Excision surgery is the removal of diseased tissue along with a margin of normal skin to include any microscopic extension of the tumor. A local anesthetic is used to numb the area and an incision is made. After the cancerous area is removed, the incision is closed with stitches. If the incision is large, sometimes a skin graft or flap is required, in some cases reconstructive surgery may be needed.
Following surgery, the specimen is sent to a laboratory where a pathologist examines the removed tissue. If the excision is inadequate, subsequent removal and closure surgeries followed by a separate laboratory analysis may be required. In a routine pathology lab, only a small percentage of the removed tissue is evaluated with less than 1% of the margins viewed. If cancer cells are present in unexamined sections, they will be missed and the cancer can recur.
Excision surgery is different from Mohs micrographic surgery. It works well to remove basal cell and squamous cell carcinomas. Mohs surgery works better for some skin cancer in places, such as the face, where it is important to save as much skin as possible. In Mohs surgery, the skin cancer is removed one layer at a time. Each layer is checked under a microscope right away, so the surgeon can cut away all the cancer cells and spare as much healthy skin as possible. Standard excision treatment for basal cell carcinoma less than 20 mm (0.8 in.) wide has cure rates as high as 95 out of 100 people, when done with 4 mm (0.2 in.) margins. When standard excision is used to treat squamous cell carcinoma, about 92 out of 100 people are cured.
What to Expect
Surgery is performed in a pleasant outpatient suite. Our staff will escort you into an exam room where you will consult with one of our doctors or nurse practitioner who will discuss your case with you and further explain the procedure. A local anesthetic is injected into the skin. Once the area is numb, the cancer/abnormal lesion is removed as well as a layer of tissue around the area. The procedure takes about 45 minutes. A pressure dressing is applied to the area and verbal/written wound care instructions will be given to you afterwards.
Pre-operative Consultation: Consultations with our doctors or nurse practitioner are generally done the day of surgery but can be arranged prior to surgery if desired. If you’re uncertain about having surgery because you are considering another form of treatment or no treatment, please call before your scheduled surgery date to avoid a cancellation fee.
Biopsy Site Identification: Occasionally, smaller cancers are dicult to identify. You must be able to identify your biopsy site the day of surgery. It’s helpful if you take a photo of your biopsy site before it heals. Bring it with you the day of your surgery or email it to firstname.lastname@example.org.
Medications: Continue all medications, except narcotics and benzodiazepines, prescribed by your doctor, including blood thinners, aspirin, Coumadin, Plavix, Vitamin E and blood pressure medications. Studies show discontinuation of prescribed medications, even for short periods, can put one at risk for life threatening events, such as heart attack and stroke.
Do NOT take any benzodiazepines- Diazepam (Valium), Lorazepam (Ativan), Alprazolam (Xanax), Clonazepam (Klonopin), Temazepam (Restoril), Chlordiazepoxide (Librium), Clorazepate (Tranxene), Oxazepam (Serax), or narcotics- Codeine, Fentanyl, Hydrocodone, Lortab, Norco, Vicodin, Hydromorphone (Dilaudid), Demerol, Methadone, Morphine, Oxycodone, OxyContin, or Percocet the day of your surgery. Identification of the site and signing of the consent form need to be done PRIOR to taking any of these medications. Bring your medication with you the day of surgery, and it can be taken after signing the consent. If any of these medications are taken prior to signing the consent, surgery will be canceled and a cancellation fee will apply.
Food and Drink: Since surgery is performed under local anesthesia, you may eat and drink that day.
Alcohol: Alcohol promotes bleeding. We ask you to avoid alcoholic beverages 48 hours before and after surgery.
Smoking: Smoking can affect healing by diminishing blood supply at your surgery site. Discontinue smoking 2 days before surgery and for 1 week after surgery. If you can’t discontinue entirely, cut back to less than 1 pack per day.
Transportation: Make arrangements for someone to drive you the day of surgery. Patients given medicine to relieve anxiety will not be allowed to drive themselves home.
Attire: Wear comfortable, older clothes, avoid make-up, perfume and jewelry. If surgery is on an area covered by clothing, wear something easy to remove.
Cancellations: If you must cancel surgery, please cancel 48 business hours before your surgery date. Less than 48 business hours notice will result in a cancellation fee.
Please don’t travel outside the area for 2 weeks so that any post-operative issues can be addressed. If you have any problems at home after surgery, please do not hesitate to call our office. Verbal and written instructions for wound care will be given to you at the end of your day.
Will I have pain and bruising after surgery? The surgical site may be sore for several days. Tylenol and Ibuprofen are usually adequate for relief. Bruising and swelling are common and may not peak until 48 hours after surgery. Do not plan surgery around an event where your physical appearance is important as you’ll be wearing a bandage for a week in most cases.
Will I be able to return to work or be able to drive? If you’re given medications during surgery, you will not be allowed to drive yourself home. Returning to work or driving will depend on the size and location of your cancer/abnormal lesion and your occupation. Please bring all FMLA paperwork with you the day of surgery. In most cases, time off work will not be granted after surgery. Specific restrictions will be discussed the day of surgery. If you would like to discuss this prior to surgery so arrangements can be made ahead of time, a consult is required.
Can I exercise after surgery? Activities, including exercise or heavy lifting, will be restricted until stitches are removed. The more activity you participate in, the more likely you may bleed from the surgery site.
Will the surgery leave a scar? Whenever surgery is performed, there will be a scar. Our doctors and nurse practitioner are trained in advanced reconstruction and fine suturing techniques to optimize the cosmetic outcome.
Will I need to come back? Suture removal and wound evaluation are usually performed one week after surgery. In some cases, visits may be needed over the next several weeks to months. Periodic visits at least once a year to your referring physician are advisable to monitor for skin cancers or signs of recurrence from previous procedures.
What causes skin cancer? The most important factor in the development of skin cancer is sun exposure.
Why should skin cancers be treated? The two most common types of skin cancer are basal cell and squamous cell carcinoma. Basal cell carcinomas grow slowly and rarely spread throughout the body, but can be locally destructive if not removed entirely. Squamous cell carcinomas can spread to lymph nodes and other parts of the body.
What treatments are used for skin cancer? Methods include curettage (scraping the tissue), excision (cutting the tumor out), radiation therapy, topical cream, and Mohs micrographic surgery. The treatment modality is based on several characteristics of the skin cancer, including location, size, aggressiveness and recurrence. Your physician is knowledgeable of the various treatment.
How can I protect myself in the future? Early detection is critical. Studies show that people who perform skin self- exams have thinner, less advanced melanomas. Early detection can reduce mortality by 63%. Regular skin exams by your physician are essential. Minimize your sun exposure and avoid tanning beds -- studies show a 75% increase in melanoma risk when indoor tanning began before age 30.