Surgical excisions are performed to remove a wide variety of skin lesions ranging from benign growths such as cysts and lipomas to skin cancers. A margin of normal appearing skin is removed around the lesion to ensure complete removal—narrow margins for benign growths and wider margins for skin cancers.
Typically, an elliptical shape of skin is removed. The resulting wound is repaired by loosening the surrounding skin and then closed in straight line using layers of deep and superficial sutures. The incision line will be longer than you may expect, as the final length is usually three times as long as the diameter of the wound.
On rare occasions, the wound may be repaired as follows:
- Flap: The skin adjacent to the wound is elevated and moved to cover the defect. Flaps are typically used for larger wounds but can also be used for wounds in delicate areas, under tension, and to minimize distortion.
- Skin graft: Skin from a different area of the body is used to cover the wound. This type of repair can take longer to heal but can provide excellent results.
- Healing by granulation: The wound is left open and allowed to heal in on its own. Certain areas heal very well by this manner. Although typically will take the longest to heal.
- The skin specimen is sent out for pathological examination. The results typically take one week. There is a small possibility that the excision margins did not adequately remove the lesion, in which case an additional excision may need to be performed on a later date.
- Most patients are scheduled directly for surgery without a preoperative visit. A consultation will be done on the day of the procedure. It is important that you read all the information that we have provided and fill out the Health Questionnaire. If you would like to see one of our dermatologists in consultation prior to the surgery date, we will gladly schedule an appointment for you.
- Please plan accordingly as you will be subject to activity restriction following your surgery. It is recommended you do not travel or plan to participate in athletic activity for 7-10 days following surgery.
- Surgical Excision is performed under local anesthesia. We suggest that you eat your normal breakfast, unless otherwise specified. Please bathe or shower and wash your hair to minimize your risk of a surgical site infection. It is important that you do NOT take any anti-anxiety medicines, narcotic pain medicines or similar types of medicines on the morning of the surgery. If needed, we will provide you with an anti-anxiety medicine once you have signed the consent form. You will be here for several hours, so bring a book, magazine, or laptop. We recommend that you have someone accompany to give you a ride home. This is a requirement if you receive anti-anxiety medicine.
- It is essential that you are able to positively identify the biopsy site on which surgery will be performed. If you cannot, please let us know ahead of time. You may need to go to your referring physician to have the site marked.
- Many of our patients are on blood thinning medications that are prescribed by their physician. We do not recommend stopping them without explicit permission from the prescribing physician. For those on Coumadin/Warfarin, please make sure that your INR is in the therapeutic range. We request that you stop taking any aspirin or ibuprofen compounds (like Anacin, Bufferin, Advil or Motrin), alcohol, vitamin E, gingko biloba and garlic pills at least one week before your surgery. They can increase your risk of bleeding during surgery. If your physician recommends aspirin please do not discontinue without permission.
- For patients scheduled with Dr. Lee for Mohs or excisional surgery: View and print the Preparing for Mohs Surgery handout.
- For patients scheduled with Dr. Adler, Alexander, Bremner, Chang, Hopkins or Resnick for surgery: View and print the Preparing for Surgery - General Dermatology handout.
Most people will experience remarkably little discomfort after surgery. Usually, Tylenol is sufficient to control the pain. If you would like a stronger prescription pain medication, we will gladly prescribe this for you.
Bruising and Swelling
Bruising and swelling are common following surgery and is usually lasts for several days. Applying ice in the first 24 hours helps reduce these symptoms.
The infection rate is very low. A preoperative antibiotic may be recommended to some patients. It is typical to develop some redness along the suture line but if it becomes more extensive or if you develop increasing pain, swelling, drainage, please notify us immediately.
The risk of significant post-operative bleeding is very low. Upon completion of the surgery, a pressure bandage will be placed on the wound. A small number of patients may have some post-operative bleeding as the epinephrine (adrenaline) in the anesthetic wears off. This usually can be stopped with direct pressure for 20 minutes. For any bleeding that is not controlled with pressure, we need to be notified immediately.
At times, the area surrounding your operative site will be numb to the touch. This area of numbness may persist for several months or longer. In some instances, it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.
Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar will often be longer than what you may have anticipated because cancer that is underneath the surface is larger than what is visible before surgery. The scar may also need to be lengthened to better fit the contours of the skin. Scars can take a few months or longer to heal completely. The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with you and give you wound care information, which will explicitly outline how to take care of whatever type of wound you have.
Activity and Follow-up
You should plan on decreased activity and restrict travel for 1 week, and in some cases longer. This is important in order to minimize the scar from spreading and to reduce the chances of bleeding. In some cases where the wound is on the legs, you may be placed on crutches. You will be asked to follow up in 1 to 2 weeks and may subsequently need more follow-ups.