Name of the Procedure:

Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm

Summary

This procedure involves the surgical removal of a cancerous skin lesion from the trunk, arms, or legs. The lesion, along with a margin of surrounding healthy tissue, is excised to ensure complete removal of malignant cells.

Purpose

Medical Condition:

• The procedure addresses malignant skin lesions, such as melanoma, basal cell carcinoma, or squamous cell carcinoma.

Goals and Outcomes:

• To completely remove the malignant tissue.
• To reduce the risk of cancer spreading or recurring.

Indications

Specific Symptoms or Conditions:

• Presence of a skin lesion that has been diagnosed as malignant through biopsy.

Patient Criteria:

• The patient has a malignant lesion on the trunk, arms, or legs with an excised diameter of 3.1 to 4.0 cm.

Preparation

Pre-procedure Instructions:

• Follow fasting guidelines if general anesthesia will be used.
• Adjust or stop certain medications as advised by the healthcare provider.

Diagnostic Tests:

• Biopsy confirming malignancy.
• Pre-operative blood tests and imaging studies if necessary.

Procedure Description

• The patient receives local anesthesia or sedation.
• The surgeon marks the lesion and planned incision margins.
• Using a scalpel, the surgeon excises the lesion along with surrounding healthy tissue (margin).
• The excised tissue is sent to a pathology lab for examination.
• The wound is closed with stitches, and a sterile dressing is applied.

Duration

• The procedure typically takes about 30 to 60 minutes, depending on the lesion size and location.

Setting

• It is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• The procedure involves a surgeon, a nurse, and possibly an anesthesiologist if sedation is used.

Risks and Complications

Common Risks:

• Bleeding
• Infection
• Scarring

Rare Risks:

• Nerve damage
• Incomplete removal of the lesion
• Recurrence of the malignancy

Management:

• Infection is managed with antibiotics.
• Additional surgery may be needed for incomplete excisions.

Benefits

Expected Benefits:

• Complete removal of the tumor.
• Decrease in the risk of cancer spreading or recurring.

Realization of Benefits:

• Healing and confirmation of complete excision through pathology typically occur within weeks of the procedure.

Recovery

Post-procedure Care:

• Keep the incision site clean and dry.
• Follow instructions for wound care and medications.

Recovery Time:

• Most patients return to normal activities within a few days to a week.

Restrictions:

• Avoid strenuous activities until cleared by the surgeon.
• Attend follow-up appointments to monitor healing and ensure complete removal of cancerous cells.

Alternatives

Other Treatment Options:

• Mohs surgery
• Radiation therapy
• Cryotherapy (freezing the lesion)

Pros and Cons of Alternatives:

• Mohs surgery is very precise but more time-consuming.
• Radiation can be non-invasive but may require multiple sessions.
• Cryotherapy is less invasive but typically used for smaller or superficial lesions.

Patient Experience

During the Procedure:

• Patients may feel pressure or tugging but should not feel pain due to anesthesia.
• If under sedation, patients may feel drowsy or relaxed.

After the Procedure:

• Some soreness and swelling at the excision site.
• Mild pain controllable with over-the-counter analgesics.
• Instructions provided for comfort measures, hygiene, and signs of complications to watch for.