Excisions

Skin excision is a minor surgical procedure involving the complete removal of a skin lesion by cutting it out with a scalpel. It is one of the most fundamental and commonly performed procedures in dermatological surgery, providing both a definitive diagnosis through histopathological examination and complete therapeutic removal of the targeted lesion.

Indications for Skin Excision

Skin excision is performed for a range of diagnostic and therapeutic purposes. The most common indication is the removal of skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma. Excision may also be performed to remove benign growths, cysts that have become inflamed or repeatedly infected, and lesions causing cosmetic concern or physical discomfort. In all cases, the excised tissue is submitted for histopathological evaluation to confirm the diagnosis and ensure complete removal.

Pre-Operative Preparation

Before the procedure, the medical rationale for excision is explained and each step of the process is outlined in detail. A consent form is reviewed and signed to confirm understanding and agreement. It is essential that all current medications be disclosed, particularly blood-thinning agents such as aspirin, clopidogrel, dabigatran, or warfarin, as these may increase the risk of bleeding. Any allergies, chronic health conditions, or the presence of implanted medical devices such as pacemakers or defibrillators should also be reported. Herbal remedies and nutritional supplements should be mentioned as well, since certain products may interfere with normal clotting.

The Elliptical Excision Technique

The most commonly used technique is the elliptical (or fusiform) excision, in which the lesion is removed in an oval shape. This design allows the final scar to follow the skin's natural tension lines, reducing wound-edge tension and producing a less noticeable scar.

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

During the procedure, minor bleeding may occur. Electrocautery, a method of sealing blood vessels using controlled heat, may be used to achieve haemostasis. This can produce a faint hissing sound and a mild burning smell, though no discomfort is felt under local anaesthesia.

Wound Closure

Once the lesion has been excised, the wound edges are carefully approximated and closed with sutures. In most cases, two layers of sutures are placed: absorbable sutures beneath the skin surface to reduce tension, and non-absorbable sutures on the surface that are removed after four to fourteen days depending on the anatomical site and rate of healing. In certain situations, surgical adhesive may be used as an alternative to surface sutures.

Post-Operative Care

Following the procedure, a sterile dressing is applied and detailed aftercare instructions are provided. Mild tenderness or discomfort may develop once the local anaesthetic wears off, typically within one to two hours. The dressing should remain in place for 48 hours or as directed, and stretching or straining the treated area should be avoided 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 beyond this period warrants prompt medical attention.

The wound should remain dry for 48 hours, after which it may 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 evaluated by a dermatologist promptly.

Scar Management

Some degree of scarring is unavoidable following excision. Experienced dermatologic surgeons aim to minimize scarring by aligning incisions with natural skin tension lines and employing precise closure techniques. Initially, the scar may appear red and raised, but it typically fades and flattens over several months.

Proper wound care, diligent sun protection, and evidence-based scar management techniques such as silicone gel application or massage can further enhance the cosmetic outcome. Certain individuals may develop thicker or more prominent scars, known as keloid or hypertrophic scars, depending on individual healing tendencies.

At the Centre for Medical and Surgical Dermatology, all excision procedures are performed by Dr. Maksym Breslavets with precision, safety, and optimal aesthetic outcomes in mind.