Last reviewed: March 2023
Author: Dr Sonya Havill MBChB FRACP, Department of Dermatology, Waikato Hospital, New Zealand, 2001.
Reviewing dermatologist: Dr Ian Coulson (2023)
What is an excision biopsy?
Excision biopsy refers to theremoval of a skin lesion by completely cutting it out.
Why do skin lesions have to be excised?
A common reason to excise a skin lesion is to remove skin cancer, such as abasal cell carcinoma, squamous cell carcinoma or melanoma.
Other reasons to remove a skin lesion include:
- To make a diagnosis
- To improve the cosmetic appearance
- To relieve symptoms (if a lesion is tender or prone to being knocked)
- To remove an inflamed or frequently infected cyst.
Scarring due to excision biopsy
It is impossible to fully excise a skin lesion without scarring in some way. Careful surgical technique should aim to minimise scarring, for example by taking the skin surface tension linesinto account.
Some people have an abnormal response to skin healing and these people may get larger and thicker scars than usual (keloidor hypertrophic scarring).
What is involved in excision of a skin lesion?
Your dermatologist will explain to you why the skin lesion needs excision and the procedure involved. You may have to sign a consent form to indicate that you understand and agree to the surgical procedure. Tell your doctor if you are taking any medication (particularly aspirin, clopidogrel, dabigatran and warfarin, which could make you bleed more), or if you have any allergies, medical conditions, or a pacemaker or implanted defibrillator. 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 most common type of excision is an elliptical excision. The ellipse is often designed so that the resulting scar runs parallel with existing skin creases. This usually provides a wound under less tension and orientates the scar in a direction which is less noticeable to the eye.
The area to be excised is marked with a surgical marker. A local anaesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. The dermatologist will then cut around and under the lesion with a scalpel and sharp scissors along with an appropriate margin of normal surrounding tissue. The lesion is placed in formalin ready to go to the pathology laboratory. Here, a pathologist will process and examine the specimen under the microscope, and provide your doctor with a report a few days later.
There may be some bleeding in the area from where the lesion has been removed during the surgery. The doctor may coagulate the blood vessels with a cautery. This can make a hissing sound and a burning smell, but will not be felt.
The edges of the ellipse will then be sewn together to make a thin suture line. This type of wound closure is called primary closure. There may be two layers of sutures (stitches) a layer underneath that is absorbable and a layer of sutures on the surface which will need to be removed in 4-14 days. Occasionally special skin glue is used to join the edges together, instead of sutures.
A dressing may be applied and instructions will be given on how to care for your wound and when to get the stitches out.
Excision with primary closure
Excision wound Sutured wound Healed wound
How do I look after the wound following skin excision?
Your wound may be tender 1–2 hours after the excision when the local anaesthetic wears off.
Leave the dressing in place for 48 hours or as advised by your dermatologist. Avoid strenuous exertion and stretching of the area until the stitches are removed and for some time afterwards.
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 48 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 your dermatologist promptly — it could be infected and need a course of antibiotics.
The scar will initially be red and raised but usually reduces in colour and size over several months.
FAQs
A local anaesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. The dermatologist will then cut around and under the lesion with a scalpel and sharp scissors along with an appropriate margin of normal surrounding tissue.
What is the surgery for skin lesions? ›
Complete excision (excision biopsy)
It's usually done with a local anaesthetic to block any pain. Your doctor uses a surgical blade to remove the whole lesion, as well as some normal skin around the edge. Your doctor will close the wound using stitches and cover it with a dressing.
How painful is a skin excision? ›
The excision surgery itself should not be painful, as your provider will likely numb the area with local anesthesia before the procedure. However, you may experience some swelling, soreness, or pain following the procedure.
What is the medical term for removal of lesion? ›
Curettage: Scraping off the unwanted lesion
Examples of lesions that may be suitable for this procedure include seborrheic keratoses, viral warts, actinic keratoses, and skin tags. Excision: Cutting out the unwanted lesion.
How long does it take for skin excision to heal? ›
Most wounds take 1 to 3 weeks to heal. If a large area of skin was removed, you may have a skin graft. In that case, healing may take longer. Some soreness around the site of the wound is normal.
What is an excision in dermatology? ›
A surgical excision, also known as shave excision of a skin lesion, is a skin cancer treatment that surgically removes malignant moles, lesions and tumors from the skin along with a healthy margin around the tumor. Surgical excisions can be performed to treat basal and squamous cell carcinomas as well as melanomas.
What is excision of large skin lesions? ›
Your provider will grab the skin lesion with small forceps and lightly pull up. Small, curved scissors will be used to carefully cut around and under the lesion. A curette (an instrument used to clean or scrape skin) maybe used to cut any remaining parts of the lesion. You will rarely need stitches.
Which is better, Mohs or excision? ›
Mohs surgery is the best treatment option for most skin cancers. This tissue-sparing procedure offers high cure rates and excellent outcomes, especially if the lesion is removed early.
Do they put you to sleep for an excision? ›
Excisional skin surgery involves the use of relatively superficial structures, is performed under local anesthesia, and seldom entails major blood loss or fluid shifts. That being said, it is still an invasive procedure, and a preoperative assessment of the patient is essential.
What are the disadvantages of excision? ›
The main disadvantage of the excision and repair of skin cancers is the scarring that may occur after the procedure, especially for larger incisions. This procedure also calls for the removal of healthy skin around the tumor, which at times, makes it difficult to put the edges of the resulting wound back together.
Most of these procedures take about 5 to 20 minutes. Sometimes the more complicated procedures, such as Mohs' micrographic surgery, can take a few hours. Most people can go back to their normal routine on the same day or the day after the procedure.
How do they remove benign skin lesions? ›
Your surgeon will make an elliptical (oval) cut over the cyst and then cut out the cyst. To remove a lipoma, your surgeon will make a straight cut on your skin directly over it. The lipoma is freed up from the tissues around it and removed. A skin tag can simply be numbed with local anaesthetic and then removed.
What do benign skin lesions look like? ›
Seborrheic keratoses may be the most common benign tumor of the skin. Typically, they are scaly (hyperkeratotic), brown (hyperpigmented), often somewhat greasy plaques that vary in size and thickness and often appear to be stuck onto the skin surface (Fig. 1).
What should you avoid after excision? ›
Avoid stretching the area or any heavy lifting/exercise until the wound has been checked by a doctor or nurse and the stitches removed (up to two weeks later). If the wound is on your face or head, avoid lowering your head, which may increase blood pressure abd bleeding.
How long do you have to wear a bandage after an excision? ›
Caring for surgical site:
Keep pressure bandage on for at least 24hrs – do not get wet. It is important to keep the surgical site moist and covered with band aid to insure healing. Micro-mend or Hemigard ONLY: Keep pressure bandage on for at least 24hrs – do not get wet.
Can you drive after skin excision? ›
Procedures are performed using a local anaesthetic, which makes the area around the skin lesion numb for several hours. There is no sedation, so in most cases, it's safe to drive home after the procedure.
How long does lesion surgery take? ›
Most of these procedures take about 5 to 20 minutes. Sometimes the more complicated procedures, such as Mohs' micrographic surgery, can take a few hours. Most people can go back to their normal routine on the same day or the day after the procedure.
How long does it take to recover from skin lesion removal? ›
Most wounds take 1 to 3 weeks to heal. If you had laser surgery, your skin may change colour and then slowly return to its normal colour. You may need only a bandage, or you may need stitches. If you had stitches, your doctor will probably remove them 5 to 14 days later.
What is the treatment for skin lesion? ›
They can be treated with topical lotions, creams, ointments or medications that you take orally that target the specific type of lesion. They may require surgical removal. Secondary lesion as a side effect of a medical condition: Treatment for the underlying medical condition.
How do you repair skin lesions? ›
Keep the wound bandaged and dry for the first day. After the first day, wash around the wound with clean water 2 times a day. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a non-stick bandage.
