Name of the Procedure:

Excision of Malignant Lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

Summary

This surgical procedure involves removing a small, cancerous lesion from delicate areas such as the scalp, neck, hands, feet, or genitalia. The excised area will include the lesion and some surrounding healthy tissue to ensure all cancer cells are removed.

Purpose

The procedure addresses malignant (cancerous) skin lesions. The goal is to completely remove the cancerous cells and prevent the spread or recurrence of the cancer.

Indications

• Presence of a biopsy-confirmed malignant lesion in the specified areas.
• Lesions that show signs of malignancy such as rapid growth, irregular borders, or bleeding.
• Patients who meet criteria based on their medical history and physical exam.

Preparation

• Patients may need to fast a few hours prior to the procedure if sedation or general anesthesia will be used.
• Medication adjustments may be necessary, particularly for blood thinners.
• Preoperative assessments such as blood tests or imaging studies may be required.

Procedure Description

1. Anesthesia: Local anesthesia will be administered to numb the area. Sedation or general anesthesia may be used based on lesion size and patient comfort.
2. Incision: The surgeon will make an incision around the lesion, including a margin of healthy tissue.
3. Removal: The lesion and surrounding tissue are carefully excised.
4. Closure: The incision is closed with sutures, skin glue, or staples.
5. Pathology: The excised tissue is sent to pathology to ensure all malignant cells have been removed.

Duration

The procedure typically takes between 30 minutes to one hour, depending on the size and complexity of the lesion and its location.

Setting

This procedure is usually performed in an outpatient clinic, a dermatology office, or a surgical center.

Personnel

• Surgeon (often a dermatologist with surgical training or a general surgeon)
• Surgical nurse
• Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is required)

Risks and Complications

• Common Risks: Infection, bleeding, and scarring.
• Rare Risks: Nerve damage, recurrence of the lesion, and adverse reactions to anesthesia.

Benefits

• Complete removal of cancerous cells.
• Reduced risk of cancer spreading or recurring.
• Improved prognosis and potential for complete recovery from the malignancy.

Recovery

• Patients will receive care instructions including how to keep the wound clean and signs of infection to watch for.
• Activities may be restricted to avoid stressing the incision site.
• Stitches may need to be removed in a follow-up visit, typically within 1-2 weeks.
• Full recovery generally occurs within a few weeks to a month.

Alternatives

• Topical Treatments: Topical chemotherapy or immunotherapy, though less effective for deeper lesions.
• Laser Therapy: Non-invasive but generally less effective for malignant lesions.
• Cryotherapy: Freezing off the lesion, suitable for very small, superficial lesions.
• Each alternative varies in effectiveness and applicability depending on the lesion size and type.

Patient Experience

• During the Procedure: Patients will feel minimal discomfort due to the local anesthesia but may feel pressure.
• After the Procedure: Pain is usually mild and manageable with over-the-counter pain relief. Some swelling and redness are typical. Following post-procedure care instructions is crucial for optimal healing and minimizing complications.