Cutaneous or subcutaneous lesions are usually benign and not dangerous. Most common include birthmarks or nevuses, senile warts or seborrhoic keratoses, moles, papillomas, xanthelasmas, atheromas or epidermal inclusion cysts and lipomas. Even though, they do not cause serious problems, they may appear unsightly, and many people want to have them removed for practical or aesthetic reasons.
On the other hand, suspicious or malignant (cancerous) skin lesions should be removed as soon as they are recognized. These include basal cell carcinomas, squamous cell carcinomas and melanomas. If an experienced doctor suspects that the lesion could be malignant, it should be removed (excised) with appropriate margin of healthy skin and send to the pathologist, for microscopic analysis. This examination reveals the nature of the lesion and gives information about safety margin. In most skin cancers, the patient is cured if the lesion is removed completely.
Based on the type, size and location of the lesion and patient’s preferences we can decide what technique should be used for removal. Aesthetic considerations are always taken into account. Benign lesions can be burned away with diathermy or laser, scraped, sanded off or excised. With skin excision, elliptical piece of skin is cut away so that resulting wound can be closed neatly without excess skin at the edges. Excised lesion can be sent for microscopic examination to prove that it is harmless. Usually, the only acceptable way to remove malignant or potentially malignant skin lesions is complete excision with a safety margin.
Every time skin excision is necessary a visit to an experienced plastic surgeon is your best option. As plastic surgeons perform aesthetic and reconstructive surgery on daily bases, we are best acquainted with surgical and suturing techniques to provide the finest aesthetic outcomes, with minimal rate of complications. In addition, knowledge of reconstructive techniques (flaps and skin grafts) enables us to choose the best method for closure of larger defects that cannot be simply sutured together.
There is really no real reason to limit the number of lesions excised other than practical. The amount of local anesthetic used is very small and the dose will normally not even get close to the recommended maximum. It could, however, be very inconvenient to have multiple wounds on various body parts. Therefore, we usually recommend the patient to limit the number of excisions to no more than 12 at a time. Smaller lesions can be an exception.
Pregnancy is not the greatest time to have surgery and the safest course of action is to postpone all elective treatments until after the birth. However, there are certain conditions when skin lesion removal is necessary. If possible, local anesthesia should be avoided in the first trimester when fetus is most vulnerable. It is preferable to have the operation in the second or third trimester, as current medical literature states that local anesthetic do not cause birth defects to the fetus, provided the surgery is done during this period of pregnancy.
There is rarely a limited amount of pain or discomfort in the first days following the procedure. This can be alleviated with mild pain killers. The wounds are normally covered with steri-strips and there is no need for a change of dressing unless instructed otherwise by your surgeon. The wounds should be kept dry with the exception of wounds on the hair-bearing areas of scalp and genitals which can be washed daily with mild shampoo or soap. Preferably we use absorbable sutures which will dissolve spontaneously and do not need to be removed. For certain areas and size of wounds it is better to use the non-absorbable sutures. The sutures need to be removed on day 5 to 7 on the face, day 10 on the hands and day 14 on the other areas.