Name of the Procedure:

Excision of a Malignant Lesion with Margins, Trunk, Arms, or Legs (Excised Diameter Over 4.0 cm)

Summary

This surgical procedure involves removing a cancerous (malignant) skin lesion from the trunk, arms, or legs along with surrounding healthy tissue (margins) to ensure that all cancer cells are eliminated. It is typically done when the lesion is larger than 4.0 cm in diameter.

Purpose

The procedure aims to treat skin cancer by completely excising the malignant lesion. This helps prevent the spread of cancer, reduces the risk of recurrence, and promotes healing.

Indications

• Presence of a malignant lesion on the trunk, arms, or legs.
• Lesions larger than 4.0 cm in diameter.
• Biopsy-confirmed skin cancer.
• Patients with a history of skin cancer or with lesions showing rapid growth, pain, bleeding, or changes in color or shape.

Preparation

• Patients may need to fast for several hours before the procedure.
• Stopping certain medications, such as blood thinners, may be necessary.
• Pre-procedure assessment may include a physical exam, blood tests, and imaging studies like an ultrasound or MRI.

Procedure Description

1. Anesthesia: Local anesthesia is typically administered to numb the area.
2. Incision: The surgeon makes an incision around the lesion, including a margin of healthy tissue to ensure complete removal.
3. Excision: The malignant lesion and surrounding tissue are excised.
4. Closure: The wound is closed with sutures, staples, or surgical glue.
5. Pathology: The excised tissue is sent to a pathology lab to confirm that all cancer cells are removed.

Duration

The procedure usually takes about 30 minutes to 1 hour, depending on the size and location of the lesion.

Setting

The procedure is commonly performed in an outpatient surgical center or a hospital.

Personnel

• Surgeons specialized in dermatology or surgical oncology.
• Nurses and surgical technologists.
• Anesthesiologist or nurse anesthetist if sedation is required.

Risks and Complications

• Common risks: Bleeding, infection, and scarring.
• Less common risks: Nerve damage, recurrence of the cancer, or an adverse reaction to anesthesia.
• Management: Antibiotics for infection, pain relief medications, and follow-up appointments for wound care and monitoring.

Benefits

• Complete removal of the malignant lesion.
• Reduced risk of cancer spreading or recurring.
• Healing and restoration of the normal appearance and function of the skin area.

Recovery

• Wound care instructions include keeping the area clean and dry.
• Limited physical activity and avoiding strenuous exercise for a few weeks.
• Sutures may need to be removed in 1-2 weeks.
• Follow-up appointments to monitor healing and for any further treatment.

Alternatives

• Mohs surgery, especially for lesions in critical areas (e.g., face).
• Radiation therapy for non-surgical candidates.
• Cryotherapy or topical treatments for smaller lesions.

Pros of Alternatives:

• Mohs surgery offers precise removal with minimal tissue loss.
• Radiation therapy is non-invasive.

Cons of Alternatives:

• Longer recovery times.
• Higher costs.
• Radiation therapy may need multiple sessions.

Patient Experience

• Patients will feel only minor discomfort due to local anesthesia.
• Post-procedure pain is typically mild to moderate and can be managed with over-the-counter pain relievers.
• Full recovery may take several weeks, during which time patients should follow their surgeon's care instructions closely.