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Skin Cancer

Excisional Surgery

What is an excision?

An excision refers to the removal of a skin lesion, either benign or malignant in nature, by completely cutting it out.

Why do skin lesions have to be excised?

Several reasons excise to excise a skin lesion. This include:

  • To cure a skin cancer, such as a basal cell carcinoma, squamous cell carcinoma, or melanoma
  • To make a diagnosis
  • To improve the cosmetic appearance, such as in an unsightly mole
  • To relieve symptoms, such as in a painful lipoma or cyst
  • To remove an inflamed or frequently infected lesion

Will an excision leave a scar?

Whenever the skin is broken or incised into, there will always be a scar. Careful surgical technique should aim to minimize scarring. Your surgery will always be performed by a board-certified dermatologist or a fellowship-trained Mohs and reconstructive surgeon who is adept at minimizing scar appearance.

What is involved in excision of a skin lesion?

Your board-certified dermatologist will explain why the skin lesion needs excision and review a pre-operative history, including medications you are taking and whether you have a pacemaker or defibrillator. The lesion to be removed will be outlined with a temporary marker and in some cases a second outline representing a margin will be drawn to ensure complete removal. A circular shape should be outlined, but it is difficult to suture a circle into a flat line. Your board-certified dermatologist may then draw two triangles on either end of the circle drawn. This will result in an elliptical shape outlined on the skin. The ellipse will allow for flat and cosmetically-appealing scar.

A local anesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. The board-certified dermatologist will then surgically remove the lesion and place the specimen in a bottle to be sent to a pathologist to establish diagnosis and/or ensure clear margins.

There may be some bleeding in the area from where the lesion has been removed. Your doctor may coagulate the blood vessels using electric cautery. This can make a hissing sound and a burning smell, but will not be felt.

The edges of the ellipse will then be stitched in 2-3 layers depending on the body location. The top layer of sutures may need to be removed in 7-14 days if dissolvable stitches are not used. A dressing will be applied and instructions will be given on how to care for your wound. You will then schedule an appointment for follow-up to get the stitches out.

Will there be any pain after the procedure?

Your wound may be tender 1-2 hours after the excision when the local anesthetic wears off. Most often, only over-the-counter acetaminophen (Tylenol) and/or ibuprofen (Motrin/Advil) is all that is needed. Icepacks also help with pain reduction.

How do I look after the wound following skin excision?

You will have a bulky dressing over the wound. The bulkiness helps apply pressure and decreases the risk of postoperative bleeding. Leave the dressing in place for 48 hours or as advised by your board-certified dermatologist. Avoid strenuous exertion and stretching of the area until the stitches are removed.

It can take up to 1 year for the scar to fade and look less prominent. You may notice your scar is raised like a “speedbump”. This is done on purpose as one of the main features of scar formation is contracture. By raising the scar, it prevents a long-term spread or depressed scar. It can take several months for the scar to flatten. The scar may initially be pink, but usually the color improves over several months.

Excisional surgery is a very common procedure performed and is done safely as an outpatient procedure at Phoenix Surgical Dermatology Group. Only a board-certified dermatologist will perform the procedure. Contact us now if you have a worrisome or bothersome lesion you would like removed. We are dedicated to providing world-class care in a comfortable, compassionate and friendly manner.

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