Definition & Overview

The excision of a benign skin lesion is the surgical procedure of removing nonmalignant (not cancerous) skin lesions or abnormal growths from different parts of the body including the trunk, arms, and legs. It also involves the removal of healthy skin layer around the lesion to ensure complete treatment and avoid recurrences.

Skin lesions are very common, and most of them are benign, with no signs or indications of developing malignancy. Most are classified as seborrheic keratosis with colours ranging from beige to brown or black. Their sizes also vary and are often found among the elderly, indicating an association with ageing. Most benign skin lesions do not exhibit any symptoms but may become irritated when rubbed against clothing and could bleed easily.

Benign skin lesions do not automatically require surgical removal. However, excision is recommended if they are prone to being irritated. For example, lesions located in the waistband, neckline, or bra line can be subjected to constant rubbing, which could lead to discomfort. Inflamed lesions and warts that are infected can also be removed with the procedure, which can also be performed for biopsy if the lesion changes in colour, appearance, or size, or if cancer is suspected.

Who Should Undergo and Expected Results

The excision of benign skin lesion with margins can be recommended for patients with:

  • Sebaceous cyst, especially if the cyst has become infected and painful. These cysts are globular in form and are firm yet movable. They are composed of keratinous, follicular, and sebaceous materials and develop when sebum is blocked and not released from the skin.

  • Warts - These benign growths are the result of human papillomavirus infection and are quite common. They are acquired through direct skin contact or autoinoculation and could spread to other parts of the body or skin if pricked or scratched. Subtypes of this condition include verrucas or plantar warts in the foot, plane or flat warts, common warts commonly found in fingers and toes, and filiform warts.

  • Acquired nevi or moles, especially if they exhibit premalignant changes like increasing size, bleeding, pain, or itching. Moles with irregular shapes can also develop into melanoma and hence, may have to be removed as soon as possible.


Other benign skin conditions that may require excision include lentigo maligna, actinic keratoses, and Bowen’s disease.

The excision of a benign skin lesion with margins has a high success rate. It benefits patients who suffer from recurring irritation, bleeding, or itching. Improved quality of life is reported, especially for those who had these lesions in highly visible body parts such as the arms and legs. There are instances in which several sessions are needed to completely remove these lesions, especially warts.

Tissues excised and collected are typically sent to a pathology laboratory for assessment.

How is the Procedure Performed?

Before the benign skin lesion is excised, the target site is cleansed and the patient is given local anaesthesia. The surgeon then marks the area to be excised, including a margin of healthy cells around it. An incision is then made, usually oval or elliptical in shape, to remove the abnormal growth. The surgeon cuts through the entire depth of the underlying skin, even down to the fatty layer when necessary.

A small-sized incision does not have to be sutured closed and can be left open to heal. However, bigger incisions are closed with non-absorbable sutures. In some cases, skin flaps or skin grafts are used to cover the excised area if the procedure leaves a big wound.

Possible Risks and Complications

Although considered a minor procedure, the excision of benign skin lesion with margins comes with a number of possible risks and complications, which include:

  • Infection of the surgical site, especially if it not kept sterile or there is constant irritation or rubbing before it is completely healed
  • Bleeding, which could occur during and after surgery
  • Scarring – Patients face the risk of having scars or keloids after the procedure. The skin colour and texture of the surgical site could also be noticeably different than the surrounding skin.
  • Nerve damage, which could lead to numbness or even partial paralysis
  • Delayed wound healing – Some patients experience delayed wound healing, which can be a source of discomfort or pain.
  • Recurrence of the lesion following the procedure. In which case, the procedure has to be performed again.

    References:

  • Leeuwen MC, van der Wal MB, Bulstra AE, et al. Intralesional cryotherapy for treatment of keloid scars: a prospective study. Plast Reconstr Surg. 2015 Feb. 135(2):580-9.

  • Elgart GW. Seborrheic keratoses, solar lentigines, and lichenoid keratoses. Dermatoscopic features and correlation to histology and clinical signs. Dermatol Clin. 2001 Apr. 19(2):347-57

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