Name of the Procedure:

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm

Summary

Excision of a malignant lesion involving the face, ears, eyelids, nose, or lips is a surgical procedure where a cancerous skin lesion larger than 4.0 cm in diameter is removed, along with some normal tissue around it to ensure complete excision. This process aims to get rid of cancerous cells and prevent the spread of skin cancer.

Purpose

This procedure addresses skin cancer located in sensitive areas like the face, ears, eyelids, nose, and lips. The goal is to completely remove malignant tissue while preserving as much healthy tissue as possible and maintaining the functionality and appearance of the affected area.

Indications

• Diagnosed skin cancer (e.g., basal cell carcinoma, squamous cell carcinoma, melanoma) on the face, ears, eyelids, nose, or lips.
• Lesions larger than 4.0 cm in diameter.
• Biopsy results indicating the presence of malignant cells.
• Patients who have not responded to non-surgical treatments.

Preparation

• Pre-procedure consultations to discuss the surgery and possible outcomes.
• Fasting for several hours before surgery if general anesthesia will be used.
• Adjustments or discontinuation of certain medications, such as blood thinners.
• Blood tests and imaging studies like MRI or CT scans to evaluate the lesion and plan the excision.

Procedure Description

1. The patient receives local or general anesthesia.
2. The surgeon cleanses and sterilizes the targeted area.
3. A surgical incision is made around the malignant lesion, ensuring that surrounding tissue margins (healthy tissue) are also removed.
4. The lesion and margins are carefully excised.
5. The site is then closed with sutures, and a dressing is applied.
6. The excised tissue is sent to a pathology lab to ensure all cancerous cells have been removed.

Duration

The procedure typically takes between 1 to 2 hours, depending on the size and complexity of the lesion.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Licensed Surgeon
• Operating Room Nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical Technicians

Risks and Complications

• Infection at the surgical site.
• Bleeding and bruising.
• Scarring and changes in skin appearance.
• Adverse reactions to anesthesia.
• Incomplete removal of cancerous cells requiring additional surgery.
• Nerve damage leading to numbness or tingling in the area.

Benefits

• Complete removal of the cancerous lesion.
• Reduced risk of cancer spreading or recurring.
• Preservation of surrounding healthy tissues.
• Improved cosmetic outcomes in visible areas.

Recovery

• Post-procedure instructions include keeping the site clean and dry, regular dressing changes, and avoiding strenuous activities.
• Pain management may involve over-the-counter pain relievers or prescribed medications.
• Sutures are usually removed within 1-2 weeks.
• Follow-up appointments to monitor healing and discuss pathology results.
• Full recovery typically occurs within a few weeks, but this can vary based on individual cases.

Alternatives

• Topical treatments like imiquimod for superficial lesions.
• Cryotherapy to freeze and destroy cancer cells.
• Radiotherapy, especially for patients who are not surgical candidates.
• Mohs surgery, a tissue-sparing technique, can be an alternative for certain types of skin cancer.

Patient Experience

During the procedure, the patient may feel pressure or mild discomfort if local anesthesia is used; general anesthesia will prevent any sensation. After the procedure, there may be pain, swelling, and minor bruising, which can be managed with medication. Proper care and follow-ups are crucial to ensure effective healing and optimal outcomes.