Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm
CPT4 code
Name of the Procedure:
Excision of Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Excised Diameter 1.1 to 2.0 cm
Summary
This procedure involves the surgical removal of a cancerous skin lesion from sensitive areas of the face, such as the ears, eyelids, nose, or lips, along with a margin of surrounding healthy tissue.
Purpose
The procedure aims to remove malignant skin lesions to prevent the spread or recurrence of skin cancer. It ensures clear margins to reduce the likelihood of cancer cells remaining in the surrounding tissues.
Indications
- Presence of a confirmed malignant skin lesion (e.g., basal cell carcinoma, squamous cell carcinoma, melanoma) in the specified facial regions.
- Lesions that have changed in size, shape, or color, or that cause symptoms such as pain or bleeding.
- Patients with a history of skin cancer or recurrent lesions.
Preparation
- Patients may need to fast for a few hours if general anesthesia is used.
- Certain medications might be adjusted or paused before the procedure.
- Pre-procedural diagnostic tests, including biopsy and imaging, are often necessary to confirm the extent of the malignancy.
Procedure Description
- Anesthesia: Local anesthesia is typically administered to numb the area.
- Incision: A precise incision is made around the malignant lesion, removing it along with a margin of healthy tissue.
- Examination of Margins: The excised tissue is examined (often frozen section analysis) to ensure clear margins.
- Closure: The wound is carefully sutured to minimize scarring, considering the aesthetic importance of the facial area.
Tools used include a scalpel, surgical scissors, forceps, and suturing materials. General anesthesia may be employed in more extensive cases.
Duration
The procedure usually takes about 30 minutes to an hour, depending on the lesion's size and complexity.
Setting
Typically performed in an outpatient clinic, surgical center, or hospital setting with appropriate surgical facilities.
Personnel
- Dermatologic or plastic surgeon
- Surgical nurse
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
- Infection at the surgical site
- Bleeding and hematoma formation
- Scarring or cosmetic dissatisfaction
- Nerve damage, leading to temporary or permanent numbness
- Possible need for additional surgery if margins are not clear
Benefits
- Effective removal of malignant tissue to prevent further spread
- Clear margins reduce recurrence risk
- Potential for cosmetic reconstruction techniques to minimize visible scarring
Recovery
- Keep the incision site clean and dry.
- Follow prescribed wound care instructions, including the use of antibiotic ointment.
- Avoid strenuous activities and sun exposure for a specified period.
- Follow-up appointments to monitor the healing process and discuss any pathology results.
Alternatives
- Mohs micrographic surgery: Offers high precision in removing skin cancer with minimal healthy tissue loss.
- Radiation therapy: Non-surgical option but might not be suitable for all types and sizes of lesions.
- Topical chemotherapy for superficial lesions: Less invasive but might be less effective for deeper malignancies.
Patient Experience
Patients might experience discomfort during local anesthesia injection, but the procedure itself is typically painless. Post-operative pain can usually be managed with over-the-counter pain relievers. Some swelling and bruising may occur but generally subside within a few days to weeks.