Excision: Preparation, Operation, and Post-Operative Care
In a broad surgical sense, excision refers to the removal of unhealthy tissues, tumours or organs of the body. Excision is an essential feature of professional dermatology used to treat a range of skin problems. It is especially useful for removing many forms of skin cancer, including dangerous melanomas. In dermatology, excision involves removing the lesion entirely by cutting it out, assisting healthy skin cells to regenerate and repair the surgical site.
Excision is generally performed when lab results from a previous biopsy show abnormal or atypical skin cell structure of a basal cell carcinoma, squamous cell carcinoma or melanoma. The operation aims to remove any remaining abnormal tissue, and is important to ensure melanoma doesn’t spread to other areas of the body (metastasise). Removal of less dangerous cancers, cysts or other growths is advised where necessary for both medical and cosmetic reasons.
The dermatologist will oversee every step of the excision procedure. In most cases, there are no pre-operative adjustments required, although it is important to maintain an accurate medical history. For this reason, most patients prefer the specialist treatments available at a dedicated skin clinic such as Pymble Dermatology. Your dermatologist keeps you informed of progress at every stage, and as a patient, you will need to inform the dermatologist of any medications, over-the-counter drugs or other remedies you are taking.
Although providing significant improvements, excision of cancer and other skin growths is conveniently performed as a day-surgery. Pymble Dermatology treatment rooms are purpose-built for sterile operating procedures and the operation is performed by an experienced dermatologist specialising in skin treatment techniques.
Excisions naturally vary in size according to the amount of tissue being removed. The wound area is usually closed with sutures (stitches) so some scarring is inevitable, although elliptical excisions designed to run parallel with natural skin creases are often remarkably hard to spot once fully healed. This type of incision also enables normal and comfortable facial movements along with a greatly improved appearance.
The dermatologist will first outline the excision site with a surgical marker. Local anaesthesia is then injected to numb the area for the duration of the procedure. Using special surgical tools, the dermatologist will then cut the lesion out, including a small margin of healthy skin tissue surrounding the area. Excess blood flow can be slowed using specialised medical equipment prior to the wound being sewn closed.
In some cases, there will be two layers of sutures. Internal sutures are absorbed by natural body mechanisms, while external sutures are removed a week or two after surgery. The dermatologist will apply a surgical dressing or pressure bandage to protect the wound and assist with healing.
Excision post-operative care
The bandage or dressing should remain in place for the first 48-72 hours. Don’t allow the surgical site to get wet during this time. After two to three days, the dressing can be removed and gentle washing of the area is possible using mild soap, followed by the application of ointment or gauze as directed by your dermatologist. Physical activities can stress the wound site and should be avoided for 48 hours after excision to avoid unnecessary bleeding, while vigorous exercise that adds pressure to the site should be avoided for up to six weeks. Bleeding is not uncommon during the first day or two of recovery, and is usually stopped by holding a soft towel against the wound for 20 minutes without peeking. If bleeding is continuous or excessive, contact your dermatologist for advice and instructions or emergency department if after office hours.
There will probably be some swelling and bruising around the surgical site as these are natural healing mechanisms of the body. Healing often also includes tightness, itchiness or sensitivity to touch. Once healing is complete, additional therapies can be employed to improve the appearance of the surgical site. These include laser therapy, topical applications and other cosmetic approaches that are all performed at Pymble Dermatology. Total skin care is a full-body approach to health, and dermatologists have all your surgical and cosmetic needs covered from head to toe.