What is meant by an excision of a skin lesion?
Excisions are performed to remove skin cancers, abnormal moles and other abnormal lesions.
After discussing the type of lesion to remove and the reason to remove it, a consent form will be signed to indicate that you understand and agree to the surgical procedure.
Your medications (particularly aspirin, clopidogrel, dabigatran and warfarin, which could make you bleed more), allergies, medical conditions, will be reviewed. Your past history of artificial heart valves, or artificial joints or history of pacemaker/defibrillator will be reviewed. If you must take antibiotics prior to dental visits, the same is true for skin excisions. Remember, to tell your doctor about any over-the-counter supplements or herbal remedies as a number of these can also lead to abnormal bleeding.
The area to be excised is marked. A local anesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. You may feel pressure and movement but the procedure is not painful.
The lesion is removed with an appropriate margin. The specimen removed is sent to the dermatopathologist to evaluate for diagnosis and/or clear margins. We will give the results to you.
If there is bleeding, cautery is used to stop bleeding. This does not hurt but you may hear a buzzing sound.
The open wound is most often closed in two layers with deep sutures that dissolve over weeks to months. The top layer is closed with sutures that are removed in 7 - 14+ days depending on the location and tension on the wound. Sometimes dissolving outer sutures are used.
Wound dressings may include steristrip tapes, ointments, pressure bandages. Specific care instructions will be given to you for your site. It is imperative that you follow the instructions carefully to prevent infections or the stitches from popping.
Your wound may be tender 1-2 hours after the excision when the local anesthetic wears off. Intermittent ice packs, Tylenol and Advil in appropriate doses may be advised.
Leave the dressing in place for 24 hours or as advised by your My Dermatologist. Avoid strenuous exertion and stretching of the area until the stitches are removed and for some time afterwards. Do not lift or strain or pull the surgery site until the sutures are removed. The wound strength at 3 months is only 50% and only ever reaches 80% of the previous strength of normal skin.
Suture removal is not painful. The suture is gently clipped on one end and gently removed. Steristrips may be reapplied to protect the new wound.
We recommend being in town and not traveling while you are healing.
Do not swim in pools, oceans, lakes or submerge the area in bath water while the wound is healing.
If there is any bleeding, press on the wound firmly with a clean folded towel without removing the existing dressing or looking at it for 20 minutes. If it is still bleeding after this time, seek medical attention.
Keep the wound dry for 24 hours. You can then gently wash and dry the wound. A small amount of pinkness and tenderness to touch around the wound edges is normal but, if the wound becomes increasingly red or painful, consult My Dermatologist promptly – it could be infected and need a course of antibiotics.
The scar will initially be red and raised but usually reduces in color and size over several months. It is impossible to cut the skin without scarring in some way, so you will always have some sort of scar. Some people have an abnormal response to skin healing and these people may get larger scars than usual (keloid or hypertrophic scarring). If this occurs, we have techniques to improve the scar.
Please contact My Dermatologist for any questions at
612-621-8888.