Excision Biopsy of Skin Lesions

An excision biopsy is a minor surgical procedure that involves the complete removal of a skin lesion by cutting it out. One of the most common reasons for performing an excision is to remove skin cancer, such as basal cell carcinoma, squamous cell carcinoma, or melanoma.

Excision may also be performed for other purposes, including obtaining a definitive diagnosis, improving cosmetic appearance, relieving discomfort when a lesion is tender or easily irritated, or removing an inflamed or repeatedly infected cyst.

Some degree of scarring is unavoidable following the complete excision of a skin lesion. However, experienced dermatologic surgeons aim to minimize scarring by aligning the incision with the skin's natural tension lines and applying precise closure techniques. Certain individuals may develop thicker or more prominent scars, known as keloid or hypertrophic scars, depending on their natural healing tendencies.

Before the procedure, the dermatologist explains the medical reasons for the excision and outlines each step of the process in detail. The patient is asked to sign a consent form confirming understanding and agreement to the procedure. It is essential for patients to inform their physician about all current medications, particularly blood thinners such as aspirin, clopidogrel, dabigatran, or warfarin, as these can increase the risk of bleeding. Any allergies, chronic health conditions, or the presence of medical devices such as a pacemaker or defibrillator should also be disclosed. In addition, patients are advised to mention any herbal remedies or supplements, as certain products may interfere with normal clotting.

The most common technique is the elliptical excision, in which the lesion is removed in an oval shape. This design allows the final scar to follow natural skin creases, minimizing tension and making the mark less noticeable.

Before the excision begins, the area is marked with a surgical pen, and local anaesthesia is administered to numb the skin. The dermatologist then uses a scalpel and surgical scissors to carefully remove the lesion along with a small margin of normal tissue to ensure complete removal. The specimen is placed in formalin and sent to a pathology laboratory for microscopic evaluation, with results typically available within a few days.

During the procedure, some minor bleeding may occur. The physician may use electrocautery, a method of sealing blood vessels using controlled heat, which can produce a faint hissing sound and a mild burning smell, though the patient does not feel discomfort.

Once the lesion is excised, the wound edges are carefully brought together and closed with sutures. In most cases, two layers of sutures are used: absorbable sutures beneath the skin and removable sutures on the surface, which are typically taken out after four to fourteen days, depending on the site and rate of healing. In some cases, surgical adhesive may be used in place of sutures.

Following the procedure, a sterile dressing is applied, and the patient receives detailed aftercare instructions. Mild tenderness or discomfort may occur once the local anaesthetic wears off, usually within one to two hours. The dressing should remain in place for 48 hours or as advised by the dermatologist, and the patient should avoid stretching or straining the treated area until healing is complete.

If bleeding occurs, firm pressure should be applied over the dressing with a clean folded towel for approximately 20 minutes. Persistent bleeding after this time warrants medical attention.

The wound should remain dry for 48 hours, after which it can be gently cleansed and patted dry. A mild pink hue or slight tenderness around the wound edges is normal; however, increasing redness, swelling, pain, or drainage may indicate infection and should be promptly evaluated by a dermatologist.

Initially, the scar may appear red and raised but typically fades and flattens over several months. Proper wound care, diligent sun protection, and evidence-based scar management techniques such as silicone gel or massage can further enhance the cosmetic outcome.