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Excisions

What is a skin cancer excision? 

Most skin cancers are removed or cut out via an excision.  Basal cell carcinomas, squamous cell carcinomas, melanomas, and even Merkel cell carcinomas can all be removed with a surgical excision.  Surgical excisions allow us to remove the skin cancer with a safety margin at the same time.  The margin is very important for all skin cancers to make sure that no abnormal cells have spread beyond the tumor itself.

 

How do you know the skin cancer has been removed? 

For most excisions, we utilize an onsite pathologist to confirm that the margins are clear before you leave the office.  After the skin cancer has been excised the pathologist starts reviewing the tissue.  If there happens to be some left over skin cancer, we know exactly where to remove it.  This allows us to minimize the size of your final scar.

 

What about the sutures? 

The excision will require sutures.  We utilize a layered approach when closing your excision.  This means that you will have sutures underneath the skin that you do not see.  Also, there will be sutures on top of the skin that you do see.  The sutures on top will need to be removed by us and the sutures underneath the skin will absorb.

A layered closure allows us to put tension on the subcutaneous and dermal layers of the skin.  Having the tension on the deeper layers of skin tends to allow us to create better looking scars when healed.

 

What happens during an excision? 

  1. The skin cancer is marked with a surgical marking pen. This is where we will draw an ellipse around the skin cancer.  Typically, the length will be about 4 times longer than the width.  Most patients are surprised to see how big the excision is going to be when it is drawn out.  This is because we need to create a safety margin, as well as make sure the skin comes back together naturally without creating puckered skin.
  2. TIME OUT! This where we stop for a moment and confirm patient name, DOB, procedure, etc.
  3. The area is cleaned with some rubbing alcohol and local anesthesia is injected. You will feel a little stinging sensation during the injection, which quickly fades away.
  4. The nurse will now “prep” the skin and operating area. This includes cleansing the skin with chlorhexidine and creating a clean field around the excision site.
  5. The skin cancer will now be cut out with a scalpel along the marking pen lines that were drawn earlier. The excision extends to the depth of the subcutaneous fat and is only as wide as what was drawn on the skin in step 1.
  6. As soon as the skin cancer is removed the tissue is marked to delineate the 12 o’clock position.
  7. The nurse takes the skin cancer to our pathologist to confirm that the margins are clear. If they are not clear, the pathologist will tell us where the cancer is still present.  This is why we delineate the 12 o’clock position.  For instance, the pathologist may tell us the cancer is still present at the 4-6 o’clock position, but clear everywhere else.
  8. The excision is closed with layered sutures. This means you will have sutures that are absorbable underneath the skin and sutures on top of the skin that will need to be removed.
  9. Finally, the excision site is cleaned, dressed with Vaseline and a bandage. You will need to keep the area dry for 24 hours and then shower normally.  No rivers, lakes, or oceans until the sutures are removed.
  10. We will schedule you a follow up visit to have your sutures removed.

 

What are the possible complications with an excision?

Typically, there are three main items to worry about with an excision.

  1. Bleeding – some amount of bleeding is to be expected during an excision. This is controlled during the surgical excision.
  2. Infection – sometimes an infection can occur after a surgical excision. The good news is that this is not very common. If this does happen a topical antibiotic and oral antibiotic may be prescribed.
  3. Scarring – there will be some type of scar afterwards. If you are concerned about scarring, we might suggest starting a scar therapy after your sutures are removed.

 

Do I need to do anything before my excision? 

Prior to your excision we will ask you about medications you may be taking.  You may be asked to discontinue certain medications prior to your procedure.  We may even need to work with your primary care doctor or cardiologist to stop certain medications.

 

When do I come back for my next skin cancer screening? 

Most of the time for basal cell and squamous cell carcinomas your next skin check will be in 6 months.  For melanoma, more frequent exams may be necessary.

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