Background Information:

What are the other Names for the Procedure?

• Excisional Surgery of Skin lesions
• Shave Excision of Skin Lesions
• Tangential Excision of Skin Lesions

What is Excision of Skin Lesions surgical procedure?

Excision of Skin Lesions is a procedure to remove skin lesions for health and/or cosmetic reasons. There are two major approaches to Excision of Skin Lesions, based on the depth to which the incision (cut) is made.

• Elliptical Excision of Skin Lesions is a procedure in which the surgeon uses traditional surgical techniques to cut a skin lesion free from the surrounding skin. A scalpel or other device is used to cut through the epidermis and dermis, into the subcutaneous fat
• Shave Excision of Skin lesions is the term for removing skin lesions elevated over the level of the surrounding skin in a superficial manner. The cutting instrument (scalpel) is held parallel to the skin surface, and the elevated lesion is sliced at the base. This leaves behind much of the dermis, the thicker portion of the skin, composed mainly of collagen, and the cells that form it.

The purpose of both techniques is to remove the skin lesion, for reasons of comfort, concern, or cosmetic. It is ALWAYS correct and prudent to submit the removed portion of skin for pathologic exam, to determine and document the true identity of the lesion.

What part of the Body does the Procedure involve?

The Excision of Skin Lesions procedure involves any skin surface. Different areas of the skin have quite variable features, such as thickness, flexibility, functional responsibilities (think of eyelid skin, or around the mouth), hair or no hair, and so on. These factors are kept in mind, yet all areas of skin can be addressed surgically.

Why is the Excision of Skin Lesions surgical procedure Performed?

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

• If a physician has a very likely diagnosis of a skin lesion, yet cannot be sure, excising the lesion with the correct technique will yield a specimen to permit a pathologic diagnosis, to confirm or alter the provisional (initial) diagnosis
• If a biopsy has been done of a lesion, the pathology of it may make the excision mandatory or advisable. If a lesion is malignant, it may be addressed with one of the excisional techniques. If it is premalignant, or borderline in its biology, many times excision is the correct approach
• If a lesion is frequently traumatized, or gets intermittently infected or inflamed, it is appropriate to excise it
• If a skin lesion is of cosmetic concern to a patient, it can be appropriate to excise it. The risks and benefit of the lesion itself, and the outcome possibilities (from best to worst), must be weighed and explained before proceeding with the procedure

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Excision of Skin Lesions include:

• For common skin malignancies, curettage and cautery or Mohs micrographic surgery may be considered
• For melanomas and other lesions, Mohs microscopic controlled surgery may be used
• For minor skin growths, cryosurgery, cautery, or laser ablation may be considered

What are the Recent Advances in the Procedure?

Currently, no significant advances specific to Excision of Skin Lesions procedure are reported.

What is the Cost of performing the Excision of Skin Lesions surgical procedure?

The cost of the Excision of Skin Lesions 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 of Skin Lesions 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://columbiasurgery.org/conditions-and-treatments/skin-lesion-excision#:~:text=Skin%20lesion%20excision%20is%20a,surrounding%20tissue%20called%20the%20margin. (accessed on 05/16/2021)

https://dermnetnz.org/topics/excision-of-skin-lesions/ (accessed on 05/16/2021)

Prior to Excision of Skin Lesions surgical procedure:

How is the Excision of Skin Lesions surgical procedure Performed?

The Excision of Skin Lesions procedure is performed in the following manner:

• The Excision (Elliptical) of Skin Lesions is a sterile procedure, so the skin is prepped, injected with local anesthetic, and covered with a sterile drape
  • An ellipse is drawn on the skin with a sterile marking pen. This will include the lesion, and a small margin or normal skin
  • A scalpel is used to cut through the skin into the subcutaneous fat, taking care not to cut into or through deeper tissues
  • The specimen is removed with a forceps and placed into a bottle of formalin to begin ‘fixing’ it for pathology examination
  • Small points of bleeding are controlled with cautery, or for veins or small arteries that get cut, a suture or two are used
  • Usually, the resulting defect is sutured shut, for faster healing and a better scar
• Shave (Tangential) Excision of Skin Lesions is not a sterile procedure, so the skin is prepped and injected with local anesthetic
  • A scalpel blade or razor blade is used to simply “shave” off the top of a protruding lesion, just at the base
  • The specimen is placed in formalin as above
  • Bleeding is controlled with cautery

Where is the Procedure Performed?

The Excision of Skin Lesions procedure is usually performed in a clinic exam room or a surgical room in a clinic setting. It can also be done in an outpatient surgical facility.

Who Performs the Procedure?

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

How long will the Procedure take?

The Excision of Skin Lesions procedure usually takes about 30 minutes. Shave technique only takes about 10 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
• Any unusual effects of local anesthesia from prior surgery

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 rarely be recommended to discontinue them for a period of time, before the procedure is performed
• Blood work, glucose, and pregnancy tests (if applicable) will be undertaken per physician recommendations
• Patients with pacemakers, defibrillators, deep brain stimulators for Parkinson’s disease or seizures, or implanted pain devices must discuss this with the staff
• Avoid application of any deodorant or topical medicines on the area, prior to the procedure

Pregnant women and individuals with severe underlying sicknesses are advised to discuss their health status before this surgical procedure.

What is the Consent Process before the Procedure?

The physician will obtain permission for the Excision of Skin Lesions 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 of Skin Lesions surgical procedure?

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

• Blood tests to assess bleeding issues
• The physician may suggest further tests depending on the health of the individual and their medical history

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 of Skin Lesions 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 of Skin Lesions 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 of Skin Lesions procedure.

What are the possible Risks and Complications during the Excision of Skin Lesions surgical procedure?

There are general factors that increase one’s risk of getting complications during the Excision of Skin Lesions 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 the Excision of Skin Lesions procedure include:

• Infection
• Bleeding
• Injury to the neighboring structures
• Pain
• Discomfort
• Anesthetic complications
• Need for further procedures

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

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Excision of Skin Lesions surgical procedure:

What are the possible Risks and Complications after the Excision of Skin Lesions surgical procedure?

The risks and complications that may arise after Excision of Skin Lesions 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 most cases, the prognosis after an Excision of Skin Lesions 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 and vomiting
• Signs of infection
• Severe fatigue
• Dizziness

What Post-Operative Care is needed at Home after the Excision of Skin Lesions Excision of Skin Lesions surgical procedure?

At home, the following post-operative care is recommended after the Excision of Skin Lesions procedure:

• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild unscented soap
• Replace dressing after showering
• Take the prescribed medications following the procedure
• Avoid any strenuous activity for a period recommended by the physician
• Continue old prescribed medications after checking with your healthcare provider
• Follow the wound care instructions from your surgeon

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

A complete recovery from the procedure may take about several weeks. The full strength of the scar develops at, or shortly after 4 weeks.

Additional Information:

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

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

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 of Skin Lesions Excision of Skin Lesions 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
• A pathologist (if the tissue was sent for analysis)

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