Background Information:

What are the other Names for the Procedure?

• Excisional Biopsy

What is Excision Biopsy surgical procedure?

• Excision Biopsy is a procedure in which an abnormal growth of the skin is removed entirely
• This is done to provide a complete specimen for pathology examination
• Excisional Biopsy simultaneously helps remove the abnormal skin growth completely, and can result in a ‘cure’ of the lesion

What part of the Body does the Procedure involve?

The Excision Biopsy procedure may involve any region of the skin - from the top of the head to the soles of the feet.

Why is the Excision Biopsy surgical procedure Performed?

There could be a variety of reasons for performing Excision Biopsy procedure. Some of these include:

• Removing an unwanted skin growth, presumed benign, and at the same time, delivering proof of the biology of the tumor
• Surgical removal of a lesion that might be benign or malignant, and determining the biologic behavior and prognosis of the lesion. This would result in complete and adequate removal of most benign lesions. Some malignancies might also be successfully removed with this one procedure, making another surgery unnecessary
• For pigmented lesions in particular, the clinical and even pathologic determination of malignancy can be problematic. A complete Excision Biopsy can be the optimum approach to difficult pigmented lesions

Excisional Biopsy is one of the most frequently performed formal dermatology surgeries.

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Excision Biopsy include:

• Incisional biopsy
• Punch biopsy

What are the Recent Advances in the Procedure?

Currently, no significant advances specific to Excision Biopsy procedure are reported.

What is the Cost of performing the Excision Biopsy surgical procedure?

The cost of the Excision Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Excision Biopsy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://www.aad.org/ (accessed on 05/16/2021)

Prior to Excision Biopsy surgical procedure:

How is the Excision Biopsy surgical procedure Performed?

The Excision Biopsy procedure is performed in the following manner:

• An ellipse is drawn with a sterile marking pen around the lesion to be excised
• Local anesthetic is injected
• The skin is prepped and draped, as Excision Biopsy is a sterile procedure
• A scalpel is used to cut through the skin into the superficial subcutaneous fat
• The ellipse of excised skin bearing the lesion (tumor) is lifted with a forceps, freed from the underlying subcutaneous fat, and placed in a formalin containing specimen bottle
• Bleeding is controlled with electrocautery or placement of sutures as required
• The resulting defect is almost always sutured shut

Where is the Procedure Performed?

The Excision Biopsy procedure is usually performed in a clinic surgical suite or an outpatient surgical suite.

Who Performs the Procedure?

The Excision Biopsy procedure is usually performed by a physician, physician assistant, or advanced practice nurse.

How long will the Procedure take?

The Excision Biopsy procedure usually takes about 30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the procedure and helps avoid complications.

• Provide medical history such as diabetes, hypertension, heart disease, etc. (if any)
• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• Any medical or family history of bleeding disorders or blood clots
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• Any unusual effects of anesthesia from prior surgery
• A list of all previous surgical procedures you have undergone, like for example - removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to the procedure and discuss the details with risks for complications and obtain his/her permission (termed informed consent).

• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Blood work, glucose, and pregnancy tests (if applicable) will be undertaken per physician recommendations
• If anesthesia team is involved in the procedure, then they too will discuss details of anesthesia with risks for complications and obtain permission from the patient (informed consent)
• Avoid application of any deodorant or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the procedure
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• Generally, the patient is required to be on fast (no solids or liquids) for at least 8 hours prior to the procedure
• Individuals with diabetes, hypertension, or other cardiac conditions, are required to discuss these (including medications being taken) with their attending physician well in advance
• For individuals with diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

Pregnant women and individuals with severe underlying sicknesses are advised to notify the surgeon or their team of their health status before undertaking this procedure.

What is the Consent Process before the Procedure?

The physician will obtain permission for the Excision Biopsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Excision Biopsy surgical procedure?

In many cases, no tests are typically necessary prior to the Excision Biopsy procedure. However, if required, the healthcare provider may recommend the following tests such as:

• Blood and urine tests as considered prudent
• Imaging studies, if required, for more complex lesions or locations

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

• What is an Excision Biopsy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Excision Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, local anesthesia by injection is administered for the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Excision Biopsy procedure.

What are the possible Risks and Complications during the Excision Biopsy surgical procedure?

There are general factors that increase one’s risk of getting complications during the Excision Biopsy procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Poor immune system due to a variety of causes

Some of the possible risks and complications that may arise during an Excision Biopsy procedure include:

• Infection
• Bleeding
• Injury to the neighboring structures
• Pain
• Discomfort
• Need for further procedures
• Heart problems

What Post-Operative Care is needed at the Healthcare Facility after the Excision Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. However, immediately following the surgery, the patient will be monitored to make certain they are safe to ambulate and drive or otherwise find their way home.

After the Excision Biopsy surgical procedure:

What are the possible Risks and Complications after the Excision Biopsy surgical procedure?

The risks and complications that may arise after the Excision Biopsy include:

• Excessive bleeding that may sometimes require an additional surgical procedure
• Any symptom that causes uneasiness such as nausea and dehydration
• Low-grade fever

• Infection of the surgical wound

What is the Prognosis after the Surgery?

In almost all cases, the prognosis after an Excision Biopsy procedure is typically excellent.

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Fever and chills
• Severe pain
• Shortness of breath
• Bleeding or fluid discharge from the surgical wound
• Nausea or vomiting
• Signs of infection
• Severe fatigue
• Dizziness

What Post-Operative Care is needed at Home after the Excision Biopsy surgical procedure?

At home, the following post-operative care is recommended after the Excision Biopsy procedure:

• Use a cold pack over the dressing to relieve pain and minimize swelling and bleeding due to the incision
• Replace dressing after showering
• Follow the written instructions given by the surgeon
• Take the prescribed medications following the procedure
• Avoid any strenuous activity for a period recommended by the physician
• Do not drive (post-procedure) for a period of 24 hours
• Avoid smoking or drinking alcohol post-procedure
• Continue old prescribed medications after checking with the healthcare provider
• Avoid sex until complete healing has taken place (under advice by the physician)
• Do not sign any legal documents post-procedure for a period of 24 hours

How long does it normally take to fully recover, from the Procedure?

A complete recovery from the procedure may take about several weeks to a month.

Additional Information:

What happens to tissue/samples (if any), taken during the Procedure?

The samples/tissue are usually sent to the microbiology and pathology departments in the hospital, and subsequently disposed as per the standard hospital protocol.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The samples/tissue is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Excision Biopsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• The dermatologist
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• The laboratory which took possession of the specimen and prepared it for examination by the pathologist)

The patient is advised to inquire and confirm the type of billing before the Excision Biopsy procedure is performed.