Excision and excision biopsy

Local anaesthetic

Procedures are performed using a local anaesthetic, which makes the area around the skin lesion numb for several hours. There is no sedation, so in most cases, it’s safe to drive home after the procedure. The doctor will inject a small amount of local anaesthetic into the area around the spot to be removed. This injection stings for 5 to 10 seconds, but there should be no pain afterwards. (You may be aware of other sensations, such as stretching.)

The anaesthetic may contain adrenaline, which helps reduce bleeding but might cause side effects such as nausea, increased heart rate or a feeling of shakiness. These side effects are rarely serious. If you experience them, we suggest you rest in our waiting room for a while before leaving.

Preparing for an excision or biopsy

Most people don’t need any special preparation for a skin excision, but in many cases simple planning can make the procedure go much more smoothly.

Medications

If you are taking anticoagulant or blood thinning medications such as aspirin, fish oil, warfarin or clopidogrel (Plavix), you may bleed more during or after your procedure. Check with the doctor who prescribed this medication and—only if that doctor approves—you can stop taking the medication a few days before your procedure to minimise bleeding.

If you have certain heart conditions, such as artificial valves, you may need to take a course of antibiotics commencing before your procedure to prevent infections of the heart. Please inform the doctor if you have such conditions in advance of your procedure.

Pacemakers

If you have a pacemaker or defibrillator, please make sure the doctor knows before commencing the procedure. There is a small risk that the electric current produced by diathermy may interfere with pacemakers, so we will avoid using it in these cases.

After the procedure

Leave the dressing in place and keep the wound dry for three days. Leave Steri-Strips on the wound until the stitches are removed. Don’t swim or immerse the wound while stitches are in place.

Learn more about excision aftercare.

Scarring

Your procedure will leave a scar. Some lesions and some sites on the body scar more than others. In most cases, there will be a red or pink mark at the site of the excision for several months. This is considered normal and it will gradually fade.

After that, there will usually be a fine line, or some times an oval-shaped mark which will persist long term.

The doctor will attempt to minimise scarring as much as possible, but you can help by not stretching the wound and taping it or applying silicone ointment.

Pain

Sometimes the local anaesthetic does not completely control the pain during the procedure. If this occurs, an extra dose of anaesthetic should eliminate any discomfort.

It is unusual to experience pain after a skin lesion excision as the wounds are usually quite small and shallow. If you do have pain, simple painkillers such as paracetamol or paracetamol/codeine should be sufficient. Avoid aspirin and ibuprofen as they might increase bleeding.

Pain occurring days after the procedure could be a sign of infection.

Wound breakdown

The skin on each side of the excision site is held together by stitches while it grows together. If the wound is stretched too much, the stitches can break, causing the edges of the wound to pull apart. This can also happen even after the stitches have been removed, as the skin takes several months to reach maximum strength after an excision.

This is usually an inconvenience and not a significant medical problem.

When a wound pulls open, the usual management is to let it heal from the bottom up without restitching it. The wound may need to be dressed repeatedly by a nurse, requiring multiple visits to the clinic. Most wounds heal well, but this process may take several weeks. Scarring is generally worse than it would otherwise have been.

You can reduce the chance of wound breakdown by avoiding stretching and heavy lifting for several weeks after the excision.

Insufficient margins

When performing an excision, the doctor aims to remove the entire skin lesion with a margin of normal skin around it. By ensuring that there is normal skin surrounding the lesion, we can be sure that none of it remains behind.

The usual margin is 2 mm at first, but sometimes after a lesion is confirmed to be a skin cancer, you need re-excision with a larger margin. For example, melanoma may require a margin of 5mm to several cm depending on its size and depth.

Sometimes the skin pathology result shows that the margins around the removed lesions aren’t wide enough. When this happens, in some cases the wound might need to be re-excised.

Nerve damage

Damage to nerves is a rare complication of excisions. It occurs when the doctor cuts a nerve in the process of cutting out a lesion. In practice, nerve damage occurs almost exclusively when lesions are being removed from the face. If your lesion is in an area where nerves might be damaged, your doctor will discuss the risks before your procedure.