Excisional surgery or shave excision is a surgical procedure that involves the removal of growths, such as moles, masses and tumours, from the skin along with the healthy tissues around the tumour.
This procedure is done by one of our specialist surgeons which would be done under local anaesthetic injections. First, they remove a part or the whole or a part of the lesion or tumour. The sample will then be sent off to a lab for testing and checking under a microscope. If cancer cells are seen whether it is adequately removed, or additional skin will be removed and examined again. This procedure can take up to an hour to complete, depending on the amount of skin or tumours need to be removed.
Please inform our 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 the doctor about any over-the-counter supplements or herbal remedies as a number of these can also lead to abnormal bleeding.
Our doctor 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.
The area to be removed 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 numbing medication can cause a burning sensation in the skin for a few seconds. 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.
There may be some bleeding in the area from where the lesion has been removed during the surgery. To stop bleeding 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 wound 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.
The time the procedure may take varies, but it is likely to be between 30 and 90 minutes.
The lesion needs to be analysed for the precise diagnosis it will be 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.
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.
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.
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