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University Surgeons Associates Services

Excision of Skin Lesions

 

ABOUT Skin Biopsy

The surgeons at University Surgeons Associates, PC are frequently called on to remove skin lesions to diagnose or treat skin cancer, benign growths, chronic bacterial and fungal skin infections, or other skin conditions.  Skin cancer forms in tissues of the skin. There are several types of skin cancer.

  • Melanoma forms in melanocytes (skin cells that make pigment).
  • Basal cell carcinoma forms in basal cells (small, round cells in the base of the outer layer of skin).
  • Squamous cell carcinoma forms in squamous cells (flat cells that form the surface of the skin)
  • Neuroendocrine carcinoma of the skin forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system)

Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.  It is estimated there were more than 1,000,000 new cases and less than 1,000 deaths from skin (nonmelanoma) cancer in the United States in 2009.

ABOUT YOUR skin

This picture shows the layers of the skin.

Layers of the Skin

 

The skin is the body's largest organ. It protects against heat, light, injury, and infection. It helps control body temperature. It stores water and fat. The skin also makes vitamin D.

The skin has two main layers:

  • Epidermis: The epidermis is the top layer of the skin. It is mostly made of flat cells. These are squamous cells. Under the squamous cells in the deepest part of the epidermis are round cells called basal cells. Cells called melanocytes make the pigment (color) found in skin and are located in the lower part of the epidermis.
  • Dermis: The dermis is under the epidermis. It contains blood vessels, lymph vessels, and glands. Some of these glands make sweat, which helps cool the body. Other glands make sebum. Sebum is an oily substance that helps keep the skin from drying out. Sweat and sebum reach the surface of the skin through tiny openings called pores.

 

Risk factors for skin cancer

Doctors cannot explain why one person develops skin cancer and another does not. However, we do know that skin cancer is not contagious. You cannot "catch" it from another person.

Research has shown that people with certain risk factors are more likely than others to develop skin cancer.  Studies have found the following risk factors for skin cancer:

  • Ultraviolet (UV) radiation comes from the sun, sunlamps, tanning beds, or tanning booths. A person's risk of skin cancer is related to lifetime exposure to UV radiation. Most skin cancer appears after age 50, but the sun damages the skin from an early age.  UV radiation affects everyone. But people who have fair skin that freckles or burns easily are at greater risk. These people often also have red or blond hair and light-colored eyes. But even people who tan can get skin cancer.  People who live in areas that get high levels of UV radiation have a higher risk of skin cancer. In the United States, areas in the south (such as Texas and Florida) get more UV radiation than areas in the north (such as Minnesota). Also, people who live in the mountains get high levels of UV radiation.  UV radiation is present even in cold weather or on a cloudy day.
  • Scars or burns on the skin
  • Infection with certain human papillomaviruses
  • Exposure to arsenic at work
  • Chronic skin inflammation or skin ulcers
  • Diseases that make the skin sensitive to the sun, such as xeroderma pigmentosum, albinism, and basal cell nevus syndrome
  • Radiation therapy
  • Immunosuppresion
  • Personal history of one or more skin cancers
  • Family history of skin cancer
  • Actinic keratosis is a type of flat, scaly growth on the skin. It is most often found on areas exposed to the sun, especially the face and the backs of the hands. The growths may appear as rough red or brown patches on the skin. They may also appear as cracking or peeling of the lower lip that does not heal. Without treatment, a small number of these scaly growths may turn into squamous cell cancer.
  • Bowen's disease is a type of scaly or thickened patch on the skin. It may turn into squamous cell skin cancer.

If you think you may be at risk for skin cancer, you should discuss this concern with your University Surgeons Associates doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a biopsy or a schedule for checkups.

HOW tO prevent skin cancer

 

The best way to prevent skin cancer is to protect yourself from the sun. Also, protect children from an early age. Doctors suggest that people of all ages limit their time in the sun and avoid other sources of UV radiation:

  • It is best to stay out of the midday sun (from mid-morning to late afternoon) whenever you can. You also should protect yourself from UV radiation reflected by sand, water, snow, and ice. UV radiation can go through light clothing, windshields, windows, and clouds.
  • Wear long sleeves and long pants of tightly woven fabrics, a hat with a wide brim, and sunglasses that absorb UV.
  • Use sunscreen lotions. Sunscreen may help prevent skin cancer, especially broad-spectrum sunscreen (to filter UVB and UVA rays) with a sun protection factor (SPF) of at least 15. But you still need to avoid the sun and wear clothing to protect your skin.
  • Stay away from sunlamps and tanning booths.

what to do before surgery?

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Blood transfusion and/or blood products may rarely be needed depending on your condition.
  • It is recommended that you shower with an antibacterial soap the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist has told you to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

how is a Skin Biopsy performed?

If you have a change on the skin, the doctor must find out whether it is due to cancer or to some other cause. Your doctor removes all or part of the area that does not look normal. The sample goes to a lab.  A pathologist checks the sample under a microscope. This is a biopsy.  A biopsy is the only sure way to diagnose skin cancer.

You may have the biopsy in a doctor's office or as an outpatient in a clinic or hospital. Where it is done depends on the size and place of the abnormal area on your skin. There are four common types of skin biopsies:

  • Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.
  • Incisional biopsy: The doctor uses a scalpel to remove part of the growth.
  • Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it.
  • Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.

You will most likely be asked to check into the hospital for an excisional biopsy on the morning of your surgery.

  • A skin lesion excision is performed under a local or a general anesthesia.  It usually takes less than one hour.
  • An elliptical incision is made around the skin lesion with a margin of normal skin.
  • After the surgeon removes the lesion, the incision is closed.

 

what should i expect after surgery?

Our goal is for your surgery and recovery to be as comfortable and convenient as possible.  After a port placement, you may experience temporary pain and swelling at the port site.

  • Most Patients are able to engage in light activity while at home after surgery. Patients shower the day after the operation.
  • Post-operative pain is generally mild and patients may require a pain pill or pain medication.
  • Most patients can resume normal activities within a day or two, including driving, walking up stairs, light lifting, and work.
  • You should call and schedule a follow-up appointment within 2 weeks after your operation.

 

what complications can occur?

Skin lesion excision is generally considered extremely safe. As with any operation, there is a risk of a complication. Complications during the operation may include:

  • Bleeding or hematoma
  • Rarely infection of the wound
  • Skin wound separation
  • Adverse reaction to anesthesia

 

when to call your doctor

Be sure to call your physician or surgeon if you develop any of the following symptoms after surgery:

  • Persistent fever over 101 degrees F (39 C)
  • Chills
  • Bleeding
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • You are unable to eat or drink liquids
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from the incision
  • Redness surrounding the incision that is worsening or getting bigger

 

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