Excision of Skin Tumours

Excision of skin tumours is the surgical removal of a lesion on or beneath the skin, together with a margin of healthy tissue set by the doctor. The term “tumour” refers to any newly formed growth, and most of these are benign, meaning they are not cancerous.

Commonly removed lesions include moles (naevi), cysts, lipomas, skin tags, seborrhoeic keratoses, as well as lesions that are suspicious or confirmed to be malignant, such as basal cell carcinomas or melanoma. At Detalii Med, in Baia Mare, the assessment is made by the dermatologists, and the excision is performed by the dermatologists or by the clinic's plastic surgeons, depending on the case.

Excision may be recommended for people who have:

• a mole or lesion that has changed in shape, colour or size, or that bleeds;
• a lesion considered suspicious on dermatological and dermoscopic examination;
• a growth that is enlarging, becoming inflamed or causing pain;
• lesions frequently irritated by clothing, jewellery or shaving;
• benign growths that are aesthetically bothersome.

Any new or changing lesion should be assessed by a dermatologist before deciding on treatment.

Excision removes the growth and allows it to be analysed under the microscope, which provides an exact diagnosis. For malignant lesions detected early, complete excision is often an essential step in treatment.

The procedure leaves a scar, usually linear, whose size depends on the size of the lesion and the margins required. Excision does not prevent other lesions from appearing elsewhere. If the analysis shows a malignant lesion or insufficient margins, a re-excision, further investigations or cancer treatment may be needed.

The consultation begins with a dermatological assessment of the lesion, usually including dermoscopy, a magnified examination with special lighting that helps distinguish benign lesions from suspicious ones. The doctor asks how long the lesion has been present, what changes have been noticed, about sun exposure and about any personal or family history of skin cancer.

Based on the assessment, it is decided whether the lesion should be removed, with what margins and by which technique, so that the scar is as discreet as possible. Current medication is also discussed, especially anticoagulants.

After the area has been disinfected and numbed with local anaesthetic, the doctor removes the growth, usually in an elliptical shape aligned with the natural lines of the skin, for a more discreet scar. The wound is closed with stitches, sometimes in two layers.

For larger lesions or those in areas with little spare skin, such as the face, closure may require a local flap or, rarely, a skin graft. The excised tissue is sent for histopathological examination. As a guide, the procedure takes between 15 and 60 minutes, depending on size and location.

Excision is usually performed under local anaesthesia, by injecting an anaesthetic around the lesion. The patient stays awake and feels only a sting at the moment of the injection. For large, multiple or deep growths, another form of anaesthesia may be discussed.

The patient goes home straight after the procedure. The dressing is kept on as instructed and the wound is cared for at home. Stitches are usually removed after 5 to 14 days, depending on the area: sooner on the face, later on the back or limbs.

Discomfort is generally mild. For a few weeks, exertion that puts tension on the area is avoided, and the scar is protected from the sun for at least a few months. The histopathology result is usually available within one to three weeks and is discussed with the doctor.

Excision is usually well tolerated, but it does carry risks:

• bleeding or haematoma;
• wound infection or wound opening;
• a widened or thickened scar or, in predisposed people, a keloid;
• local changes in skin sensation or colour;
• recurrence of the lesion, especially with certain types of growth;
• the need for re-excision if the margins are not sufficient.

The risks are discussed at the consultation, depending on the lesion and its location.

Wound healing usually takes a few weeks, and the scar gradually fades over 6 to 12 months. The histopathology result determines the next steps. For malignant lesions or patients at higher risk, regular dermatological check-ups are recommended, at the interval set by the doctor.

Excision of skin growths has a dual role: it removes the lesion and, through histopathological examination, provides a clear diagnosis. Prior dermatological assessment is essential. Any mole or lesion that changes deserves to be checked early, and the decision on treatment is made at the consultation.