Many benign skin growths and non-aggressive skin cancers or early evolving skin cancers can be removed with a standard excision or destroyed by several different methods. The treatment choice is typically based on four factors: the condition, size, location, and the patient’s overall health. For potentially malignant lesions, the first step is to 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 cancerous lesion diagnosis is made, the two most common surgical treatments used are standard excisions and electrodesiccation and curettage.
A standard excision involves marking a margin around the skin cancer and then drawing a fusiform shape (football-shaped) design around it. This shape is used to remove the lesion, and the skin is sewn back together with minimal scarring. After numbing the lesion, the tissue is removed with a scalpel, and bleeding is stopped with electrocautery (a low voltage electrical current applied to the bleeding vessels/tissue). Undermining is performed, a process of loosening the surrounding skin to stretch easier, and then the skin is sewn back together. Typically, two layers of stitches are placed. The deep layer is stitched with absorbable sutures that take 2-6 months to dissolve. The top layer is then closed with either absorbable sutures or sutures that need to be removed. The choice of the future 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 the removal of benign lesions. The removed tissue is 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 procedure typically used to destroy low-risk small cancers or benign lesions. The lesion is numbed, scraped with a curette (a circular sharp scraping tool), then cauterized with an electrocautery device (a low voltage electrical current applied to the bleeding vessels/tissue).
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