Many benign skin growths and non-aggressive skin cancers or early evolving skin cancers can be either be removed with a standard excision or destroyed by several different methods. The choice of treatment is typically based on four main factors: what the condition is, how large it is, where the lesion is located, and the overall health of the patient. For potentially malignant lesions, the first step is to always biopsy the lesion. This is typically done in one of three ways: a shave biopsy which entails a razor slicing off a portion of the lesion, a punch biopsy where a circular knife is used to remove a portion or all of the lesion, or an excisional biopsy where a scalpel is used to remove the entire lesion, if possible, with a very narrow margin. Once a diagnosis of a cancerous lesion is made, the two most common surgical treatments used are standard excisions and electrodesiccation and curettage.
As standard excision involves marking a 0.4 to 2.9 cm margin around the skin cancer (the margin size is dependent on the type of skin cancer) and then drawing a fusiform shape (football shaped) design around it. This shape is used so that once the lesion is cut out and it is sewn back together, the scar will be a thin line scar. After numbing the lesion, the tissue is removed with a scalpel and any residual bleeding is stopped with electrocautery (a low voltage electrical current applied to the bleeding vessels/tissue). Undermining, a process of loosening the surrounding skin so that it stretches easier is performed and then the skin is sewn back together. Typically, two layers of stitches are placed. The deep layer is always stitched together with absorbable sutures that take 2-6 months to dissolve. The top layer is then closed with either fast absorbable sutures or sutures that need to be removed. The choice of the suture is dependent on the amount of tension on the wound and the risk for scarring in the surgical area. Sutures that need to be removed are usually removed in 7-14 days. Standard excisions are also used for benign lesions when they need to be removed. The tissue that is removed is always sent to a pathologist to evaluate whether the lesion has been completely removed or if additional concerning features are present.
Electrodesiccation and Curettage (EDC)
An EDC is a destructive procedure typically used for low-risk small cancers or benign lesions. It entails numbing the lesions then scraping the lesion with a curette (a circular sharp scraping tool) followed by cauterizing the scraped area with an electrocautery device (a low voltage electrical current applied to the bleeding vessels/tissue). This process is repeated two more times.
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