Surgical removal of skin lesions

Surgical removal of skin lesions involves excising the lesion with a scalpel under local anesthesia and then closing the wound with precise sutures. The most important advantage of this method is the ability to send the excised lesion for histopathological examination, i.e. assessment under a microscope.

Histopathological examination makes it possible to unambiguously determine the nature of the lesion and verify it oncologically – to rule out or confirm a neoplastic process. For this reason, surgical excision is the method of choice for suspicious lesions, lesions that change over time, and wherever diagnostic certainty is important.

The procedure is performed by a surgeon after a consultation and qualification. We care not only about the complete removal of the lesion, but also about an aesthetic scar result – we make the incision along the skin's tension lines and close the wound with a technique that minimizes its visibility.

Surgical excision of a skin lesion is indicated in cases such as:

• moles (nevi) and pigmented lesions that change shape, color, or size, or that bleed
• lesions suspicious for cancer that require histopathological verification
• moles exposed to constant irritation (by a belt, strap, or collar)
• keloids and hypertrophic scars — after assessing the risk of recurrence
• larger fibromas, sebaceous cysts, lipomas, and cysts
• lesions recurring after previous non-surgical treatment
• lesions that the patient wants removed with diagnostic certainty as to their nature

After a consultation and assessment of the lesion, with dermatoscopy if needed, the surgeon plans the extent of the excision and administers local anesthesia. Thanks to this, you remain conscious throughout and feel no pain.

The surgeon excises the lesion with a scalpel along with a margin of healthy tissue chosen according to its nature, then closes the wound with sutures, taking care of an aesthetic scar line. The excised lesion – if there are indications for it – is sent for histopathological examination. The whole procedure usually takes from 20 to 45 minutes, depending on the size and location of the lesion. We discuss the examination result at a follow-up visit.

The lesion is removed in its entirety, and histopathological examination provides certainty as to its nature and oncological safety. After the procedure, a suture remains at the excision site, which we remove usually after 7–14 days, depending on the area of the body.

The scar fades over time and becomes less visible. Its final appearance depends on the location, the size of the lesion, and your skin's individual characteristics, and proper care significantly improves the aesthetic result.

Proper care of the wound and sutures determines the aesthetics of the scar and reduces the risk of complications. Remember to:

• keep the wound clean and dry as instructed by the physician
• change the dressing and cleanse the wound with an antiseptic as instructed
• avoid wetting the wound – the swimming pool, sauna, and long baths until healed
• limit physical exertion and tension on the skin around the sutures
• come in to have the sutures removed on the scheduled date (usually 7–14 days)
• protect the scar from the sun and use a high-SPF sunscreen for many weeks
• come in to collect and discuss the histopathological examination result

Contraindications and situations requiring caution include:

• blood clotting disorders or taking anticoagulants (requires assessment and adjustment)
• an active infection of the skin or tissues at the planned treatment site
• poorly controlled chronic diseases (diabetes, hypertension)
• poorly controlled wound-healing disorders
• a tendency to form keloids and hypertrophic scars (relative contraindication)
• pregnancy and breastfeeding (requires individual assessment)
• allergy to local anesthetic agents

The final qualification is carried out by the surgeon during the consultation.