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Skin lesion removal

Shave excision - skin; Excision of skin lesions - benign; Skin lesion removal - benign; Cryosurgery - skin, benign; BCC - removal; Basal cell cancer - removal; Actinic keratosis - removal; Wart - removal; Squamous cell - removal; Mole - removal; Nevus - removal; Nevi - removal; Scissor excision; Skin tag removal; Mole removal; Skin cancer removal; Birthmark removal; Molluscum contagiosum - removal; Electrodesiccation - skin lesion removal

A skin lesion is an area of the skin that is different than the surrounding skin. This can be a lump, sore, or an area of skin that is not normal. It may also be a skin cancer.

Skin lesion removal is a procedure to remove the lesion.

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Description

Most lesion removal procedures are easily done in your doctor's office or an outpatient medical office. You may need to see your primary care provider, a skin doctor (dermatologist), or a surgeon.

Which procedure you have depends on the location, size, and type of lesion. The removed lesion is usually sent to the lab where it is examined under a microscope.

You may receive some type of numbing medicine (anesthetic) before the procedure.

The different types of skin removal techniques are described below.

SHAVE EXCISION

This technique is used for skin lesions that rise above the skin or are in the upper layer of skin.

Your doctor uses a small blade to remove the outermost layers of skin after the area is made numb. The area removed includes all or part of the lesion.

You usually do not need stitches. At the end of the procedure, medicine is applied to the area to stop any bleeding. Or the area may be treated with cautery to seal blood vessels shut. Neither of these will hurt.

SIMPLE SCISSOR EXCISION

This technique is also used for skin lesions that rise above the skin or are in the upper layer of skin..

Your doctor will grab the skin lesion with small forceps and lightly pull up. Small, curved scissors will be used to carefully cut around and under the lesion. A curette (an instrument used to clean or scrape skin) maybe used to cut any remaining parts of the lesion.

You will rarely need stitches. At the end of the procedure, medicine is applied to the area to stop any bleeding. Or the area may be treated with cautery to seal blood vessels shut.

SKIN EXCISION - FULL THICKNESS

This technique involves removing a skin lesion in the deeper levels of the skin down to the fatty layer under the skin. A small amount of normal tissue surrounding the lesion may be removed to ensure it is clear of any possible cancer cells (clear margins). It is more likely to be done when there is a concern about a skin cancer.

• Most often, an area the shape of an ellipse (an American football) is removed, as this makes it easier to close with stitches.
• The entire lesion is removed, going as deep as the fat, if needed, to get the whole area. A margin of about 3 to 4 millimeters (mm) or more surrounding the tumor may also be removed to ensure clear margins.

The area is closed with stitches. If a large area is removed, a skin graft or flap of normal skin may be used to replace the skin that was removed.

CURETTAGE AND ELECTRODESICCATION

This procedure involves scraping or scooping out a skin lesion. A technique that uses high frequency electrical current, called electrodesiccation, may be used before or after.

It may be used for superficial lesions that do not need a full thickness excision.

LASER EXCISION

A laser is a light beam that can be focused on a very small area and can treat very specific types of cells. The laser heats the cells in the area being treated until they "burst." There are several types of lasers. Each laser has specific uses.

Laser excision can remove:

• Benign or pre-malignant skin lesions
• Warts
• Moles
• Sunspots
• Hair
• Small blood vessels in the skin
• Tattoos

CRYOTHERAPY

Cryotherapy is a method of super-freezing tissue in order to destroy it. It is most commonly used to destroy or remove warts, actinic keratoses, seborrheic keratoses, and molluscum contagiosum.

Cryotherapy is done using either a cotton swab that has been dipped into liquid nitrogen, with a spray canister containing liquid nitrogen, or with or a probe that has liquid nitrogen flowing through it. The procedure usually takes less than a minute.

The freezing may cause some discomfort. Your doctor may apply a numbing medicine to the area first. After the procedure, the treated area may blister and the destroyed lesion will peel away.

MOHS SURGERY

Mohs surgery is a way to treat and cure certain skin cancers. Surgeons trained in the Mohs procedure can do this surgery. It is a skin-sparing technique that allows skin cancer to be removed with less damage to the healthy skin around it.

Why the Procedure Is Performed

It may be done to improve a person's appearance, or if the lesion is causing irritation or discomfort.

Your doctor may recommend having a lesion removed if you have:

• Benign growths
• Warts
• Moles
• Skin tags
• Seborrheic keratosis
• Actinic keratosis
• Squamous cell carcinoma
• Bowen disease
• Basal cell carcinoma
• Molluscum contagiosum
• Melanoma
• Other skin conditions

Risks

Risks of a skin excision may include:

• Infection
• Scar (keloids)
• Bleeding
• Changes in skin color
• Poor wound healing
• Nerve damage
• Recurrence of the lesion
• Blisters and ulcers, leading to pain and infection

Before the Procedure

Tell your doctor:

• About the medicines you are taking, including vitamins and supplements, herbal remedies, and over-the-counter medicines
• If you have any allergies
• If you have bleeding problems

Follow your doctor's instructions on how to prepare for the procedure.

After the Procedure

The area may be tender for a few days afterward.

Taking proper care of your wound will help your skin look its best. Your provider will talk with you about your options:

• Allowing a small wound heal itself, since most small wounds heal well on their own.
• Using stitches to close the wound.
• Skin grafting during which the wound is covered using skin from another part of your body.
• Applying a skin flap to cover the wound with skin next to the wound (the skin near the wound matches in color and texture).

Outlook (Prognosis)

Having lesions removed works well for many people. Some skin lesions, such as warts, may need to be treated more than once.

References

Dinulos JGH. Benign skin tumors. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 20.

Dinulos JGH. Dermatologic surgical procedures. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 27.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Cutaneous laser surgery. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 38.

Pfenninger JL. Skin biopsy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 26.

Stulberg D, Wilamowska K. Premalignant skin lesions. In: Kellerman RD, Rakel DP. eds. Conn's Current Therapy 2022. Philadelphia, PA: Elsevier; 2022:1088-1091.

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Review Date: 2/18/2022  

Reviewed By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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