Skin pigmented lesions in the hands of an ambulatory surgeon

The ambulatory surgeon deals daily with patients who come for various pigmented skin lesions. A number of patients come on the recommendation of a dermatologist, but for the majority of patients, the primary visit is directly to the surgical clinic. The reason for removing a pigmented lesion may be an unsatisfactory cosmetic appearance or frequent irritation due to inappropriate location of the lesion, but also the fear of the development of malignancy. Pigmented lesions of the skin are a very hetero-geneous group represented from benign nevi to malignant melanoma. They occur in all age groups. Congenital nevi and hemangiomas are most often treated at an early age, and the incidence of skin malignancies increases in older patients. The ambulatory surgeon is often faced with the decision whether and how radically the pigmented lesion needs to be removed. Skin lesions such as lentigo solaris do not need to be treated surgically. Other lesions, such as basal cell carcinoma, require radical excision and subsequent professional dispensary. However, the treatment of melanoma is complex, it is led by specialists in dermato-oncology centers and therefore interdisciplinary approach is neces-sary. Every ambulatory surgeon should be knowledgeable and experienced enough to be able to decide on the need for removal of pigmented lesions and, in case of uncertainty, refer the patient to a skin specialist. This article provides a brief overview and specifics of basic skin pigment manifestations and criteria for their surgical removal.