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EXCISION OF SKIN LESION/SKIN CANCER

PROCEDURE

1. The skin lesion is identified and marked.

2. Local anaesthetic is injected under and around the lesion (It can sting a bit when the local anaesthetic is injected in but soon the area will feel numb). The skin is then cleaned with an antisepticskin solution(eg Cholorhexidine, Betadiene) to reduce the risk of infection.

3. The lesion is cut out with a small margin(usually 2-3 mm) of normal-looking skin. This is then sent to the Pathology lab where it will be looked at under the microscope(Note: some Pathology lab charge an out-of-pocket cost) - it may take 1 week before the results are back

4. Associated plastic surgical procedures that may be done at the same time:

LOCAL FLAP - sometimes in order to close the skin that is excised, the surgeon has to make some cuts to move skin from the surrounding area. This is usually done for skin excision around the nose, eye, fingers and lower leg. Rarely, a SKIN GRAFT needs to be performed - skin is taken from another area(eg behind the ear, neck, forearm, groin) and laid on.

RISKS

Generally, this is a safe procedure - however any surgery does carry some risk.

The risks include: 1. Scarring - most will end up with a small scar. However some people scar easily and may get keloids or hypertrophic scars. 2. Wound infection - sometimes the wound can become red and discharge pus. The sutures may need to be removed or antibiotics may be needed. This may also cause the scar to be bigger. 3. Need for reoperation - sometimes the skin cancer may have spread to the edge of the excision margin(this may be because of microscopic spread). To reduce the risk of recurrence, a wider excision may be neccessary. 4. Skin edges of flap not viable or skin graft not surviving - sometimes the skin that is moved to cover the excised area may not heal fully. This may cause the area to form a scab or open wound that may take slightly longer to heal. 5. Bruising/bleeding - sometimes the wound can bleed a bit or there may be bruising around the wound(especially for cuts around the eye) 6.Wound dehiscence - occassionally, if the wound is in a spot where the skin can be stretched considerable, there is a risk of the wound opening up even after the sutures are removed(eg wounds in the middle of the back) Care must be taken - eg reinforcing dressings may be used to hold the skin on both sides of the wound together.

POSTOP CARE/FOLLOW-UP

A waterproof dressing is usually placed over the wound except where it is not possible(eg scalp, lesions on parts of the face/ear). It is advisable to leave it on for 2-7 days.

The surgeon will inform you when the sutures need to be removed - Usually in 5-7 days for wounds in the face/body and 7-14 days for wounds in the back/legs. (Occassionally, dissolvable sutures are used)

Generally, the wound will feel like any cut of the same size. Once the local anaesthetics wear off in a few hours, there may be some pain. Analgesics is usually not needed.

Contact with water - Generally it is all right to shower with an exposed sutured wound after 48 hours. However it is advisable not to immersed the wound in potentially contaminated water (eg swim in a river/lake) until it is fully healed because of the risk of infection.

It is important to come back to see the surgeon who performed the excision to discuss the pathology results. If you cannot make it to the planned appointment, please make another appointment (Do not assume that a pathology result is normal if you are not contacted!)

Notes on the author : Mr LP Cheah has had long-standing interest in dermatology and surgery on the skin. As a 4th year medical student, he won the Herman Lawrence Prize in Dermatology at the University of Melbourne(this prize is open to medical students from the 4th - 6th year and usually won by students in the 6th/final year). He also did his Advanced Study Unit on Melanoma. During his surgical training, he has also trained under plastic surgeons in Australia and UK and is familiar with plastic surgical techniques for the skin(eg local flaps to close defects in face/nose/lip/leg, skin grafts). A significant portion of his current work involves treating skin lesions/cancers.