The skin mantle
Nowadays both doctors and patients have finally become aware of the importance of the skin, being it not only the largest and the most exposed to mechanical damage out of all the organs, but also very sensitive to several kinds of neoplastic degeneration (tumors), in its different parts. The number of cells that daily develop into cancer cells is unknown, but the majority of them is detected and defeated by the immune system. When our defenses, especially in the old age, are no longer very effective, a tumorous line of cells that most often corresponds to a little ulcerated tumor termed basalioma. This is of course not the only neoformation of surgical interest, but certainly the most common among the ones that a specialist might observe, also because it is often found on exposed areas that can easily be examined. Cutaneous tumors represent the most frequent pathology of oncological interest. It is only in our Country that the importance of the information about skin cancer is pretty much undervalued, while people are generally well informed on other kinds of tumors. Since cutaneous neoplasia may produce severe complications only when neglected, a program on diagnosis and follow-up involving dermatologists, plastic surgeons and pathologists has recently been developed. It is about creating easily accessible points where both people at high and low risk rate can refer to and meet specialists. Two main kinds of lesions are taken into consideration: ulcerated and pigmented. Sooner or later the majority of us produces some kind of skin lesion, but we can very rarely remember when and how they developed. Establishing exactly how old the lesion is and how it has changed through the time is of great importance in order to decide whether it should be surgically excised, left alone or followed in time. Nowadays patients' written personal records have generally been substituted with pictures that show the size and the shape of the lesion, thus highlighting the changes it undergoes as time passes. During the first consultation patients are photographed and a map of their skin at time zero is easily created and stored in a computer. This way the patient's picture can be brought up at any time and compared with the present situation. Therefore one can always follow the chronology of events and be sure of any nevus evolution or development of new ones. This mapping has shown particularly useful in those subject considered at risk, always producing a large number of new lesions. Most of these subjects are very fair and undergo skin transformation due to sun damage and thermal insults. Mapping is also advisable in patients that have already developed malignant lesions in the past and in those with immunodeficiency or genetically predisposed to skin cancer. Less frequent but of great importance are congenital lesions that by means of this method can be examined and followed throughout the years. While the basalioma is considered to show typically between 35 and 75 years of age, pigmented neoformations can develop at any age (though quite rare in children), being particularly aggressive between 30 and 40. There are of course several kins of lesions with different aggressiveness and prognosis. Since melanoma represents the most concerning of these pathologies and its immediate removal, before it has penetrated the deeper planes, has certainly shown to be the most winning strategy against it, subjects at risk should undergo traditional examinations, but, most of all, map their skin mantle. Of course, once a correct diagnosis has been made, each patient should be given the opportunity of excising the potentially malignant lesion and having it sent to pathology for a histological examination that will tell about its actual characteristics and confirm whether was completely removed.
Aside from what specifically concerns oncology, there are several aspects of the skin that must be taken into consideration with great care in order to prevent, not only any pathological transformation, but also its deterioration, its precocious aging and the onset of immunological diseases. For what concerns cellular aging, the face shows few standardized problems that characterize very specific areas. Modern biotechnologies have been applying very sophisticated techniques and biomaterials aimed at reducing and/or correcting the natural reabsorbing of subcutaneous tissue as well as grooves and wrinkles. These modifications are linked to hereditary factors, to the face anatomical conformation, as well as to physical habits and to the microclimate in which one lives. As always, prevention represents the best of therapies. In this field prevention is the primary interest of cosmetology, that supplies the patient with hydrating substances (in form of gel, cream, bandages, etc.) aimed at limiting the risk of tissue deterioration. Each kind of skin and each age have their specific indication and the criteria of application of these elasticizing products change according to the tissue characteristics. These vary from area to area and are function of the mobility of the anatomical part as well as of the dermal and epidermal thickness. In fact a cream that shows to be effective on the back, where the dermis is very thick, might reveal itself irritating when used on the eyelids, that have the thinnest dermis of the whole body. Surgical techniques aimed at giving shine, tonicity and tightness to the tissues are many. There are several chemical peels as well as various techniques based on scrubbing/burning away the epidermis most superficial layers such as dermoabrasion or LASER resurfacing. They all grant satisfactory results without undergoing heavy surgical procedures. They are particularly effective on the cheek, forehead and zygomatic regions. For whar concerns the peri-orbital region, traditional operations, purpose of which is correcting eyelid skin excess or the presence of bags and folds, are still among the most reliable. The oral and peri-oral regions show good results when injected with fillers that grant a more feminine and seducing appearance to any lips that look particularly thin, whether this is their own natural conformation or volume loss was caused by reabsorbing of the subcutis due to aging or dental treatments. When the whole face has suffered modifications that make it necessary to recreate harmony between container (the skin) and content (subcutis, muscles and fat pad) it is possible to resort to traditional cosmetic surgery. There is indeed a wide variety of face-lifts, ranging from quite simple to rather complex ones, allowing to get good result without altering one's main facial features. In this field it is very important to give advice to those who wish to correct imperfections due to the aging process. Above all it is indispensable for patients to understand exactly what they will have to face in order to reach certain results.