Name of the Procedure:

Excision of Malignant Lesion, Including Margins, Scalp, Neck, Hands, Feet, Genitalia; Excised Diameter 2.1 to 3.0 cm

Summary

This procedure involves surgically removing a cancerous skin lesion along with a margin of surrounding healthy tissue to ensure complete removal. It is performed on sensitive areas like the scalp, neck, hands, feet, and genitalia when the excised diameter is between 2.1 to 3.0 cm.

Purpose

The goal is to treat skin cancer by completely removing the malignant lesion, including a margin of healthy tissue to ensure clear boundaries. This helps to prevent the spread of cancer and to achieve local control of the disease.

Indications

• Presence of a malignant skin lesion, such as melanoma, squamous cell carcinoma, or basal cell carcinoma.
• Lesions that measure between 2.1 to 3.0 cm in diameter and are located on the scalp, neck, hands, feet, or genitalia.
• Patients with confirmed diagnosis of skin cancer requiring surgical intervention.

Preparation

• Patients may be instructed to fast for a few hours before the procedure if general anesthesia is planned.
• Avoid certain medications, such as blood thinners, as advised by the healthcare provider.
• Undergo pre-procedure diagnostic tests like biopsy, imaging studies to determine the extent of the lesion.

Procedure Description

1. The patient is positioned to allow the best access to the lesion.
2. The area is cleansed and sterilized.
3. Local anesthesia is administered to numb the area, or general anesthesia is applied if necessary.
4. A surgical incision is made around the lesion, including a margin of healthy tissue.
5. The lesion along with the surrounding margin is excised.
6. The excised tissue is sent for pathological examination to confirm complete removal.
7. The surgical site is closed with sutures and dressed appropriately.

Duration

The procedure typically lasts between 30 minutes to 2 hours, depending on the complexity and size of the lesion.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• Surgeon or dermatologic surgeon
• Nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Scarring
• Possible nerve damage causing numbness or pain
• Recurrence of the cancer
• Adverse reactions to anesthesia

Benefits

• Complete removal of the malignant lesion
• Reduced risk of cancer recurrence
• Prevention of cancer spread
• Pathologic confirmation of clear margins

Recovery

• Keep the surgical site clean and dry
• Follow wound care instructions and medication regimen
• Activity limitations as advised by the surgeon
• Sutures may need to be removed in follow-up visits
• Most patients can resume normal activities within 1-2 weeks, but full recovery may take longer depending on the site and extent of surgery

Alternatives

• Mohs micrographic surgery: precise method, especially for cosmetically sensitive areas
• Radiation therapy: non-surgical, but less effective for some types of lesions
• Cryotherapy: freezing lesion, suitable for smaller, less invasive cancers
• Topical treatments: used for superficial lesions but less effective for larger or invasive cancers

Patient Experience

• Local anesthesia typically means minimal pain during the procedure.
• Some discomfort or soreness at the surgical site post-procedure, managed with prescribed pain relief medications.
• Swelling and bruising are common and reduce over several days.
• Monitoring for signs of infection or other complications is necessary.