rare tumours:
- Atypical fibroxanthoma
- Dermatofibrosarcoma protuberans
- Merkel cell carcinoma
- Adnexal carcinomas
- Carcinoma of the sweat glands
- Paget's disease
- Congenital melanocytic nevi
- Atheromas
- Keloids and hypertrophic scars
- lipomas
- Nail diseases
- Hidradenitis suppurativa
- Rhinophyma
- Unguis incarnatus (ingrown toenail)
- Spider veins/reticular varices
- Lateral branch varicosis
- Truncal varicosis (varicose veins)
- Ulcus cruris
- Disturbing benign skin changes (e.g. seborrhoeic keratoses, naevi etc.)
- Disturbing scars
Excisions of various skin changes (e.g. congenital moles) are sometimes necessary in children. For children <6 years of age, it is possible to perform an excision under general anaesthetic in our outpatient surgery centre.
Frequently asked questions
- Current medication plan
- Allergy passport if available
- List of known pre-existing conditions
- Power of attorney in the case of assisted patients
- Previous findings
- External histological findings
Your dermatologist will send us a fax request as well as the histological findings in the case of a skin tumour that has already been histologically diagnosed. You will then receive an appointment from us at our university outpatient clinic. This is where the clinical organ-specific examination takes place and, after consultation with the surgeons, the surgical procedure is planned. You will be clinically examined, informed about the exact procedure and, if necessary, introduced to the anaesthetist in the event of a major operation. Your previous illnesses and your current medication list are important for individualised and optimal surgical planning, so please bring your current treatment plans with you. We will also ask you about any known allergies (such as antibiotics, latex, plasters, painkillers). If you already have an allergy passport, please bring it with you. Before the procedure, we will usually take a blood sample to check your coagulation and baseline values. In the case of operations on the skin with a higher risk of bleeding and a positive bleeding history, the INR will be determined preoperatively.
You will then be given an appointment for the operation. On the day of the operation, you must register and, depending on whether the procedure is being performed as an inpatient or outpatient, you will either be taken to ward CG6 or to the operating theatres.
When planning the operation, you will always be asked if you are taking blood-thinning medication. The surgeon will tell you if and for how long anticoagulation must be interrupted preoperatively. Depending on the type of anticoagulation, there are different recommendations in the S3 guideline (S3 guideline on the management of anticoagulation in skin surgery. German Society for Dermatosurgery (DGDC); German Dermatological Society (DDG)):
- Vitamin K antagonists (phenprocoumon/warfarin/acenocoumarol): Medication should not be switched from vitamin K antagonists to heparin (bridging) during skin surgery; if necessary, the INR value should be between 1.8-2 before the procedure. Switching to heparin has no clinically relevant benefit in terms of reducing the risk of perioperative bleeding or preventing thromboembolic events during skin surgery.
- Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, desirudin): The last dose should be taken 24 hours preoperatively; medication can be resumed one hour postoperatively at the earliest.
- ASA: Medication with acetylsalicylic acid that is medically necessary should be continued during skin surgery. If higher doses (>500mg ASA) have been taken within the last 72 hours before surgery, consideration should be given to postponing elective skin surgery with a high risk of bleeding. An increase in the postoperative bleeding risk with ASA has not been shown for either mild to moderate or severe bleeding
- Clopidogrel: As a rule, there is an absolute indication to continue cardiovascular-protective medication with clopidogrel. Medication should therefore not be changed during skin surgery due to the underlying disease.
- Clopidogrel and other platelet aggregation inhibitors: As a rule, there is an absolute indication to continue cardiovascular-protective medication with clopidogrel and other platelet aggregation inhibitors for a limited period of time. It should be checked whether it is possible to postpone a procedure on the skin until the time of switching to monomedication. A skin procedure that cannot be postponed should be performed without changing the medication with clopidogrel and other antiplatelet agents.
You will also be given your operation date at the first appointment. Depending on how the operation was planned, whether under local anaesthetic or general anaesthetic, you will receive a letter stating whether you need to come to the operation on an empty stomach. You do not have to be fasting for procedures in the operating theatre; patients who receive sedation or anaesthesia must be fasting on the day of the operation. The anaesthetist will determine whether and which medication you may take before the operation when you are admitted.
To ensure undisturbed wound healing and achieve the best possible cosmetic result, we ask you to follow a few recommendations:
- Regular dressing changes with dry plasters
- Bathing/showering: The wound should not come into contact with water until one day after suture removal. Depending on the body part and size, the wound can be closed with a waterproof plaster while showering. You can obtain suitable plasters from the pharmacy. After showering, the wound must be re-dressed. If the wound accidentally gets wet, it should be dried with a fresh, dry towel and re-dressed. Moist dressings must always be renewed quickly
- If pain occurs, ibuprofen 400 mg tablets, for example, can be taken up to three times a day, provided there is no intolerance. If in doubt, please contact us or your dermatologist/family doctor
- In the event of inflammation and post-operative bleeding, please contact us or your GP/dermatologist immediately. The dermatological outpatient clinic is the point of contact during the day. On weekdays from 4 p.m. and on Sundays and public holidays, please contact the surgical emergency department
- Physical exertion and sport should be avoided until about 5 weeks after the stitches have been removed. Depending on the localisation of the wound, longer periods may be necessary. If the wound is located in an area exposed to the sun, for example the face, lower legs and forearms, sun exposure must be strictly avoided for several months to prevent scar discolouration. A sun cream with a high sun protection factor should be used.
Excisions of various skin changes (e.g. congenital moles) are sometimes necessary in children. For children <6 years of age, it is possible to perform an excision under general anaesthetic via our outpatient surgery centre.
Publications from the OR area
[1-15]
1. Crisan D, Schneider LA, Muhlberger M, Scharffetter-Kochanek K, Kastler S. A neurofibroma-like tumour in a congenital giant navus. J Dtsch Dermatol Ges. 2018;16(12):1507-10.
2. Crisan D, Schneider LA, Coneac A. Miniaturising the keystone flap: an alternative to helical crus reconstruction after tumor surgery. J Am Acad Dermatol. 2018.
3 Crisan D, Kastler S, Schneider LA, Veit J. Repair of a Complex Marginal Auricular Defect After Lentigo Maligna Melanoma Excision. Dermatol Surg. 2018;44(12):1615-8.
4 Crisan D, Schneider LA, Kastler S, Scharffetter-Kochanek K, Crisan M, Veit JA. Surgical management of skin cancer and trauma involving the middle third of the auricle. J Dtsch Dermatol Ges. 2018;16(6):694-701.
5 Crisan D, Sindrilaru A, Badea A, Scharffetter-Kochanek K, Crisan M. Slowly growing exophytic hyperpigmented nodule of the calf. J Dtsch Dermatol Ges. 2018;16(6):798-801.
6. Crisan D, Scharffetter-Kochanek K, Kastler S, Crisan M, Manea A, Wagner K, et al. Dermatologic surgery in children: an update on indication, anesthesia, analgesia and potential perioperative complications. J Dtsch Dermatol Ges. 2018;16(3):268-76.
7 Manea A, Crisan D, Badea AF, Dumitrascu ID, Baciut MF, Bran S, et al. The value of ultrasound diagnosis in the multidisciplinary approach of cutaneous tumours. Case report. Med Ultrason. 2018;1(1):108-10.
8. Crisan D, Gulke J, Janetzko C, Kastler S, Treiber N, Scharffetter-Kochanek K, et al. Digit preserving surgery of subungual melanoma: a case series using vacuum assisted closure and full-thickness skin grafting. J Eur Acad Dermatol Venereol. 2017;31(12):e537-e8.
9. Sindrilaru A, Neckermann V, Eigentler T, Kampilafkos P, Crisan D, Treiber N, et al. Self-detection frequency and recognition patterns in medium to high-risk cutaneous melanoma patients. J Dtsch Dermatol Ges. 2017;15(1):61-7.
10. Crisan D, Scharffetter-Kochanek K, Dummer R, Treiber N, Sindrilaru A, Kastler S, et al. Beware when the hair turns dark again: clinical presentation and management of melanoma in situ in a giant congenital naevus on the scalp. J Eur Acad Dermatol Venereol. 2017;31(5):e226-e8.
11. Crisan D, Schneider LA, Kastler S, Psotta-Schachtner C, Gethoffer K, Sindrilaru A, et al. Giant cell arteritis with extensive scalp necrosis: A diagnostic and therapeutic challenge. Indian J Dermatol Venereol Leprol. 2016;82(5):539-42.
12 Crisan D, Treiber N, Kull T, Widschwendter P, Adolph O, Schneider LA. Surgical treatment of melanoma in pregnancy: a practical guideline. J Dtsch Dermatol Ges. 2016;14(6):585-93.
13 Crisan D, Badea AF, Crisan M, Rastian I, Gheuca Solovastru L, Badea R. Integrative analysis of cutaneous skin tumours using ultrasonogaphic criteria. Preliminary results. Med Ultrason. 2014;16(4):285-90.
14 Crisan D, Gheuca Solovastru L, Crisan M, Badea R. Cutaneous histiocytoma - histological and imaging correlations. A case report. Med Ultrason. 2014;16(3):268-70.
15 Crisan M, Crisan D, Sannino G, Lupsor M, Badea R, Amzica F. Ultrasonographic staging of cutaneous malignant tumours: an ultrasonographic depth index. Arch Dermatol Res. 2013;305(4):305-13.