Excisional Surgery

A skin lesion is an abnormal growth or an area of atypical appearance. In traditional excisional surgery, your DermOne affiliated provider removes a skin lesion surgically. First, the surgeon starts by asking and documenting the patient’s permission to perform the procedure. Next, the surgeon confirms that the area being operated on is the correct one; this is usually accomplished by comparing clinical photographs to previous biopsy reports. The affected area is then usually photographed.

Next, the surgeon marks around the skin lesion with ink to help guide treatment. An anesthetic is used to numb the skin completely. Then, using a scalpel and sharp scissors, the doctor removes a football-shaped portion of the skin around the lesion. In the case of skin cancers, this is done in order to remove the skin cancer completely and to prevent it from spreading—or metastasizing—to other parts of the body. A portion of healthy skin, known as “the margin,” is usually removed along with the skin lesion itself. Thus, the resulting wound is almost always larger than the lesion was. This is done to help ensure that the skin lesion is completely removed.

Excisional surgery is often performed to remove basal cell and squamous cell carcinomas on low-risk body sites such as the torso, arms and upper legs. It’s also used to help cure local melanomas that have not yet spread beyond the skin.

Wound healing varies greatly, depending on the size and site of the lesion that is surgically excised and the technique used to repair the wound. In many cases, the surgeon stitches (sutures) the edges of the wound together. Stitches are removed about one to two weeks later, depending on the anatomic location.

In certain parts of the body, however, stitching may be difficult, necessitating a skin flap or skin graft to close the wound. Other wounds may be left to heal from the inside out. Known as secondary intention healing, the incision remains open until it closes naturally.

Overall, excisional surgery offers certain advantages over other treatments such as chemotherapy or radiation. First, it usually can be completed in only one session. Second, the results are typically both medically and cosmetically effective: cure rates for basal cell carcinoma and squamous cell carcinoma approach 95 percent and 92 percent, respectively. Third, the excised tissue is usually sent to a laboratory where a pathologist checks it under a microscope to make sure the margins of the wound are free of cancer; this is a good indication that the skin has locally been cleared. Risks associated with excisional surgery—including postsurgical pain or bleeding, infection and scarring—are minimized by good surgical techniques and training.