Surgical excision

Surgical excision removes a lesion by cutting it out completely, along with a margin of surrounding skin, and closing the wound with sutures.

It is the most definitive way of removing a skin lesion, and the only one that reliably answers the question what was it.

Why excision is different from every other method

Laser, cryotherapy, radiofrequency and curettage all destroy or fragment the lesion. Excision removes it whole - which means it can be sent to a pathologist, who can determine exactly what it was and whether the margins are clear.

That difference is the reason this page exists. If a lesion might be a skin cancer, destroying it leaves:

• no diagnosis
• no confirmation that it was fully removed
• no record in your file that it existed
• nothing for a future practitioner to refer back to if something recurs at the site

Excision costs you a line scar. In exchange you get certainty. For anything suspicious, that is not a close call. See skin cancers.

When excision is the right method

• Any lesion with features of concern, or where the diagnosis is uncertain
• Confirmed or suspected skin cancers
• A solar keratosis that is thickening, tender or recurring
• Deep moles, where surface methods would leave the lower portion behind and the lesion would recur
• Cysts and lipomas - which need their capsule removed, not just their contents
• A lesion that has recurred after a previous destructive treatment
• Some individual deep acne scars, replacing a pit with a fine line

What happens

1. The area is cleaned and marked. The excision is planned as an ellipse, aligned wherever possible with a natural skin crease or relaxed skin tension line - which is what makes a scar less noticeable later.
2. Local anaesthetic is injected. You feel a sting for a few seconds, then nothing but pressure.
3. The lesion is removed with an appropriate margin.
4. The wound is closed with sutures, sometimes in two layers - deep dissolving sutures to take the tension, fine surface sutures for the skin.
5. The specimen is sent to pathology.
6. A dressing is applied, and you are given wound care instructions and a follow-up date.

Most excisions take 20 to 45 minutes. Larger excisions, and those needing a flap or graft to close, are performed by our Specialist Plastic Surgeons.

Results from pathology usually take about a week. You are told the result either way, and what it means for you.

The scar, honestly

Excision always leaves a permanent scar, and the scar is always longer than the lesion was. That is not a shortcoming of technique: closing a circular defect without a bunched or puckered edge requires an elliptical excision several times the length of the lesion.

A well-planned scar fades from red to pale over 12 to 18 months and, on the face, sits along a line the eye does not read as out of place. It does not disappear. See scarring.

Aftercare

• Keep the wound clean and dry as instructed; change dressings as directed
• Avoid stretching the area - no heavy lifting or vigorous exercise while it heals, particularly on the trunk and limbs
• Do not pick at scabs or pull at sutures
• Attend for suture removal - usually 5 to 7 days on the face, 10 to 14 days elsewhere
• Once healed, protect the scar from sun for at least a year; silicone gel and gentle massage help
• Contact us for increasing pain, spreading redness, swelling, discharge or fever

Risks

• Permanent scarring, and scars that widen or stretch, particularly on the trunk and over joints
• Bleeding, bruising and haematoma
• Infection
• Wound separation
• Numbness or altered sensation at the site, sometimes permanent
• Nerve injury, uncommon but possible depending on site
• Keloid or hypertrophic scarring in those prone to it
• Distortion of a nearby feature - eyelid, nostril, lip or ear
• Incomplete excision on pathology, requiring a second procedure
• Recurrence
• Delayed healing, particularly on the lower legs, in smokers and in people with diabetes
• Reaction to local anaesthetic

See risks and complications.

Cost and Medicare

Cost depends on the lesion, its size and site, and the complexity of closure. As at September 2024 and including GST, a Cosmetic Doctor consultation is $150 and a Specialist Plastic Surgeon consultation is $350. Pathology is charged separately by the laboratory.

Excision of a medically indicated lesion - a suspected cancer, a symptomatic lesion - generally attracts a Medicare rebate. MBS item 45060 covers removal of a skin cancer with flap or graft repair, among other applicable items. Excision for purely cosmetic reasons does not. Me Clinic is not a no-gap provider, so an out-of-pocket cost applies; you are given the expected gap beforehand.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: skin lesions, mole removal surgery, all skin treatments.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.