Radiosurgery to remove nevi with minimal scarring

Dr. JJ Masani explains the process of using radio waves to remove moles, resulting in minimal or no scarring.

All moles begin to form at the junction of the epidermis and dermis, i.e. they are localized at the junction of tissues. On the skin, they stand out in a dark color.

Nature is trying to protect us and does not allow the nevus to turn into a malignant one. To do this, the melanocytic nevus sinks deeper into the dermis over time. Once it reaches the top layer of the dermis, the nevus is called intermediate. At the next stage, the nevus passes into the deep layer of the dermis and is called a complex nevus. At this stage, the novus is more pronounced, loses its dark color and becomes skin-like in color. 

When removing moles or nevi, there are two important things to know about scarring:

1. No matter what equipment you use, if you hit the dermis layer, the patient will be left with a scar. True, it is still possible to make such a neat incision that there will be no scar.
2. Radiosurgery, which is characterized by high frequency and low energy waves, can be used instead of lasers. To do this, we use the Ellman generator, which ensures minimal lateral heat transfer, which reduces damage to surrounding tissues.

The clinical advantages of this method are the minimal formation of scar tissue and pain after the operation, which is very important for aesthetic surgery.

What is radiosurgery?

The first person to successfully use radiosurgery on myeloma was Harvey Cushing, who first described the syndrome named after him – Cushing's syndrome. With the help of his friend William Bowie, Cushing removed myeloma from a 64-year-old patient. It was Ellman who was the first person to start producing generators of this type for wide use.

During the Korean War, soldiers who used cell phones suffered ear burns despite the fact that their antennas were cold. This prompted experts to the idea that – very high radio frequencies.

Radio waves used for surgery fluctuate within 1.7 – 4 megahertz, thus, the oscillations of such waves are fast, and the voltage and power – very low. The power of the Ellman device is -50 W, we use a generator with a power of 25 – 30 W.

New devices have a power of up to 100 W, which allows them to expand their scope (for example, Pelleve for skin tightening). There are different types of waves that can be used, however sine wave is the least warm and provides the best results.

Description of the process of using radiosurgery to remove nevi

When a living being is exposed to any kind of radio waves, water and proteins in the body resist such waves. We work with radio waves to make incisions at a temperature of 50-60 degrees Celsius. Collagen denatures at about 52 degrees, and the carbonization process occurs at about 200 degrees. When exposed to radio waves, tissue dehydrates or dries out rather than carbonizes.

Microwaves and mobile phones use the same principle as radio wave surgery, the only difference between them – frequency.

Before mole removal, all necessary information about the patient must be collected and a proper clinical assessment carried out. For diagnosis – benign or malignant formation – using a dermatoscope (polarized light).  

At the beginning of the procedure, a local anesthetic may be given to the patient to relieve pain from dehydration. We can remove the nevus almost intact – depending on whether you need to send it to the laboratory for analysis or not. Larger nevi are more difficult to remove due to the depth of pigmentation, so we warn the patient about possible scarring.

Contraindications for radiosurgery for removal of moles and nevi

• presence of jewelry;
• pacemaker;
• pregnancy and breastfeeding (although these conditions are not contraindications, it is still appropriate to avoid radiosurgery during these periods, except in cases of malignant melanoma).

 Other applications of radio waves include:

• treatment of vascular networks on the face or in any other part of the body;
• removal of keloid scars;
• epilation;
• rhinolipoma treatment.

All of the above makes radiosurgery an important tool in aesthetic practice.