Excisions
Surgical excisions are performed to remove a wide variety of skin lesions ranging from benign growths such as cysts and lipomas to skin cancers. A margin of normal appearing skin is removed around the lesion to ensure complete removal – narrow margins for benign growths and wider margins for skin cancers.
How is Surgical Excision Performed?
Typically, an elliptical shape of skin is removed. The resulting wound is repaired by loosening the surrounding skin and then closed in straight line using layers of deep and superficial sutures. The incision line will be longer than you may expect, as the final length is usually three times as long as the diameter of the wound.
On rare occasions, the wound may be repaired as follows:
- Flap: The skin adjacent to the wound is elevated and moved to cover the defect. Flaps are typically used for larger wounds but can also be used for wounds in delicate areas, under tension, and to minimize distortion.
- Skin graft: Skin from a different area of the body is used to cover the wound. This type of repair can take longer to heal but can provide excellent results.
- Healing by granulation: The wound is left open and allowed to heal in on its own. Certain areas heal very well by this manner, although typically will take the longest to heal.
The skin specimen is sent out for pathological examination. The results typically take one week. There is a small possibility that the excision margins did not adequately remove the lesion, in which case an additional excision may need to be performed on a later date.
How Do I Prepare for Surgery?
Most patients are scheduled directly for surgery without a preoperative visit. A consultation will be done on the day of the procedure. It is important that you read all the information that we have provided and fill out the Medical History Form. If you would like to see one of our dermatologists in consultation prior to the surgery date, we will gladly schedule an appointment for you.
Please plan accordingly as you will be subject to activity restriction following your surgery. It is recommended you do not travel or plan to participate in athletic activity for 7-10 days following surgery.
Surgical Excision is performed under local anesthesia. We suggest that you eat your normal breakfast, unless otherwise specified. Please bathe or shower and wash your hair to minimize your risk of a surgical site infection.
Many of our patients are on blood thinning medications that are prescribed by their physician. We do not recommend stopping them without explicit permission from the prescribing physician. If your physician recommends aspirin please do not discontinue without permission.
What are the Risks Associated with the Surgery?
Pain
Most people experience little discomfort after surgery. Usually Tylenol is sufficient to control the pain.
Bruising and Swelling
Bruising and swelling are common following surgery and usually lasts for several days. Applying ice in the first 24 hours helps reduce these symptoms.
Infection
The infection rate for skin surgery is very low. A preoperative antibiotic may be recommended to some patients. It is typical to develop some redness along the suture line but if it becomes more extensive or if you develop increasing pain, swelling, drainage, please notify us immediately.
Bleeding
The risk of significant post-operative bleeding is very low. Upon completion of the surgery, a pressure bandage will be placed on the wound. Small number of patients may have some post-operative bleeding as the epinephrine (adrenaline) in the anesthetic wears off. This usually can be stopped with direct pressure for 20 minutes. For any bleeding that is not controlled with pressure, we need to be notified immediately.
Numbness
At times, the area surrounding your operative site will be numb to the touch. This area of numbness may persist for several months or longer. In some instances it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.
Scar
Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar will often be longer than what you may have anticipated because cancer that is underneath the surface is larger than what is visible before surgery. The scar may also need to be lengthened to better fit the contours of the skin. Scars can take months or longer to heal completely. The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with you and give you wound care information, which will explicitly outline how to take care of whatever type of wound you have.
Allergy
Allergy Fortunately allergic reactions to lidocaine are rare. Occasionally people who are prone to fainting with procedures may experience lightheadedness known as a vagovagal response. Rarely, epinephrine, which is used along with the lidocaine, can cause a rapid heart rate. Notify your doctor prior to surgery if you have experienced any of these symptoms in the past.
Prepare for Surgery
Activity and Follow-up
You should plan on decreased activity and restrict travel for 1 week, and in some cases longer. This is important in order to minimize the scar from spreading and to reduce the chances of bleeding. You will be asked to follow up in 1 to 2 weeks and may subsequently need more follow-up visits.
Wound Care Instructions
Click for wound care instructions