Excision of Skin Lesion

Indications 

  • Resection of a known skin tumour (BCC, SCC, melanoma or benign lesions)
  • Excisional biopsy of an uncharacterised skin lesion.  (Incisional biopsy is often preferred if the diagnosis is unclear).
  • Cosmesis 

ENT surgeons will often perform this in cosmetically sensitive areas such as the face, so appropriate reconstruction is essential.  This can mean secondary intention healing, primary closure, partial or full-thickness skin grafts, local skin flaps etc, as per the “reconstructive ladder”. See this reference.

 

Procedure

The skin lesion is excised under local or general anaesthesia, with a margin appropriate for the likely pathology.  Separate margins may also be sent for histology or frozen section. Careful haemostasis is achieved, and the defect is then reconstructed (occasionally, this is delayed to a second stage). A safe resection should never be compromised to make reconstruction simpler.

 

Length of procedure

Highly variable depending on the reconstruction needed.

 

Complications

Again dependent on the lesion and reconstruction required:

  • Pain
  • Bleeding/haematoma
  • Infection
  • Unfavourable scarring
  • Distortion of surrounding structures (e.g. ectropion if performed near the lower lid).
  • Numbness
  • Flap/graft necrosis
  • Recurrence of the lesion
  • Need for further excision/reconstruction/other treatment.

 

Post-operative management

A pressure dressing is often applied to prevent haematoma – this may be stitched in place. Check the operation note for when dressings and sutures should be removed.

The operative site should be kept strictly dry while sutures are in place. If healing well, it can be gently wet but not soaked after sutures have been removed.

 

TTO

Analgesia. Some surgeons use chloramphenicol or similar ointment, applied topically for 1-2 weeks.

 

 

 

 Page last reviewed: 23 September 2017