Excision: general information

Excision is a minor surgical procedure where a doctor cuts out a skin spot (which we refer to as a lesion).

Before you have an excision it's important to understand what will happen, how to prepare, and potential complications.

Why perform an excision?

Excision is performed to:

  • remove—and usually cure—skin cancers
  • remove suspicious-looking skin lesions 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 lesion 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. But 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 Molescreen in our treatment room.

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 two working days, and the doctor will make arrangements with you about the best way to get them.

After the skin specimen has been removed, the doctor will reduce any bleeding by applying pressure or sometimes by sealing off 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. Please see our Excision Aftercare page for 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 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, but if you experience them, we suggest that you rest in our waiting room for a while before you leave.

Complications

Excision is a surgical procedure with potential complications like any other surgery. It is very important that you understand the risks before you proceed with the excision. Ask the doctor or nurse if you have any concerns.

The most common complications of excision are

  • scarring
  • pain
  • bleeding and bruising
  • wound breakdown
  • infection
  • insufficient margins
  • nerve damage

For further information, see the Complications of Excision page.

Preparing for an excision

Most people don’t need any special preparation for a skin excision, but you should consider the following:

  • Tell your doctor if there are any important medical considerations, such as previous problems with overgrown or keloid scars or bleeding disorders.
  • You may need to temporarily stop taking some medications in consultation with your doctor
  • It might be helpful to shave the area around the lesion in advance

For further information, see the Preparing for Excision or Biopsy page.

After the procedure

If you have stitches, they will need to be removed.

You need to obtain and make sure you understand your pathology results.

You may need further follow-up for dressing changes or to check the progress of the wound.

See the Excision Aftercare page for further information.

Costs

There may be some out-of-pocket costs associated with your procedure. See the Pricing page for further information.