We perform surgical excisions to remove a wide variety of skin lesions. Our experience ranges from benign growths, such as cysts and lipomas, to skin cancers. We excise a margin of normal appearing skin around the lesion to ensure complete removal. We excise narrow margins for benign growths and wider margins for skin cancers.
HOW IS SURGICAL EXCISION PERFORMED?
Typically, we remove an elliptical shape of skin. Then we repair the resulting wound by loosening the surrounding skin. To close the wound, we layer deep and superficial sutures to achieve a straight line. The suture line may be longer than expected, approximately three times as long as the diameter of the wound.
On rare occasions, we may apply more advanced repair techniques to close the wound, such as:
- Flap — we elevate the skin adjacent to the wound and move it to cover the defect. We typically use flaps for larger wounds and wounds in delicate areas or under tension.
- Skin graft — we harvest skin from a different area of your body to cover the wound. This type of repair can take longer to heal but can provide excellent results.
In some instances, we promote healing by granulation. We leave the wound open and allow it to heal on its own. Certain areas heal very well this way but take longer to heal completely.
Following excision, we submit the skin specimen for a pathological examination. Results are typically available in a 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 at a later date.
HOW DO I PREPARE FOR SURGERY?
PRIOR TO SURGERY
We schedule most clients for surgery directly without a preoperative visit. The consultation is performed the day of the procedure. It is important that you read all the information we provide and fill out the Medical History Form. If you would like to consult with one of our dermatologists prior to the surgery date, we will gladly schedule an appointment.
THE DAY OF SURGERY
We perform surgical excision under local anesthesia. We suggest that you eat your normal breakfast unless otherwise specified.
Please bathe or shower and wash your hair to minimize the risk of a surgical site infection.
If you are on a blood-thinning medication or aspirin regimen prescribed by your physician, we do not recommend stopping them without explicit permission from the prescribing physician.
You must restrict your activity for seven to ten days following surgery, so please plan accordingly. We recommend no travel or athletic activity during this time.
WHAT ARE THE RISKS ASSOCIATED WITH THE SURGERY?
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 last for several days. Applying ice in the first 24 hours helps to reduce these symptoms.
The infection rate for skin surgery is very low. We may recommend a preoperative antibiotic for some patients. Some redness along the suture line is typical, but if you experience increased pain, swelling, or drainage, please notify us immediately.
The risk of significant post-operative bleeding is very low. When your surgery is complete, we’ll place a pressure bandage on the wound. A small number of patients experience some post-operative bleeding as the epinephrine (adrenaline) in the anesthetic wears off. Applying direct pressure for 20 minutes will usually stop it. If bleeding continues, please notify us immediately.
In some cases, the area surrounding your operative site will be numb to the touch. This 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.
Although we’ll make every effort to ensure the best possible cosmetic result, you will be left with a scar. It may be longer than anticipated if the cancer underneath the skin is larger than what is visible on the surface. We may also have to lengthen the incision to better fit the contours of your skin. Scars can take months or longer to heal completely. Proper wound care can minimize your scar. We will discuss wound care in detail and provide information to enable you to take proper care of your wound.
Fortunately, allergic reactions to lidocaine used for local anesthesia are rare. People who are prone to fainting during 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 one week, and in some cases longer. This is important in order to minimize scarring and to reduce the chances of bleeding. You will be asked to follow up in one to two weeks. Subsequent visits may be necessary.
WOUND CARE INSTRUCTIONS
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