Excision: Safe and Effective Removal of Skin Lesions

Excision is the removal of damaged skin by completely cutting it out. Excisions can be performed for many reasons, including removing skin cancers, for diagnostic purposes, to improve cosmetic appearance, or to relieve symptoms.

FAST FACTS

1. Excisions are most commonly performed for the removal of skin cancers.

Your dermatologist generally uses a thorough visual examination (often using dermoscopy) and biopsies to confirm a skin cancer diagnosis. When a skin cancer such as squamous cell carcinoma or melanoma is confirmed, the dermatologist will schedule you for a surgery appointment to excise the cancerous area. The goal of the excision is to cut out the cancer completely at the appropriate layers – the epidermis, dermis, and subcutaneous fat, so the cancer does not spread or reoccur from any remaining malignant tissue. Achieving clear margins is what the dermatologist is aiming for. After the surgery, the dermatologist will stitch the wound using surgical sutures to promote healing. Stitches heal in a few weeks, mainly leaving unblemished skin.

2. Excisions can sometimes be performed for other conditions too.

Treatment of benign growths such as cysts has different approaches, one of which involves excisions. A small excision is made to remove the cyst and stitch the wound back up surgically.

3. There are different types of excisions.

Excisions come in different varieties, depending on the type of condition being treated. Two common examples are:

• Elliptical excision

The excision is in the form of an ellipse or an oval. The ellipse is often designed so that the resulting scar runs parallel with existing skin creases. This usually provides a wound under less tension and orientates the scar in a direction that is less noticeable to the eye.

• Deep saucer excision

This excision removes a deeper scoop of tissue, leaving a circular wound. With this procedure, suturing or stitches are often not required. The wound is left to heal naturally.

4. Excisions involve a series of steps.

• The dermatologist marks the area with a surgical marker.
• A local anesthetic injection is administered to rapidly numb the area of the skin involved and keep it numb during the procedure.
• The dermatologist then cuts around and under the lesion with a scalpel, sharp scissors, and an appropriate margin of normal surrounding tissue.
• The lesion is placed in a formalin container to preserve and transport it to the pathology laboratory.
• A pathologist processes and examines the specimen under the microscope and provides your dermatologist with a report a few days later.
• There may be some bleeding in the area where the lesion is removed during the procedure. The dermatologist may coagulate the blood vessels with a cautery. This can make a hissing sound and a burning smell, but the patient will not feel it.
• If an elliptical excision was performed, the edges of the ellipse are sewn together to make a thin suture line. This type of wound closure is called primary closure.
• There may be two layers of sutures – a layer underneath that is absorbable and a layer of sutures on the surface, which are removed in 4-14 days. Occasionally, special skin glue is used to join the edges together, instead of sutures.
• A dressing may be applied, and instructions will be given to you on how to care for your wound to promote healing and prevent infections. If applicable, you will be scheduled for an appointment to get the sutures out.

Frequently Asked Questions About Excision

5. There is minimal scarring post-excision.

It is impossible to entirely excise a skin lesion without scarring in some way. Careful surgical techniques aim to minimize scarring by taking the skin surface tension lines into account. Different people heal differently at different rates. Scars are usually barely noticeable and in the form of a pencil-thin line that is barely visible and generally hidden along the skin’s natural lines and folds.