Excisions of Lesions

Excision refers to removal of a skin lesion by completely cutting it out. A common reason why skin lesions are excised, is to fully remove skin cancers such as basal cell carcinoma,squamous cell carcinomas or melanomas. If the cancer is not cut out it may spread to the surrounding skin and to other parts of the body (metastasise).

Other reasons why a lesion may be removed include for diagnosis, cosmetic appearance, if it is symptomatic (eg painful or prone to being knocked), or to remove an inflamed or frequently infected cyst.

Will I have a scar?

It is impossible to cut the skin without scarring in some way, so you will always have some sort of scar. Your dermatologist will excise the lesion and repair the wound in a way that will keep the scar to a minimum.

Some people have an abnormal response to skin healing and these people may get larger scars than usual (keloid or hypertrophic scarring).

What is involved in excision of a skin lesion?

The most common type of excision is an elliptical excision. 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 which is less noticeable to the eye.

The area to be excised is marked with a surgical marker. A local anaesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. The dermatologist will then cut around and under the lesion with a scalpel and sharp scissors.

The edges of the ellipse will then be sewn together to make a thin suture line. This type of wound closure is called primary closure. There may be two layers of sutures (stitches) ¬ a layer underneath that is absorbable and a layer of sutures on the surface which will need to be 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 on how to care for your wound and when to get the stitches out.

“The best way to find yourself is to lose yourself in the service of others” – Gandhi.