Excision and excision biopsy

Close-up of doctor's hands and scalpel

Why perform an excision?

Excision is performed to:

  • remove—and usually cure—skin cancers
  • remove suspicious-looking spots so that they can be tested

A doctor would recommend excision if:

  • he or she is confident that a lesion is a skin cancer and must be entirely removed to properly treat it
  • a spot looks like it could be a skin cancer and it needs to be tested to reach a diagnosis. Sometimes, the doctor might choose to remove only part of the lesion, performing a punch or shave biopsy—usually if the lesion looks like one of the less serious skin cancers such as basal cell carcinoma or squamous cell carcinoma. If the spot is suspected of being a melanoma, it’s best to remove the entire lesion for testing.

The procedure

The procedure usually takes approximately 20 minutes (although this varies according to the size and complexity of the procedure) and is performed at Spot Check Clinic.

The doctor cuts through the skin around the lesion, usually in an oval shape. Depending on the type of lesion, there will typically be a margin of between 2 and 5mm of normal skin around the lesion. The cut usually needs to be about 3-4 times as long as it is wide, so that the skin edges can close together after the lesion is removed.

Once the doctor has cut around the lesion, he or she peels off the lesion and surrounding skin. It will be sent to a skin pathology laboratory for analysis. The results are usually available in less than a week. The doctor will make arrangements with you about the best way to get them.

After the skin lesion has been removed, the doctor will reduce any bleeding by applying pressure or sometimes by sealing small blood vessels with a small electric current. This process (called diathermy) makes the tissues hot and you may notice a burning smell, but there should be no pain

When any bleeding is controlled, the doctor will pull the skin edges together and secure them with stitches. The number and type of stitches, and the thickness of the material used, depend on the size of the skin lesion and the location on the body.

The doctor will advise you when the stitches need to be removed.

See the Excision aftercare page or advice on looking after the wound and dressing after your procedure.

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 after- wards. (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 that you rest in our waiting room for a while before you leave.

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.

Preparing the area

If the area to be excised is hairy, it is very helpful to shave the region at least 24 hours before your procedure. (Unfortunately we can't shave it on the day, as this would increase the risk of infection.) You should shave at least 10 cm around the lesion so there is plenty of room for adhesive dressings.

Reducing stress

Some people have needle phobias or feel anxious about undergoing procedures. These strategies might help:

  • Purchase some EMLA cream from a pharmacy and apply it to the lesion and surrounding area at least an hour before your procedure. This cream can help to make the area numb and helps reduce the discomfort of the local anaesthetic injection.
  • Bring a portable music player or your phone with your favourite music or podcasts
  • Have a calm and responsible support person with you. If you like, this person can sit in the treatment room and talk to you while you are having the procedure.