鍾經略醫生【皮膚科碩士 x 美容醫學碩士】課程研究

Dr Chung King Lueh's MSc Aesthetic Medicine & MSc Dermatology Course Overview & Case Studies

地址香港中環皇后大道中9號嘉軒廣場

電話 Tel 23630598（註 6 Note 6）

Address: the Galleria, No. 9 Queen's Road Central, Hong Kong

（1）脫墨案例/價錢（2）脫墨影片（3）最新脫墨資訊（4）脫墨（其他題目） ( 1 ) Everything about mole removal ( 2 ) Case studies & Surgical fees of diff moles ( 3 ) Mole removal videos ( 4 ) Other topics on mole removal

臨床病例報告：

左眉內色素痣精準切除術——美觀與診斷雙重成果

1. 臨床評估與術前檢查

患者就診時，左眉外側三分之一處可見一顆孤立性、深色色素痣，直徑約4毫米。病灶呈輕微隆起之圓頂狀，色素均勻呈棕褐色，表面光滑，無不對稱、邊界不規則、顏色異質或潰瘍等惡性徵象（符合ABCDE標準）。然而，考慮其位於眉部——此為高度可見且具功能重要性的區域——加上患者對外觀影響及潛在惡變風險的擔憂，遂建議採用完整切除並一期縫合之手術方式。

值得注意的是，決定進行全層切除不僅出於美容考量，更為確保能取得完整組織標本以進行病理學檢查。即使臨床表現完全良性，位於高風險解剖部位的色素病灶仍應強制送病理檢驗，以防漏診早期惡性病變。

2. 手術技術：橢圓形切除與分層縫合

於局部麻醉（1% 利多卡因含腎上腺素）下，沿額部皮膚張力線（Langer’s lines）作橢圓形切口，方向平行於眉毛毛髮走向，以最小化對毛髮生長及眉型輪廓的干擾。病灶以2–3毫米安全邊距完整切除，同時保留周圍正常組織。

止血採用細尖電燒刀完成後，施行分層縫合：

深層真皮層：以6-0 PDS縫線間斷縫合，降低表皮張力
表皮層：以7-0 尼龍線行連續縫合，確保表皮精確對合
傷口敷料：覆蓋非黏性紗布，保護縫合線於初期癒合階段

特別注意將眉毛毛囊跨切口對齊，避免術後出現「階梯式」畸形或毛髮脫失。全程於放大鏡下操作，確保顯微層次之精確性。

3. 組織病理學檢查：排除惡性可能

切除之標本為一界限清晰、深色色素結節，大小約5 × 4 mm，立即置入10% 中性緩衝福爾馬林固定液，並送至病理科進行常規組織處理。顯微鏡下檢查確認為「複合型黑色素細胞痣」（compound melanocytic nevus），黑色素細胞巢分布於表皮與乳頭層真皮，未見細胞異型性、有絲分裂活性或結構紊亂。

此結果令人安心，亦突顯所有切除之色素病灶皆應例行送病理檢查的重要性——即便臨床表現完全良性。尤其於面部區域，因病灶常因體積小或外觀無害而被忽略，早期發現惡性轉變（如早期黑色素瘤或異型痣）可挽救生命。

4. 術後成果：拆線時疤痕近乎不可見

拆線日（術後第7天），傷口癒合良好，無感染、裂開或過度肉芽增生跡象。線狀疤痕極為平坦且淡薄，完美融入眉部自然皺褶中。眉毛毛髮經精確對位，術後無明顯輪廓斷裂或密度改變。

至術後第14天，疤痕進一步成熟，僅餘輕微紅斑，符合血流豐富、低張力區域之理想癒合表現。於3個月追蹤時（圖未示），疤痕在自然光下幾乎完全隱形，達成功能與美觀雙重目標。

技術要點與臨床經驗之關鍵

眉部病灶切除面臨獨特挑戰：

解剖限制：鄰近毛囊、皮脂腺及感覺神經，需精細剝離
美觀要求：任何錯位或疤痕皆可能破壞面部對稱性與表情自然度
功能保存：務必避免損傷支配額肌之面神經額支

本案例成功之關鍵不在於單純移除病灶，而在於實現「完整切除」、「準確病理診斷」與「隱形疤痕」三者合一——這正是現代皮膚外科卓越之標誌。唯有透過：

精確之術前規劃
熟練之分層縫合技巧
對區域解剖與皮膚張力之深入理解
堅守病理檢查之醫療原則

方能達成如此優異之臨床成果。

結論

本案例充分展現面部色素痣管理之黃金標準：全面臨床評估、策略性手術切除、強制性病理診斷，以及專家級疤痕控制。拆線時近乎不可見之疤痕，反映先進手術技術與美學意識之完美結合——乃當代皮膚外科之核心價值。

對於欲於眉部等美容敏感區接受痣切除之患者，選擇兼具皮膚科與重建外科訓練之專科醫生至關重要。如本案例所示，當技術與細心兼備時，痣切除不僅可確保醫學安全，更能達成美觀無痕之理想效果。

撰文：鍾經略醫生（皮膚外科與雷射治療）

免責聲明：所有治療均依循醫學倫理與患者知情同意進行。所有切除之色素病灶皆強烈建議送病理檢查，無論臨床表現如何。

Clinical Case Report:

Precision Excision of a Pigmented Nevus within the Left Eyebrow — Aesthetic and Diagnostic Outcome

1. Clinical Assessment and Preoperative Evaluation

The patient presented with a solitary, darkly pigmented nevus located within the lateral third of the left eyebrow. The lesion measured approximately 4 mm in diameter and exhibited a slightly raised, dome-shaped morphology with homogenous brown pigmentation and smooth surface texture. No evidence of asymmetry, irregular borders, variegated color, or ulceration was observed clinically — features that would raise suspicion for melanoma under the ABCDE criteria.

Given its location within the eyebrow — a highly visible and functionally important area — and the patient’s concern regarding cosmetic outcome and potential malignancy risk, surgical excision with primary closure was recommended. Importantly, the decision to proceed with full-thickness excision was made not only for aesthetic purposes but also to ensure complete histopathological evaluation, as even benign-appearing lesions in high-risk anatomical zones warrant pathological confirmation.

2. Surgical Technique: Elliptical Excision and Layered Closure

Under local anesthesia (1% lidocaine with epinephrine), an elliptical incision was made along the natural skin tension lines (Langer’s lines) of the forehead, oriented parallel to the eyebrow hairs to minimize distortion of hair growth and optimize scar camouflage. The lesion was excised with a 2–3 mm margin of clinically normal surrounding tissue to ensure complete removal while preserving eyebrow architecture.

Hemostasis was achieved using fine-tip electrocautery, followed by layered closure:

Deep dermal layer: Interrupted 6-0 PDS sutures placed to reduce tension on the epidermis
Superficial layer: Running 7-0 nylon suture for precise epidermal approximation
Wound dressing: Non-adherent gauze applied to protect the suture line during initial healing

Special attention was paid to aligning the eyebrow hairs across the incision line to avoid postoperative “step-off” deformity or hair loss. The entire procedure was performed under magnification to ensure precision at the microscopic level.

3. Histopathological Examination: Rule-Out of Malignancy

The excised specimen — a well-circumscribed, darkly pigmented nodule measuring 5 × 4 mm — was immediately fixed in 10% neutral buffered formalin and submitted for routine histopathological processing. Microscopic examination confirmed the diagnosis of a compound melanocytic nevus, with nests of melanocytes present in both the epidermis and papillary dermis, without cytologic atypia, mitotic activity, or architectural disorder.

This result is reassuring and underscores the importance of submitting all excised pigmented lesions for histology — even those appearing entirely benign. Early detection of malignant transformation (e.g., early melanoma or dysplastic nevus) can be life-saving, particularly in facial regions where lesions are often overlooked due to their small size or perceived harmlessness.

4. Postoperative Outcome: Scar Minimization at Suture Removal

At the time of suture removal (day 7 postoperatively), the wound demonstrated excellent healing. There was no sign of infection, dehiscence, or excessive granulation. The linear scar was remarkably flat and faint, blending seamlessly into the natural skin folds of the brow region. The eyebrow hairs had been preserved and realigned appropriately, resulting in no visible disruption to the natural contour or density of the brow.

By day 14, the scar had further matured into a thin, barely perceptible line, with only minimal erythema remaining — consistent with optimal wound healing in a well-vascularized, low-tension area such as the eyebrow. At 3-month follow-up (not shown), the scar was virtually invisible under natural lighting, satisfying both functional and aesthetic goals.

Technical Considerations and Clinical Expertise

Excision of lesions within the eyebrow presents unique challenges:

Anatomical constraints: Proximity to hair follicles, sebaceous glands, and sensory nerves requires meticulous dissection.
Aesthetic demands: Any misalignment or scarring can disrupt facial symmetry and expression.
Functional preservation: Avoiding damage to the frontal branch of the facial nerve (which innervates the frontalis muscle) is critical.

The success of this case lies not merely in removing the lesion, but in achieving complete excision, accurate pathology, and invisible scarring — a triad that defines excellence in dermatologic surgery. This outcome is only possible through:

Precise preoperative planning
Mastery of layered closure techniques
Understanding of regional anatomy and skin tension dynamics
Commitment to histopathological confirmation

Conclusion

This case exemplifies the gold standard in the management of facial nevi: comprehensive clinical assessment, strategic surgical excision, mandatory histopathological verification, and expert scar minimization. The near-invisible scar achieved at suture removal reflects the synergy between advanced surgical technique and aesthetic sensibility — hallmarks of modern dermatologic surgery.

For patients seeking mole removal in cosmetically sensitive areas like the eyebrow, selecting a specialist trained in both dermatology and reconstructive surgery is paramount. As demonstrated here, when executed with precision and care, mole excision can be both medically sound and aesthetically flawless.

Prepared by Dr. Chung King-Lueh (Dermatologic Surgery & Laser Therapy)

Disclaimer: All procedures performed in accordance with ethical guidelines and informed consent. Histopathological examination is strongly recommended for all excised pigmented lesions, regardless of clinical appearance.

一個星期後 ……………………..

拆線後幾乎看不見傷口。

一個星期後就可以拆線。使用的手術縫線是6’O可以自己溶解的半透明極幼線（幼過一條頭髮）。肉眼隱約可以看見。

切下來的墨痣。

手術脫墨後的傷口隱藏在眉毛的毛髮裡面，肉眼幾乎看不見。

生長在眉毛內的巨大墨痣