Surgical Excision

Surgical excision (elliptical excision, full-thickness excision) is a procedure used to cut out skin cancers, moles, cysts, and various growths. An anesthetic is usually injected to the skin prior to excision. The injection is slightly painful, but the procedure itself is not. The anesthetic used in my practice (lidocaine with epinephrine) provides immediate numbing of the skin. It is not necessary to wait for it to take effect.

When a skin cancer or a severely atypical (dysplastic) mole are cut out of the skin, the surgeon needs to take a margin of normal skin around the lesion. The purpose is to ensure complete removal. When a benign lesion (such as lipoma, cyst, congenital mole) is excised, no additional normal skin is removed around it. The depth of excision varies. For most of the lesions, the full-thickness layer of the skin to the fat level is removed. For especially large and deeply-located basal and squamous cell carcinomas, as well as melanomas, the fat is removed to the level of underlying muscle.

Bleeding is usually not a problem with skin excisions. Patients taking blood-thinners (coumadin, aspirin) or with history of prolonged bleeding when cut need to notify their physician prior to the procedure. Even though blood thinners complicate the excisions by causing excessive bleeding, in most cases they do not have to be stopped prior to the procedure. A recent study demonstrated that stopping a blood thinner prior to excisions has a much higher risk of a serious medical complication, than not stopping it. The worst case scenario for a patient on a blood-thinner is excessive bleeding during surgery. That bleeding can be stopped with electric cautery or ligation (tying) of bleeding vessels. The worst complication for someone who really needs a blood thinner, but stops it prior to skin surgery, is stroke and death. Hence, most patients on coumadin and aspirin may continue taking their medication prior to skin surgery.

After the skin containing a skin cancer or a mole is removed, the wound is closed with several layers of sutures. Absorbable sutures are usually used to close deeper layers of the skin. These sutures remain in the wound to keep it together until they are broken down by the body. The superficial layer of sutures is non-absorbable. It needs to be removed in anywhere from 7 days (facial wounds) to 14 days (trunk and extremities). See the section on wound care instructions to learn what to do after your surgery.

Alexander Doctoroff, D.O., F.A.O.C.D.
Assistant Chief of Dermatology
Veterans Administration Medical Center, East Orange, New Jersey
Clinical Assistant Professor of Medicine
University of Medicine and Dentistry of New Jersey
www.metropolitanderm.com