Skin Neoplasm Excision

Surgical excision is a common and effective procedure to remove skin cancers and other abnormal growths from the skin, typically performed in a doctor’s office using local anesthesia.

Table of contents

• What is Skin Neoplasm Excision?
• When is Excision Recommended?
• What Happens During the Procedure
• Recovery and Aftercare
• Success Rates and Effectiveness
• Possible Risks and Complications

What is Skin Neoplasm Excision?

Skin neoplasm excision, also known as surgical excision, is a medical procedure that involves removing abnormal growths or tumors from the skin through a surgical incision^[1]. To excise means to completely remove surgically, typically using a scalpel, laser, or other instrument^[1]. This procedure is commonly used to remove skin lesions (areas of skin that are different from the surrounding skin), including moles, cysts, and skin cancers^[2].

The procedure is frequently employed in dermatology (the medical specialty dealing with skin conditions) for removing various types of skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma^[1]. The surgery involves removing not only the visible cancerous part but also a border of tissue surrounding it, called a margin, to maximize the chance that all cancerous tissue will be removed^[1].

When is Excision Recommended?

Surgical excision may be recommended for patients who have been diagnosed with various types of skin conditions. For skin cancers not requiring specialized techniques like Mohs surgery, surgical excision is generally the preferred treatment^[4]. Mohs surgery is typically reserved for areas of high cosmetic importance such as the face, scalp, hands, neck, and feet, or for particularly aggressive or recurrent cancers. In other areas such as the arms or thighs, where preserving every millimeter of healthy tissue is not as critical, excision is often the most reasonable approach^[4].

For patients with melanoma, if diagnosed from a skin biopsy (removal of a small tissue sample for examination), a surgical excision is likely needed to remove the entire cancerous tumor. Most patients with thin melanomas can be cured with a surgical excision^[8]. The procedure is also suitable for patients with low-risk basal cell carcinoma and squamous cell carcinoma^[8].

Beyond cancer treatment, surgical excision is used to remove benign (non-cancerous) growths that cause discomfort, cosmetic concerns, or need to be examined to rule out more serious conditions^[5].

What Happens During the Procedure

Surgical excisions are typically performed in a doctor’s office or outpatient medical center, without the need for a hospital visit or general anesthesia (medication that puts you to sleep)^[4]. The area to be excised is first marked with a surgical marker. The spot to be removed is circled, and a margin of healthy-appearing tissue around the lesion is also marked, along with any additional area that needs to be removed to allow for proper wound closure^[4].

Local anesthetic is administered to rapidly numb the area of skin involved^[4]. Depending on the size of the lesion being removed, the procedure may require only local anesthesia so you will not feel anything. You may feel slight pressure and a scraping sensation as the doctor cuts the lesion out^[1]. For larger melanomas, however, general anesthesia may be needed^[1].

The dermatologist or surgeon will then cut around and under the likely extent of the skin lesion. Removal of a standard margin of healthy tissue maximizes the chance that all of the cancerous tissue will be removed^[4]. For basal cell carcinoma and squamous cell carcinoma, the amount of healthy tissue excised along with the visible tumor is generally 2 to 4 millimeters^[4].

Some minor bleeding may occur during the procedure, and the physician might cauterize (seal with heat) the area. Although you may be able to hear the buzz of the cautery device, the area will remain completely numb. Any pain is usually mild and quickly corrected with additional anesthesia^[4].

Excisions are typically closed with stitches and generally heal without complications^[4]. Most often, an area shaped like an ellipse (like an American football) is removed, as this makes it easier to close with stitches^[3]. If a large area of skin was removed, a skin graft (a patch of skin from another part of your body used to help close the wound) may be needed^[1].

The excised tissue is then placed in a laboratory container and sent to a pathologist (a doctor who examines tissues under a microscope) for processing and examination^[4]. The pathologist will check the margins of the excision to make sure they are clear of tumor. If tumor is still present, you will need to return to the physician’s office for another excision of the lesion^[4]. Pathology results are generally received within 5 to 14 business days, depending on whether the pathologist needs to order special stains to identify the type or extent of a tumor^[4].

Recovery and Aftercare

Recovery after a surgical excision depends on the site and extent of surgery^[4]. Local anesthetic usually begins to wear off 1 to 2 hours after the excision, after which time you may feel tenderness around the surgical site. Pain is generally mild and adequately relieved by acetaminophen or another comparable medicine that your doctor recommends^[4].

Most excision sites will have been dressed with a bandage. You should leave the dressing on and avoid getting the bandage wet for 24 to 48 hours or as advised by your physician^[4]. After keeping the area covered for the first 24 to 48 hours, you can gently wash the site with cool water and soap, then pat it dry^[3]. Your healthcare provider may recommend applying petroleum jelly or an antibiotic ointment on the wound^[3].

Most excision wounds heal in about one to three weeks following the procedure^[2]. If a skin graft or flap was required to close the wound, the healing process may take up to two months to completely heal^[2]. How quickly your wound heals depends on its size^[19].

It is common for the area to be slightly pink, tender, and swollen during healing. Moderate or severe redness, tenderness, or swelling should prompt a call to your doctor^[4]. Your doctor will tell you when to come back to have stitches removed if they were placed^[3]. The affected site may be red and inflamed for up to a month but will get lighter over time^[8].

Success Rates and Effectiveness

Excisions are used to treat both primary and recurrent tumors. For basal cell carcinoma and squamous cell carcinoma, when the amount of healthy tissue excised along with visible tumor is generally 2 to 4 millimeters, the cure rate is approximately 95%^[4]. By comparison, Mohs micrographic surgery (a specialized technique that examines all margins during the procedure) provides published cure rates of 99% for these cancers^[4].

For many patients with early-stage melanoma, a wide local excision is curative^[13]. Most patients with thin melanomas can be cured with a surgical excision^[8]. A surgical excision of a skin cancer lesion has comparable cure rates to other skin cancer treatments, and the procedure takes less time than other skin cancer treatments^[8].

Compared with Mohs surgery, excisions save a patient time. If a sufficient margin of healthy-appearing tissue is removed, then the cure rate is comparable^[4]. The size of the margins is selected to ensure that additional procedures are rarely necessary^[4].

Possible Risks and Complications

Complications associated with surgical excision include scarring, bleeding or swelling at the affected site, pain, infection, nerve damage, and incision opening after surgery^[8]. Surgical excision often leaves a scar, which is typically the size of the incision^[2]. On average, the length of a scar from excisional surgery of skin cancers is three to four times the diameter of the lesion that is removed, due to the need to remove margins and create an elliptical shape for easier closure^[15].

Surgeons prioritize aesthetic outcomes by minimizing scarring where possible^[2]. The scar should fade with time^[19]. Before your procedure, you should talk to your doctor about how the scar may look and how to care for your incision after the procedure to minimize scarring^[2].

Contact your healthcare provider right away if you experience signs of infection, such as increased pain, swelling, warmth, redness near the area, red streaks leading from the wound, pus draining from the wound, or fever^[3]. You should also contact your provider if there is bleeding at the injury site that will not stop after 10 minutes of direct pressure, if the wound has split open, or if stitches have come out too soon^[21].