Understanding your excision
An excision removes a lesion or skin cancer with a border of surrounding skin, called a margin. It may follow a biopsy diagnosis, be the first step in diagnosing a suspicious lesion, or remove more tissue when an earlier sample had involved margins.
A simple excision is usually closed with stitches. A larger wound may need a skin graft, flap or BTM reconstruction. Your surgeon explains which closure is suitable.
What is a wide local excision?
After a melanoma diagnosis, a further operation may be recommended to remove a wider margin around the original biopsy site. The recommended margin depends on the melanoma’s features, including its depth. Your surgeon will explain the plan rather than applying one margin size to every patient.
Preparing for surgery
Bring a current list of medicines, vitamins and supplements, and tell us about allergies to medicines, latex, antiseptics or dressings. Let the team know about diabetes, circulation problems, previous healing difficulties or a tendency to develop thick scars.
Do not stop blood thinners or change prescribed medicines without advice from your treating team. This includes prescribed aspirin. Ask about any medicine instructions before your appointment.
For a procedure under local anaesthetic alone, fasting is usually not needed unless you have been told otherwise. If sedation or general anaesthetic is planned, follow the fasting and medicine instructions provided by your hospital or anaesthetic team. Call if these are unclear.
- Bring your Medicare card, relevant referral or test results, and comfortable clothing that gives access to the treatment area.
- Discuss transport home. Arrange a responsible adult after sedation or general anaesthetic. Wound location, pain and movement can affect driving even after local anaesthetic.
- Smoking can slow healing. Ask your GP or the clinic for help stopping before surgery and during recovery.
- Ask about the benefits, risks, alternatives and likely scar before giving consent. You can ask for more time or further explanation.
What happens during an excision
Many excisions take place in the clinic under local anaesthetic. Others need an operating theatre, depending on the site, size and anaesthetic plan. Your doctor marks the lesion and planned margin, numbs the area, removes the tissue and controls any bleeding.
A wound may be oval-shaped so the edges can be brought together. A deeper layer of dissolving stitches can support the wound, with surface stitches removed later. The scar may be longer than the original spot. The removed tissue is sent to pathology to check the diagnosis and margins.
A straightforward excision often takes around 30–60 minutes, but the team will give you an estimate for your procedure.
Dressings, washing and activity
Follow your written dressing plan. For many body and limb excisions, the initial pressure dressing stays in place for around two to three days. Facial wounds may have a different plan, including an ointment instead of a bulky dressing. These instructions do not apply automatically to grafts or BTM.
Keep the wound dry for the time advised. Once showering is allowed, let clean water run gently over the area and pat dry. Avoid soaking or swimming until the wound is healed and you have been cleared to do so. Use only the recommended ointment; do not routinely add antiseptics.
Avoid stretching the wound, heavy lifting or strenuous exercise until cleared. Ask about returning to work, especially if your work is physical or dusty. Elevation may help swelling, depending on the wound location. Do not drive if pain, medication or restricted movement makes it unsafe.
Some bruising or mild tenderness is expected early. Use pain relief as directed by your clinician or pharmacist.
Healing and stitch removal
Surface stitches are often removed at about one week on the face and around two weeks on the body or limbs, but your surgeon will set the date for your wound. Deeper dissolving stitches do not usually need removal.
Possible problems include bleeding, infection, wound opening, delayed healing, altered sensation and scarring. Pathology may show that further tissue needs to be removed. Diabetes, smoking and poor circulation can affect recovery.
All skin surgery leaves a scar. The early pink, firm or raised appearance can change over many months; scars may continue to mature for 12–18 months. Wound location, skin type, healing and the procedure all affect the final result.
Only start scar massage or silicone products once the wound is fully closed and your clinician says it is ready. Protect healed skin from the sun and let us know if a scar becomes increasingly raised, tight or uncomfortable.
Pathology and follow-up
A clinician will call you if your results require urgent action. Otherwise, your results will be discussed with you at your follow-up appointment.
Confirm your review appointment before leaving. If it has not been arranged, or your results are taking longer than expected, call the clinic. No contact does not mean a result is clear.
When to seek help
- Increasing or spreading redness, warmth or swelling.
- Pain that is getting worse rather than settling, pus, a new unpleasant smell, fever or feeling unwell.
- A wound that opens, a rapidly growing swelling, or a dressing that is repeatedly soaked.
- An unexpected change in the colour or appearance of a graft, flap or BTM wound.
Call 07 7520 8580 promptly. If the clinic is closed and the problem is urgent, seek an urgent medical assessment. Do not wait for a routine review.
For bleeding, apply firm, continuous pressure with a clean dressing. If bleeding persists despite pressure, seek urgent care. For severe bleeding, collapse or another medical emergency, call 000.