Lesion Excision

What is an excision?

An excision is a minor surgical procedure in which a skin lesion, such as a mole, cyst or lump, is completely cut out and the wound is closed with stitches. It is carried out under local anaesthetic, so you are awake but the area is numb.

When a lesion is removed to find out what it is, the procedure is often called an excisional biopsy. Everything that is removed goes to the laboratory for microscopic examination.

What is it used for?

Excision is used for moles and other marks that have changed or look unusual, for skin cancers such as melanoma and basal cell or squamous cell carcinoma, and for troublesome harmless lumps such as cysts and lipomas.

For moles and skin lesions, the lesion is usually removed with a small margin of normal-looking skin around it, often a few millimetres, so that it can be fully examined. For cysts, the whole cyst wall needs to be removed, because any wall left behind can allow the cyst to come back.

Before your procedure

If you have private medical insurance, you will be given a procedure code. Please contact your insurer to obtain pre-authorisation, and check whether any excess applies, before booking. If you are self-funding, the clinic can give you the cost in advance.

Please tell us if you take any medicines that thin the blood, such as aspirin, clopidogrel, warfarin, apixaban or rivaroxaban, if you have a pacemaker or other implanted cardiac device, if you have ever reacted to a local anaesthetic, or if you are pregnant or breastfeeding. Do not stop any prescribed medicine unless you have been advised to.

You can eat and drink normally on the day. Try not to book the procedure in the two weeks before a holiday, an important event or a period of heavy physical activity, and avoid sun exposure, sea water and swimming while the wound heals.

If you need to cancel, please let the clinic know with as much notice as possible rather than on the day.

What happens on the day?

Dr Mounsey carries out the procedure himself. The area is cleaned, and the outline of the excision is marked on the skin. A local anaesthetic is then injected around the area. This stings for a few seconds, after which the skin becomes numb. You may feel pushing or pulling during the procedure, but it should not be painful.

The lesion is removed, usually in the shape of an ellipse, which allows the skin to be closed neatly in a straight line. The wound is closed with stitches, which may be dissolvable or may need to be removed, and a plaster is applied. Most excisions take around 20 to 30 minutes, though you should allow extra time for the whole appointment.

You can usually drive and return to normal, light activities afterwards, unless the excision is close to the eye or your clinician advises otherwise.

What to expect afterwards

You will be left with a straight scar, typically two to three times the length of the original lesion. This is because the wound needs to be longer than it is wide for the skin to close flat. The scar is often red and slightly raised or lumpy at first, and it usually becomes flatter and paler over several months.

Scars on the back, shoulders and chest are more likely to stretch or widen over time because of movement in those areas.

Aftercare

Keep the plaster put on at the end of your procedure in place for the first 48 hours. After 48 hours, take it off, clean the wound with soap and water, then pat it dry. You can shower daily from this point. Each day, continue to clean the wound with soap and water, pat it dry, then apply a thin layer of Vaseline before putting on a fresh plaster. Continue this until the wound has healed.

For a minimum of a week, or until healing is complete, steer clear of strenuous exercise, swimming, baths and hot tubs. Depending on where the excision is, you may need to avoid heavy lifting, stretching or activities such as cycling for longer, to reduce the risk of the wound opening or the scar stretching.

Stitches that need removing are usually taken out between 4 and 14 days afterwards, depending on the site, with those on the face removed earliest, often by a nurse at your GP surgery or at the clinic. Dissolvable stitches usually disappear within a few weeks.

If the wound bleeds, press firmly on it with a clean, folded cloth or gauze for 10 to 15 minutes without lifting to check. If it is still bleeding after a second period of firm pressure, seek medical advice.

Paracetamol can be taken for discomfort once the local anaesthetic wears off. Avoid aspirin and anti-inflammatory painkillers such as ibuprofen for the first couple of days unless they have been prescribed for you, as they can increase bleeding. Avoiding alcohol for 48 hours and not smoking or vaping while the wound heals both help healing.

Contact the clinic if you notice signs of infection, such as increasing pain, redness, warmth or swelling around the wound, pus, or a fever, or if you have any other concerns.

Once the wound has fully healed, protect the scar from the sun with a broad-spectrum sunscreen of SPF 30 or above for at least six months, as sun exposure can darken or redden a new scar.

What are the risks?

Excision is a safe procedure, but as with any surgery there are some risks. These include pain or discomfort, bleeding or bruising, a collection of blood under the wound, infection, the wound opening up, and a scar that is wider, raised, indented or a different colour from the surrounding skin. Rarely, scars can become keloid, particularly on the chest, shoulders and upper back and in people with brown or black skin. There is also a small risk of nerve damage, which can cause numbness or tingling around the scar, usually temporary but occasionally permanent.

Occasionally, the laboratory report shows that a wider area of skin needs to be removed, or that further treatment is needed.

Results and follow-up

The removed tissue is examined in the laboratory, and results are usually available within around two weeks. A follow-up appointment, which may be virtual, will be arranged to discuss the results and check that the wound has healed. If you have not heard about your results within three weeks, please contact the clinic.

More information

If you have any questions about your procedure, please contact the clinic before booking.

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.