If you have a skin cancer, a surgical excision might be recommended. A surgical excision is the removal of skin cancer along with a margin/rim of perceived healthy tissue. For skin cancers not requiring Mohs micrographic surgery, surgical excision is generally performed. Excision allows for the complete removal of skin cancers such as basal cell carcinoma, squamous cell carcinoma or melanoma.
What is involved in excision of a skin cancer or lesion?
After consulting with your dermatologist, it may be determined that your skin lesion needs Mohs micrographic surgery or surgical excision. Mohs surgery is generally performed on areas of high cosmetic importance such as the face, scalp, hands, neck and feet or on particularly aggressive or recurrent cancers. In other areas such as the arms or thighs where a meticulous approach to preserve every millimeter of healthy tissue is not necessary, the most reasonable approach is often excision. 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 as well.
Surgical excisions are performed in office, without the need for a hospital visit or general anesthesia. The spot to be excised is circled with a surgical marker. A “margin” or area of healthy appearing tissue around the lesion is then also marked along with any additional area that needs to be removed to allow for wound closure. Local anesthetic is administered to rapidly numb the area of skin involved. The dermatologist 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. Some minor bleeding may occur, for which the physician might cauterized the area. Although you may be able to hear the buzz of the cautery, the area will remain completely numb. Any pain is usually mild and quickly corrected with additional anesthesia. Excisions are closed with stitches and generally heal without complications. Depending on individual patient circumstances, antibiotics may be prescribed. The excised tissue is then placed in a laboratory cup and sent to a pathologist for processing and examination under a microscope. The pathologist will check the margins of the excisions 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. However, the size of the margins is selected to ensure that additional procedures are rarely necessary. Pathology results are generally received within 5-14 business days, depending on whether the pathologist needs to order special stains to identify the type or extent of a tumor.
What should I expect immediately after surgery?
Recovery after a surgical excision depends on the site and extent of surgery. Local anesthetic usually begins to wear off 1-2 hours after the excision, after which time you may feel tenderness around the surgical site. Pain is generally “Tylenol level” – adequately relieved by Tylenol or another comparable medicine that your doctor recommends. Most excision sites will have been dressed with a bandage: leave the dressing on and avoid getting the bandage wet for 24-48hrs or as advised by your physician. After then, you may then gently wash and pat dry the area. It is common for the area to be slightly pink, tender and swollen. Moderate or severe redness, tenderness or swelling should prompt a call to your doctor.
What is the cure rate/success of excisions and how does it compare to other skin cancer treatment options?
Excisions are used to treat primary and recurrent tumors. For basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) the amount of healthy tissue excised along with visible tumor is generally 2 to 4 mm, resulting in a cure rate of approximately 95%. By comparison, Mohs micrographic surgery provides published cure rates of 99% for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) whereas electrodessication and curettage (ED&C) yields cure rates of approximately 85-90%.
Melanomas require a much larger margin when treated by surgical excision. Melanoma margins are affected by the stage of the disease. Variables that affect cure rate include cancer site, size, subtype and pattern of the tumor. Published cure rates for melanoma with excision vary greatly according to a patient’s risk factors. Your doctor can use the information in your pathology report along with information such as your age and sex to help guide you about your cure rate with excision and whether additional measures such as sentinel lymph node biopsy are worth considering.
What are the risks of surgical excision of skin cancer?
Risks include but are not limited to:
- Infection
- Bleeding
- Hematoma (a collection of blood under the skin sometimes requiring drainage)
- Scarring
- Pain
- Persistent cancer requiring additional treatment
What are signs of an infection?
A mildly pink surgical area accompanied by tenderness is common post-surgery. If the wound becomes increasingly red or painful, hot, swollen, or produces considerable drainage contact your physician. The wound could be infected and may need antibiotics.
What if I experience bleeding from the wound?
If you experience mild bleeding from the wound, you may try pressing on the area firmly with a clean folded towel for 20 minutes. Do not remove the towel or look at the area during this time. Firm compression of the area must be maintained to stop bleeding. If the area is still bleeding after the 20 minute span, contact your physician’s office for further instruction or seek medical attention.
Will I have a scar?
It is nearly impossible to cut the skin, much less remove a skin cancer without some degree of scarring. However, at Premier Dermatology and Mohs Surgery of Atlanta, your dermatologist’s training helps to ensure that your scar is as small and insignificant as possible.
The most common type of excision is an elliptical excision. The ellipse is often designed such that the scar runs parallel with the existing skin creases in order to help minimize the visibility of the scar. Furthermore, placing the ellipse along skin lines usually creates a wound under less tension and orientates the scar in a direction that is less noticeable to the eye. Rest assured, your dermatologist will repair your wound in a way that will keep the scar to a minimum.
To help facilitate a healthy healing process, it is important to avoid any stretching of the area until the stitches are removed and for several weeks afterwards. This will help minimize the appearance of the scar.