Name of the Procedure:

Excision of Malignant Lesion Including Margins on the Face, Ears, Eyelids, Nose, and Lips; Excised Diameter 2.1 to 3.0 cm

Summary

This procedure involves the surgical removal of a cancerous skin lesion along with a margin of surrounding healthy tissue. It's typically performed on sensitive areas such as the face, ears, eyelids, nose, and lips, where the excised diameter of the lesion measures between 2.1 and 3.0 centimeters.

Purpose

The procedure aims to entirely remove malignant skin lesions along with a safety margin to ensure all cancer cells are eliminated. The anticipated outcome is the prevention of cancer spread and recurrence, along with maintaining the functionality and appearance of the affected area.

Indications

• Diagnosis of a malignant skin lesion (e.g., melanoma, basal cell carcinoma, squamous cell carcinoma).
• A skin biopsy confirming malignancy.
• Lesions located on cosmetically and functionally significant areas like the face, ears, eyelids, nose, and lips.

Preparation

• Patients may need to fast for a few hours prior if sedation or anesthesia is used.
• Preoperative assessments may include blood tests, and imaging studies.
• Patients should disclose any medications, particularly blood thinners, which may need adjustment.

Procedure Description

1. The patient is positioned and local anesthesia or sedation is administered.
2. The surgical area is disinfected and draped.
3. The surgeon then marks the lesion along with a margin of surrounding healthy tissue.
4. Using a scalpel, the surgeon excises the lesion and surrounding tissue.
5. The tissue sample is sent for histopathological examination.
6. The wound is carefully closed with sutures, considering the cosmetic importance of the location.
7. A dressing is applied to the surgical site.

Duration

The procedure typically takes about 30 to 60 minutes, depending on complexity.

Setting

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

Personnel

• Surgeon (often a dermatologist or plastic surgeon)
• Surgical nurse or assistant
• Anesthesiologist or nurse anesthetist (if sedation is required)

Risks and Complications

• Common risks: bleeding, infection, scarring.
• Rare risks: nerve damage, incomplete removal of the lesion, need for additional surgery.
• Complications are managed with antibiotics for infection or further surgical intervention if cancer cells remain.

Benefits

• Complete removal of cancerous tissue.
• Reduced risk of cancer spread or recurrence.
• Preserve or optimize cosmetic appearance and functionality in sensitive areas.

Recovery

• Patients are advised to keep the surgical site clean and dry.
• Pain management may include over-the-counter pain relief or prescribed medications.
• Sutures may need to be removed in 5 to 14 days, depending on the location and healing process.
• Avoid strenuous activity and follow specific wound care instructions.
• Follow-up appointments to monitor healing and discuss pathology results.

Alternatives

• Cryotherapy or laser therapy for smaller lesions.
• Radiation therapy in non-surgical candidates.
• Mohs micrographic surgery for precise margin control.
• Each alternative has pros and cons related to effectiveness, scarring, and recovery time.

Patient Experience

During the procedure, patients may feel pressure or tugging but should not experience pain due to local anesthesia. Post-procedure, mild discomfort and swelling are common, which can be managed with pain medications and cold compresses. Full recovery and return to normal activities generally occur within a few weeks.