Definition & Overview
Benign lesions on the face, ears, eyelids, nose, lips, and mucous membranes can be excised through a simple outpatient procedure. Since these abnormal growths are not cancerous, the procedure is commonly performed for cosmetic reasons, unless they obstruct or disrupt the proper function of the said body parts.
Prior to the procedure, the doctor assesses the lesion to ensure that it is benign, is located on the more sensitive facial area, and that removing it will result in minimal scarring (excised diameter should be 0.5cm or less).
Who Should Undergo and Expected Results
The procedure is for patients who have small abnormal skin growths on the face, ears, eyelids, nose, lips, and mucous membrane. These lesions, which could be either acquired or congenital, include:
- Nevi or moles
- Sebaceous cysts
- Seborrheic keratosis, or basal cell papillomas and warts
Most lesions are removed for cosmetic purposes, but some may also obstruct or restrict the proper functioning of the facial structures and may even cause symptoms, such as:
- Burning sensation
- Intense itching
Doctors performing this procedure have to consider some special precautions compared to when they are removing lesions from other parts of the body as the face has a more abundant blood supply and because the procedure can result in visible scarring.
Excision is considered as one of the more complex treatment options for benign lesions, especially in cases where the lesion is relatively small. The simpler techniques include biopsy and cryosurgery. However, there is a risk that these procedures may not successfully remove the entire lesion, which is not an option when it comes to facial growths. Thus, most patients prefer to undergo a complete excision, which cuts away the entire lesion including a margin of healthy skin around it, leaving a small excised area of just 0.5 cm.
How is the Procedure Performed?
The procedure begins with the cleansing of the affected area, administration of anaesthesia and the application of antibacterial ointments.
Once the affected area is fully prepared, the doctor uses a scalpel to cut an elliptical area around the lesion. This means that a margin of healthy skin will also be removed to help ensure that no abnormal tissues remain and that the lesion will unlikely to grow back. The appropriate margin size is determined before the excision simply by measuring the longest length of the lesion and adding this number to two times the narrowest margin. After this, the doctor performs a simple closure or simple wound repair.
The excision of benign facial lesions with a diameter of 0.5cm or less is an outpatient procedure. It is well tolerated by most patients, young and old, and can even be safely performed on patients suffering from some medical conditions. Since the excised diameter is small, healing is quite fast, and patients can resume their normal activities on the same day. Complete healing, however, may take up to two weeks.
Possible Risks and Complications
All surgical procedures present some risks to the patient, especially if a piece of tissue is removed from the skin. The risks associated with this procedure include:
- Nerve damage
Scarring, which is a particular concern for facial lesions due to the greater degree of visibility of facial scars. However, for small lesions with an excised diameter of 0.5cm or less, the risk of scarring is quite small
Ranjan R, Singh L, Arava S, Singh MK. “Margins in skin excision biopsies: Principles and guidelines.” Indian J Dermatol. 2014 Nov-Dec; 59(6): 567-570. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248492/
Spicer TE. “Techniques of facial lesion excision and closure.” J Dermatol Surg Oncol. 1982 Jul;8(7): 551-6. http://www.ncbi.nlm.nih.gov/pubmed/6749928