Excision is the surgical removal of a skin lesion for the purpose of diagnosis and/or treatment. Excisions are commonly performed to remove benign growths such as cysts and lipomas, precancerous growths and skin malignancies i.e. skin cancer. Excisions are performed under local anesthesia and involve removing the growth with some of the healthy tissue around it (margin). Various types of excisions include tangential or shave excision, done even to or parallel to the surface of the skin, and standard excision which is done through the full thickness of the skin. Another specialized form of excision, which is performed to treat skin cancers specifically, is Mohs micrographic surgery.
Procedure
The area to be excised is marked with a surgical marker. A local anesthetic is injected which will rapidly numb the area of skin to be removed so the patient is maximally comfortable while being pain free. The procedure involves cutting around and under the lesion with a scalpel including an appropriate margin of normal surrounding tissue. This lesion is placed in formalin and sent to a dermatopathologist who will process and examine the specimen under the microscope to determine the nature of the lesion as well as if the margins are clear.
The skin edges are sewn together to form a thin suture line. There may be two layers of sutures (stitches), a layer underneath that is absorbable and a layer of sutures on the surface that will be removed in approximately 7-14 days. A dressing is applied for 24 hours and instructions will be given on how to perform wound care during the recuperative period for proper healing.
Recovery
- Dressings are fashioned and left on as instructed by the surgeon.
- It is advisable to refrain from repetitive, strenuous activities either at work or recreationally.
- Various degrees of swelling and bruising is expected.
- Bruising and swelling usually dissipate within two to three weeks.
- Most patients resume their normal activity within two weeks.
Scarring Due to Excision
It is impossible to fully excise a skin lesion without scarring. Careful surgical technique, postoperative restrictions and recommended wound care are all important in minimizing scarring. After wound healing, several factors such as sunscreen application, the passage of time and your specific skin type will help blend your scar’s appearance with the surrounding skin.