Name of the Procedure:

Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Genitalia; Excised Diameter 1.1 to 2.0 cm.

Summary

This procedure involves the surgical removal of a cancerous skin lesion, along with a margin of surrounding healthy tissue, from specific sensitive areas such as the scalp, neck, hands, feet, or genitalia. The excised lesion is between 1.1 and 2.0 centimeters in diameter.

Purpose

This procedure is performed to remove malignant (cancerous) skin lesions to prevent the spread of cancer. The goal is to completely excise the tumor with clear margins to ensure no cancerous cells remain.

Indications

• Presence of a diagnosed malignant skin lesion within the specified size range (1.1 to 2.0 cm).
• Suspected skin cancer with biopsy-proven malignancy.
• Lesions located on sensitive areas like the scalp, neck, hands, feet, or genitalia, which require careful handling.

Preparation

• Patients may need to fast if the procedure requires general anesthesia.
• Medications such as blood thinners may need to be adjusted or paused.
• Preoperative assessments may include blood tests, imaging studies, and a detailed medical history review.
• Patients should arrange for transportation home after the procedure.

Procedure Description

1. Anesthesia: Local anesthesia is typically used to numb the area, though general anesthesia may be used depending on the lesion's location and patient preference.
2. Incision: A surgical scalpel is used to make an elliptical incision around the lesion, including a margin of healthy tissue.
3. Excision: The entire lesion and margins are carefully excised.
4. Closure: The wound is closed with sutures, and a sterile dressing is applied.
5. Pathology: The excised tissue is sent to a pathology lab to confirm complete removal of the cancerous cells and ensure clean margins.

Duration

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

Setting

This procedure is usually performed in an outpatient clinic, surgical center, or hospital operating room.

Personnel

• Surgeon
• Surgical nurse or assistant
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common risks: Bleeding, infection, scarring, and pain at the surgical site.
• Rare risks: Nerve damage, allergic reactions to anesthesia, incomplete removal of the lesion, or recurrence of cancer.

Benefits

• Successful removal of the cancerous lesion.
• Prevention of cancer spread.
• Peace of mind with pathology-confirmed clear margins.

Recovery

• The patient will receive instructions on wound care, including keeping the area clean and dry.
• Pain management may include over-the-counter pain relievers or prescribed medications.
• Sutures are typically removed within 1-2 weeks.
• Patients should avoid strenuous activities that could stress the surgical site.
• Follow-up appointments are necessary to monitor healing and discuss pathology results.

Alternatives

• Mohs surgery: A specialized technique for certain types of skin cancer, offering precise removal with minimal tissue loss.
• Radiation therapy: Used for patients who cannot undergo surgery.
• Cryotherapy: Freezing off the lesion; less effective for larger or deeper lesions.
• Topical chemotherapy: For superficial lesions, though less effective for invasive skin cancer.

Patient Experience

• Patients may feel pressure or tugging during the procedure with local anesthesia.
• Post-procedure discomfort is typically manageable with pain relievers.
• There may be swelling, redness, and mild bruising around the surgical site.
• Most patients can resume normal activities within a few days, avoiding any strain on the affected area as directed.